Cervical Screening Clinical Practice Guidelines Updated
Updated clinical practice guidelines for cervical screening in New Zealand are now available on-line on the NSU website, along with new flowcharts with summary guidance on HPV testing. The Guidelines and flowcharts can be accessed here: https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/clinical-practice-guidelines-cervical
The key changes in the document include:
1. In November 2019 the National Cervical Screening Programme (NCSP) raised the recommended commencement age for screening to 25 years for any person with a cervix or vagina who has ever been sexually active. People aged 20–25 years who have already commenced screening, including those with abnormal cytology, will be recalled and managed according to these guidelines.
2. A new section on abnormal bleeding has been included to assist medical practitioners in primary care with assessment, management and referral decisions. While this section does not wholly relate to the cervical screening pathway, it provides important information, the key messages being that symptomatic people need to be examined.
3. A new recommendation is that people aged 70 years and older who were unscreened or under-screened prior to age 70 have two consecutive normal cytology samples (taken 12 months apart) before ceasing cytology screening. Unscreened and under-screened people in this age group are at increased risk of cervical cancer because of potential undetected cervical lesions.
4. A change to the recommendation for follow-up after successful treatment for high-grade squamous disease is discharge from colposcopy to primary care for a test of cure. Cytology and HPV testing should be performed 6 months post-treatment, with a repeat co-test (cytology and HPV testing) at a further 12 months to complete a test of cure. Where there are clinical concerns, colposcopy with HPV and cytology testing at 6 months post-treatment is recommended.
The HPV testing area of the document has been reviewed, and relevant HPV testing information and flowcharts have been incorporated into the main document. A useful summary on HPV testing is available in part C of the Guidelines.