Cervical screening and follow-up care
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Unit 622
May 2025
The purpose of this activity is to help general practitioners support informed choice in cervical screening and provide sensitive care for patients from priority populations.
Cervical cancer is almost entirely preventable. Recognising this fact, in 2020, the World Health Organization launched its global strategy to accelerate the elimination of cervical cancer as a public health problem, resulting in a renewed focus on cervical cancer prevention globally. The strategy has set targets to reach and maintain a cervical cancer incidence rate of below four per 100,000 women across the globe over the next century.
Australia is on track to be the first country in the world to reach this target. However, significant disparities exist in cervical cancer outcomes in Australia. The National Strategy for the Elimination of Cervical Cancer in Australia identifies several priority populations where a concerted effort is required to improve equitable outcomes, including Aboriginal and Torres Strait Islander peoples, those from culturally and linguistically diverse backgrounds, people who identify as LGBTQA+ and those who are intersex, people with disability and those living in remote and rural areas.
The National Cervical Screening Program has been a highly successful public health program, halving cervical cancer incidence and mortality in Australia since it began in 1991.
However, under-screening remains the most important risk factor for developing cervical cancer in Australia, with over 70% of cases occurring in those who have never been screened or are overdue for screening. Engaging under-screened and never-screened patients, and ensuring follow-up for abnormal results, is key to progressing towards the World Health Organization goals and improving equity in the National Cervical Screening Program.
General practitioners hold a significant role in the elimination of cervical cancer, through the promotion and provision of cervical screening and the management of participants according to national guidelines. Research has shown that cancer screening uptake rates are higher when there is greater involvement by primary care. Providing the option of human papillomavirus self-collection, an accurate and effective test, with high levels of acceptability among priority populations and those who are under-screened, is key to addressing barriers to participation.
Here we present five cases that work through several aspects of the National Cervical Screening Program Guidelines’ screening and management pathway, with a focus on supporting informed choice in cervical screening and providing sensitive care for patients from priority populations.
At the end of this activity, participants will be able to:
Leena, aged 65 years, has come to see you for a Chronic Disease Management Plan. She has type 2 diabetes, hypertension and asthma.
As part of the management plan, you discuss cancer screening with Leena. She is not aware of the cancer screening programs as she has recently arrived in Australia. You check the National Cancer Screening Register and find Leena has no record, indicating she has never been screened for cervical cancer in Australia.
Marita, aged 53 years, presents with her disability support worker, Natalia, for her routine cervical screening test after it was identified in her health assessment that this was due. Marita is well known to you; she has a moderate intellectual disability and lives in supported accommodation.
You check the National Cervical Screening Program provider toolkit to refresh your memory on how to support people with intellectual disability. During your research, you also come across the ScreenMe webpage, which discusses common questions from people with disability about cervical screening.
You begin by asking Marita if she would prefer to speak with you on her own or have Natalia stay in the room. Marita informs you that she would like to speak with you on her own. You let Natalia know that you will invite her back into the consultation room later.
You take a history. Marita’s last cervical screening test was five years ago, and the result was human papillomavirus not detected. She reports no abnormal vaginal bleeding or discharge.
Daniel, a man aged 45 years who was assigned female at birth, presents to you as a new patient. He has recently moved from interstate for a new job. He tells you that he has been taking testosterone for gender-affirming therapy as a transgender man for the past eight years. His pronouns are he/him. He had laser treatment for abnormalities on his cervix approximately two years ago and has received an invitation and reminder from the National Cervical Screening Program to undergo a Test of Cure. He has been putting it off as he has not yet found a regular general practitioner following his move, but it has been on his mind, and he has now come in to discuss his options.
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Each unit of check comprises approximately five clinical cases, and the choice of cases will cover the broad spectrum of the unit’s topic. Each unit will be led by a GP with an interest and capability in the topic, and they will scope the five different cases for that unit in collaboration with the check team.