Understanding Cervical Cancer

A short guide to symptoms, risk factors, prevention, and screening

What is the cervix?
Understanding cervical cancer
2.1 Causes of cervical cancer
2.2 Symptoms of cervical cancer
Prevention of cervical cancer
3.1 HPV vaccination
3.2 Cervical screening
Are you due for a cervical screening test?
What happens during a cervical screening test?
4.1 Clinician-collected sample
4.2 Self-collected sample
Where can I go for a cervical screening test?
A Video Guide To Cervical Screening

What is the cervix?

The cervix is the lower part of the uterus (womb), connecting it to the vagina.

The cervix has several functions, including producing fluid to keep the vagina healthy, and mucus to aid sperm in reaching an egg. It also plays a crucial role in pregnancy and childbirth by supporting the baby and widening to allow delivery of a baby into the birth canal (vagina).

Cervical Cancer

Cervical cancer occurs when cells which line the cervix become abnormal and grow in an uncontrolled way. For more detailed information about cervical cancer and how it develops, download the ‘Understanding Cervical Cancer’ booklet by Cancer Council.

Anyone with a cervix can develop cervical cancer at any age, but is most commonly diagnosed in people over the age of 30.

Causes

Persistent HPV infection

Almost all cases of cervical cancer are caused by a persistent infection of the cervix with certain types of human papillomavirus, also known as HPV.

Genital HPV infection is a common sexually transmitted infection, often passed on by genital skin-to-skin contact with someone who has the virus. This includes penetrative sex, oral sex and other forms of sexual activity, including the use of shared sex toys. There are many types of genital HPV, some of which can cause genital warts, cervical cancer or other cancers of the vulva, vagina, anus and throat area.

About 4 in 5 people will be infected with at least one type of HPV during their lives. Most won’t know they have had an HPV infection as there are usually no symptoms.

Most people who have a HPV infection will not develop cervical cancer.
There are only a few types of ‘high risk’ HPV which can cause cervical cancer, and in most people the infection will be cleared by the immune system within 1-2 years.

If the virus stays in the body, it can cause changes in the cells lining the cervix which are abnormal. In rare cases, these abnormal cells can grow uncontrollably and develop into cervical cancer over many years – usually 10 to 15 years later.

Other risk factors

Other factors may also increase someone’s risk of developing cervical cancer. These are known as risk factors. They include:

Smoking or being around smokers (passive smoking)
Having a weakened immune system
Being over 35 years of age
A past or current chlamydia infection (this is a common type of bacterial infection spread by sexual contact)

For more information on factors which may increase the risk of cervical cancer, visit the Cancer Australia website.

Symptoms

HPV infection and abnormal cervical cell changes don’t usually have any accompanying symptoms. The only way to know if you have abnormal cell changes is to have a regular, 5-yearly Cervical Screening Test (CST). See ‘prevention’ below for more information on the CST. If abnormal precancerous cell changes develop into cervical cancer, symptoms may include:

Pelvic pain
Pain during sex
Unusual vaginal bleeding – after menopause, between periods, during or after sex, heavier or longer menstrual periods
Changes to your usual vaginal discharge

These changes can be caused by many other conditions. However, if you have any concerns or the symptoms are ongoing, it’s best to check in with your general practitioner (GP). You can use the Healthdirect Australia website to locate a GP near you that suits your needs.

You know your body best. If you’re still concerned after your discussion with your healthcare provider, seek a second opinion.

Prevention

Cervical cancer is one of the most preventable cancers. Australia is on track to be among the first places in the world to eliminate cervical cancer as a public health problem.

There are two important ways that cervical cancer can be prevented.

1. By receiving the HPV vaccination. This is to prevent infection with HPV.

2. Having a regular, 5-yearly Cervical Screening Test. This is a simple test used to check the health of your cervix by looking for the presence of HPV infection. This test replaced the Pap test.

The use of condoms or dental dams during sexual activity may offer some protection against HPV infection. However, as they don’t cover all genital skin, it can still be transmitted. They remain an important part of protecting yourself from other sexually transmitted infections (STIs).

1. HPV Vaccination

The HPV vaccination is a safe, rigorously tested, effective way to help protect yourself from getting an HPV infection.

The vaccine is most effective when given to young people before they become sexually active and are potentially exposed to HPV. Children aged 9 to 14 also produce a stronger immune response to HPV than older teenagers.

When given prior to HPV exposure, the vaccination (usually Gardasil®) offers protection against infection by nine types of HPV, responsible for causing:

Almost all cervical cancers
90% of genital warts
Many male HPV-related cancers.

The recommended age is 12 to 13 years. In Victoria, the vaccine is available for free for children of all genders in year 7 of secondary school, as part of the school-based National Immunisation Program.

For most people, only one dose is needed.

If the HPV vaccination is missed, it is available for free until age 26 from a pharmacy, doctor or local immunisation provider. If you are 26 years-of-age or over and didn’t receive the HPV vaccination, check in with your doctor or immunisation provider to determine if you may benefit from having the vaccine.

More information about the HPV vaccine can be found on the Department of Health, Disability and Ageing website and Cancer Council website.

2. Participate in regular 5-yearly cervical screening

All people with a cervix between who have ever been sexually active should have a Cervical Screening Test every 5 years from the age of 25 to 74, unless told otherwise by your healthcare provider. If you notice any of the symptoms between your regular 5-year screenings, however, it’s important to talk to your healthcare provider.

Regular CSTs are important, even if you have received the HPV vaccination. This is because the vaccine protects against some, but not all types of HPV that can lead to cervical cancer.

You can visit the Healthdirect website to find more information on who should get a cervical screening test.

Are you due for a Cervical Screening Test?

There are several ways you can check whether you’re due for your cervical screening test.

Ask your healthcare provider to check the National Cancer Screening Register for you.
Check the register online through your myGov account or by calling the National Cancer Screening register.

Phone: 1800 627 701 8am to 6pm, Monday to Friday. (For language assistance, call the Translating and Interpreting Service on 13 14 50.)

You will also get a reminder letter in the post when you are due to screen. It will be sent to the primary address you have recorded with Medicare.

If you need help linking your myGov account to the National Cancer Screening Register, visit the National Cancer Screening Register (NCSR) website. If you don’t have a myGov account, visit https://my.gov.au/en/about/help/mygov-website/create-mygov-account

You may have previously heard of the Pap test or Pap smear test. This was replaced by the Cervical Screening Test in Australia in 2017.

The Pap smear test was done every 2 years and looked for abnormal cells in the cervix. The current Cervical Screening Test looks for infection with HPV strains that can cause abnormal cells in the cervix, which may develop into cervical cancer.

This is what makes the Cervical Screening Test more sensitive and specific and why screening every 5 years is safe. The test can find people at risk of developing cervical cancer earlier than the Pap test could — before any abnormal cells appear. This usually takes a long time.

If HPV is found, then the test will check for any abnormal cells in the cervix so they can be monitored and treated if necessary – before they have a chance to develop into cervical cancer.

For more information about the replacement of the Pap test with the Cervical Screening Test, visit Cancer Council Victoria’s website.

What happens during a cervical screening test?

You have choice in how you collect your sample.

There are two options available, you can take your own sample or have a healthcare provider collect your sample. Both methods are safe and accurate at detecting HPV. If you’re unsure what to expect, your doctor or nurse can talk you through both options, so you can choose the one that feels most comfortable for you.

Option 1: Clinician-collected sample

Your healthcare provider will ask for your consent before collecting the sample. This means you understand what’s involved and agree to proceed.

Remember, you don’t have to do the test on the day, and you can stop the test at any point. You can talk with your doctor about your options and come back another time if that feels better for you. If you feel nervous, you can bring someone with you to your appointment.

The procedure will take place in a private, confidential space. You will usually be asked to undress from the waist down and lay down with your knees up on an examination bed. It’s a good idea to wear clothes that you find easy to remove, or to opt for a dress or skirt. You will be given a cover or sheet to place over your lap to cover your lower body.

Your doctor or nurse will use an instrument called a speculum to gently open the vagina so they can see your cervix. If you prefer, you can insert the speculum yourself.

Your healthcare provider will then collect a sample of cells from the cervix using a small, soft brush. This sample will be sent to the laboratory for testing.

If you are feeling any discomfort, communicate this with the doctor or nurse, and know that the test can be stopped at any time.

Option 2: Self-collected sample

The second option is to collect your own sample, by inserting a swab into the vagina. This is called self-collection.

If you choose this option, you’ll have support from your healthcare provider to make sure you understand what to do, that you feel safe and comfortable, and that you have enough privacy.

Your healthcare provider will give you a sampling swab and provide you with a private space. Usually, you will then collect your sample within the clinic – behind a curtain, in the bathroom or other private room. In certain situations, your doctor or nurse may be able to support you to do at-home testing or guide you over telehealth.

Your sample will then be sent to the laboratory for testing. Results from your test will be recorded in the National Cancer Screening Register and sent to your healthcare provider. They can explain your results and what to do next.

Where can I get a Cervical Screening Test?

Most general practices (GPs) will offer cervical screening. Other options include:

A community health centre
A women’s health centre
A family planning clinic
A sexual health clinic
An Aboriginal Medical Service (AMS) or Aboriginal Community Controlled Health Service

See a list of sexual and reproductive health services in the Loddon Mallee here.

If you would like assistance to find and book a cervical screening service that suits your needs, Cancer Council can assist you. This includes supporting you to locate clinics with sexual assault sensitive providers, providers who speak a language other than English and disability access.

It’s best to book your appointment for a day when you are not on your period, so that the blood does not affect the results.

A Video Guide to Cervical Screening

Women’s Health Loddon Mallee has developed a series of video resources to ensure women in our region, including Filipino and Karen speakers and community members that are Deaf or Hard of Hearing, have access to critical health information about key women’s health issues, including cervical screening.

Video Links:

English
Auslan
Tagalog (Filipino)
Karen