Changes to HPV vaccination and cervical cancer screening

Human papilloma virus (HPV) is a pathogen that affects both men and women and is usually contracted in the early 20s.  Most infections with HPV are asymptomatic and resolve, but chronic HPV infections have been shown to cause the majority of cervical cancers. Additionally, it can also cause cancers of the vagina, vulva, penis and neck. There are about 40 types of HPV that are transmitted through sexual contact. Of note, HPV18 and HPV16 are the most likely to cause cervical cancer. Therefore, vaccination against this virus before someone is sexually active has been shown to be the most effective way to protect against these cancers.

In 2007 the Australian government introduced a regular school-based vaccination called Gardasil to protect against HPV. This was given as a three-dose schedule to boys and girls aged between 12-13. This vaccine protected against HPV types 16, 18, 6 and 11. These have been shown to cause 70% of cervical cancer, 90% of related cancers in men and 90% of genital warts. This year (2018), a new vaccine was introduced called Gardasil9. This includes protection from nine types of HPV that cause 90% of all cervical cancers. Additionally, research suggests (with a few exceptions) that two doses, six months apart is enough to provide protection.  Students that still need three doses include those who started their vaccinations at 15 years of age or older and those who are significantly immunocompromised. Catch up programs are available for men and women who wish to be vaccinated against HPV, please inquire with your local GP.  If you still have questions regarding the immunisation schedule for HPV we recommend you visit these resources: http://www.health.nsw.gov.au/immunisation/Pages/HPV-vaccination.aspx and http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10-updates~handbook10-updates-09-04-2018-1

Since the introduction of the aforementioned HPV vaccination program, there is more information regarding the progression of cervical cancer and dramatically lower rates of HPV induced cancers. Therefore, the Pap smear, a well-known screening test for cervical cancer has also changed. Prior to December 2017 it was recommended that women had a two-yearly Pap smear starting from age 18. This has been replaced by the Cervical Screening Test every five years starting from age 25. This new test is collected in the same way as a Pap smear, but can detect the HPV virus before there are any abnormal cell changes that may suggest cancer. The Pap smear only detected cellular changes, therefore this new test is more sensitive. Due to the high sensitivity of the Cervical Screening Test, the interval between screens can be safely increased to five years. Research suggest that it can take up to fifteen years for HPV to make abnormal noticeable changes to cells in the cervix. Therefore, screening women younger than 25 does not change the rate or incidence of cervical cancer. Women should stop having a cervical cancer screen at the age of 74. If you have any questions regarding the new screening program please refer to: http://ww2.health.wa.gov.au/Articles/N_R/Renewal-of-the-National-Cervical-Screening-Program-FAQs

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