Chapter 2 – The Cervix
CONTENTS
-
The Cervix: An Introduction
-
Cervical ectropion
-
Nabothian cysts
- Cervical Cancer
-
Cervicitis
-
Cervical polyps
-
Preventing cervical cancer: Primary prevention – HPV vaccination
- HPV vaccination
- National immunisation program
-
Secondary prevention: cervical cancer screening
- The renewed National Cervical Screening Program
- Components of the Cervical Screening Test (CST)
- Screening pathway for asymptomatic women
-
Cervical screening in specific populations
- Screening in young patients with early sexual activity or victims of abuse
- Screening in pregnancy
- Screening in postpartum women
- Screening in postmenopausal patients
- Screening after total hysterectomy
- Screening in women who have sex with women/lesbians
- Screening in transgender men and gender diverse people with a cervix
- Screening in DES-exposed patients
- Screening in immune-deficient patients
- Screening in Aboriginal and Torres Strait Islander patients
- Screening in patients with disability
-
Self-collected cervical screening test
-
Results discussion and decision-making
-
Colposcopic evaluation of screen-detected abnormalities
- Management after colposcopy
-
National Cancer Screening Register
-
Resources
-
References
Find the information you need
Cervical Cancer
Incidence and mortality
Clinical presentation
Pathogenesis
Drake R, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students E-Book: Elsevier Health Sciences; 2009.
CloseSchiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. The Lancet. 2007;370(9590):890-907.
CloseBateson D, Bower H, Stewart M. Cervical screening in the HPV era: don’t ditch the Pap test! 2011.
CloseRead C, May T, Stellingwerff M. How to Treat: Irregular Vaginal Bleeding Australian Doctor 2007;18(May):27 -34.
CloseAustralian STI Management Guidelines for use in Primary Care [internet]. Australasian Sexual health Alliance. Cervicitis; 2018 [cited 2019 April 10]. Available from: http://www.sti.guidelines.org.au/syndromes/cervicitis#possible-causes.
CloseRoyal College of Obstetricians and Gynaecologists. Cervical Polyp Removal [internet]. 2013. Available from: rcog.org.uk/en/guidelines-research-services/guidelines/cervical-polyp-removal—query-bank/.
CloseYounis M, Iram S, Anwar B, Ewies A. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. European journal of Obstetrics, Gynaecology and reproductive Biology 2010;150(2):190-4.
CloseWorld Health Organisation (WHO). Human Papillomavirus (HPV) and Cervical Cancer. WHO [internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer.
CloseCorpus Uteri [internet]. World Health Organization International Agency for Research on Cancer: World Health Organization; 2018.
CloseAustralian Institute of Health and Welfare. Cervical Screening in Australia 2019 .[Internet]. Canberra, ACT: Australian Institute of Health and Welfare; Available from: https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2019/contents/table-of-contents.
CloseCervical Cancer [internet]. Cancer Australia; 2019. Available from: https://cervical-cancer.canceraustralia.gov.au/statistics.
CloseWalboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology. 1999;189(1):12-9.
CloseMatsumoto K, Yoshikawa H. Human papillomavirus infection and the risk of cervical cancer in Japan Journal of Obstetrics and Gynaecological Research 2013;39(1):7-17.
CloseArmstrong B, Brand A, Hammond I, Wright G, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party. National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. [Internet]. Sydney, Australia: Cancer Council Australia; 2018 [updated:16 August 2018]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening/screening-in-des-exposed-women.
CloseMoscicki A, Schiffman M, Burchell A, Albero G, Giuliano AR, et al. Updating the natural history of human papillomavirus and anogenital cancers Vaccine. 2012;20(30:Suppl5):F24-F33.
CloseThe Faculty of Sexual and Reproductive healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists. FSRH Clinical Guidance Combined Hormonal Contraception [internet]. FSRH; 2019. Available from: https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/.
CloseCancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. Sydney, NSW: Cancer Council Australia. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer-screening.
CloseBrotherton JM. How much cervical cancer in Australia is vaccine preventable? A meta-analysis. Vaccine. 2008;26(2):250-6.
CloseAustralian Immunisation Handbook [internet]. Department of Health, Australian Government; 2023. Human papillomavirus (HPV). Available from: https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/human-papillomavirus-hpv.
CloseInternational Collaboration of Epidemiological Studies of Cervical Cancer. Cervical carcinoma and sexual behaviour: collaborative reanalysis of individual data on 15,461 women with cervical carcinoma and 29,164 women without cervical carcinoma from 21 epidemiological studies. Cancer Epidemiol Biomarkers Prev. 2009;April 18(4):1060-9.
CloseAustralian Institute of Health and Welfare. Cervical screening in Australia 2014-2015 [internet]. Cancer series no. 105. Cat. No. CAN 104. Canberra, ACT: Australian Institute of Health and Welfare; 2017. Available from: https://www.aihw.gov.au/getmedia/adc621ce-a54a-4680-8b37-2a70d897964a/20434.pdf.aspx.
CloseRichter J, Rissel C, de Visser R, Simpson J, Grulich A. Australian study of Health and Relationships (ASHR) 2. Sexual Health. 2014;11(50).
CloseRequirements for Laboratories Reporting Tests for the National Cervical Screening Program (Second Edition 2019) [internet]. National Pathology Accreditation Advisory Council (NPAAC). Canberra, ACT: Department of Health, Australian Government; 2017. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/npaac-cervical-screening.
CloseCrowe E, Pandeya N, Brotherton JM, Dobson AJ, Kisely S, et al. Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia. BMJ. 2014;March (4):g1458.
CloseRussell M, Raheja V, Jaiyesimi R. Human papillomavirus vaccination i adolescence. Perspectives in Public Health 2013;133(6):320-4.
CloseCancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. [Internet]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening.
CloseStoler M. Human papillomaviruses and cervical neoplasia: a model for carcinogenesis. International Journal of Gynaecological Pathology: Official Journal of the International Society of Gynaecological Pathologists. 2000;19(1):16-28.
CloseBrotherton JM. Nonavalent vaccine and the two-dose schedule AJGP. 2018;47(7).
CloseBrotherton JM. Human Papillomavirus Vaccination: where are we now? Journal of Paediatrics and Child Health 2014;50(12):959-65.
CloseTabrizi S, Brotherton JM, Kaldor JM, Skinner SR, Liu B, et al. Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study. The Lancet Infectious Diseases 2014;14(10):958-66.
CloseGertig D, Brotherton JM, Budd AC, Drennan K, Chappell G, et al. Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study. BMC Medicine. 2013;October 22(11):227.
CloseAli H, Donovan B, Wand H, Read T, Regan D, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data 2013;346(f2032).
ClosePatel C, Brotherton J, Pillsbury A, Jayasinghe S, Donovan B, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine. Eurosurveillance 2018;23(4).
CloseJoura E, Garland SM, Paavonen J, Ferris DG, Perez G, et al. Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. 2012;27(344):e1401.
CloseAustralian Institute of Health and Welfare. Cervical screening in Australia 2018. Cat. no. CAN 111. [Internet]. Canberra, ACT: AIHW; 2018. Available from: https://www.aihw.gov.au/getmedia/8a26b34d-a912-4f01-b646-dc5d0ca54f03/aihw-can-111.pdf.aspx?inline=true.
CloseThe Pap Test has changed: More accurate, less often. National Cervical Screening Program: Australian Government; 2018 [updated 12 July 2019]. Available from: https://www.health.gov.au/resources/translated/national-cervical-screening-program-the-pap-test-has-changed-more-accurate-less-often-other-languages.
CloseSmith M, Canfell K. Impact of the Australian National Cervical Screening Program in women of different ages. The Medical Journal of Australia. 2016;205(8):359-64.
CloseRonco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. The Lancet Oncology 2010;11(3):249-57.
CloseRijkaart D, Berkhof J, Rozendaal L, van Kemenade FJ, Bulkmans NW, et al. Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomised controlled trial. The Lancet Oncology. 2012;13(1):78-88.
CloseKatki H, Kinney WK, Fetterman B, Lorey T, Poitras NE, et al. Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. The Lancet Oncology. 2011;12(7):663-72.
CloseArbyn M, Castle PE. Offering self-sampling kits for HPV testing to reach women who do not attend in the regular cervical screening program. Cancer Epidemiol Biomarkers Prev. 2015;24(5):769-72.
CloseWrede DH, Brand A. Hammond I, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party. Clinical Guidelines Network. [Internet]. 2018 [updated 2018 Aug 15; cited 2019]. Colposcopy. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening/colposcopy.
CloseFor Healthcare Providers [internet]. National Cancer Screening Register: Australian Government. Available from: https://www.ncsr.gov.au/content/ncsr/en/healthcare-providers.html.
CloseAustralian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2021. Cancer series 134. Cat. no. CAN 141. Canberra: AIHW. [Internet]. https://www.aihw.gov.au/getmedia/2a26ae22-2f84-4d75-a656-23c329e476bb/aihw-can-141.pdf
CloseArbyn M, Smith SB, Temin S, et al. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ. 2018 Dec 5;363:k4823. Doi: 10.1136/bmj.k4823.
CloseCreagh NS, Zammit C, Brotherton JMI, et al. Self-collection cervical screening in the renewed National Cervical Screening Program: a qualitative study. Med J Aust. 2021 Oct 18;215(8):354-358. doi: 10.5694/mja2.51137. Epub 2021 Jun 18.
CloseCanfell K, Saville M, Smith M, et al, Cancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Management of oncogenic HPV test results, self-collected vaginal samples. [Internet]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer-screening/management-of-oncogenic-hpv-test-results/self-collected-vaginal-samples
CloseCanfell K, Saville M, Smith M, et al, Cancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Management of oncogenic HPV test results, oncogenic hpv types not 16/18. . [Internet]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer-screening/management-of-oncogenic-hpv-test-results/oncogenic-hpv-types-not-16-18
CloseBateson D, Roeske L. Cervical Screening Program update: the intermediate risk pathway, the co-test and self collection. Medicine Today 2022; 23(6) 46-52.
CloseBateson D, Newman M, Milch V, et al. Cancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Women experienced early sexual activity or victims of abuse. [Internet]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer-screening/women-experienced-early-sexual-activity-or-victims-of-abuse
CloseBateson D, Newman M, Anderson L, et al. Cancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Screening in pregnancy. [Internet]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer-screening/screening-in-pregnancy
CloseCancer Council Australia, Cervical Cancer Screening Guidelines Working Party. Cervical Cancer Screening, Summary of recommendations.[Internet]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer-screening/summary-of-recommendations
CloseAustralia Government, Department of Health and Aged Care. HPV vaccine – Fact sheet outlining changes under the National Immunisation Program in 2023 [Internet]. Australian Government Department of Health and Aged Care. 2023 [cited 2023 Feb 20]. Available from: https://www.health.gov.au/resources/publications/hpv-vaccine-fact-sheet-outlining-changes-under-the-national-immunisation-program-in-2023
CloseAustralian Government Department of Health and Aged Care. National Immunisation Program schedule [Internet]. Australian Government Department of Health and Aged Care; 2023 [cited 2023 Mar 28]. Available from: https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule
CloseCanfell, K, Saville, M. Cancer Council Australia, Cervical Cancer Screening Guidelines Working Party. The rationale for primary HPV screening. [Internet]. Cancer Council Australia 2022 [cited 2023 Feb 20]. Available from: https://www.cancer.org.au/clinical-guidelines/cervical-cancer/cervical-cancer-screening/the-rationale-for-primary-hpv-screening
Close