DES-Exposed Women Beware!

Changes made to the National Cervical Screening Program (NCSP)  in December 2017 are putting your health at risk. Make sure you are getting the correct cervical screening test.

Now when you have a 'Cervical Screening Test" (CST), you are no longer having a Pap smear but a test for HPV (human papillomavirus).

From a woman's perspective the physical procedure remains the same - a sample of cervical cells is taken and sent off for testing. However the difference  now is that the sample is sent off to be analysed in terms of HPV status, not to cytology to screen for cervical cell abnormalities.  Only if the sample is HPV positive is the same sample of cells reanalysed using  cytology.

The CST is a HPV test, followed by a cytology test if HPV is found. So, in effect, you have a Pap smear (cytology) only if you test positive to HPV.

It is crucially important that DES-exposed women have a Pap smear, or liquid-based cytology (LBC) as it is now called.

Why? HPV is a sexually transmitted infection (STI) that can affect cervical squamous cells causing precancerous squamous cell abnormalities, termed cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL).

If these abnormalities develop and are left undetected and untreated, they have the potential to progress to squamous cell cervical cancer. Hence the HPV test is a screening tool for squamous cell cervical cancer.

However 30% of cervical cancers diagnosed in Australia are  glandular cell cervical cancer (adenocarcinoma).

DES-exposed women have an increased risk of this more aggressive form of cervical cancer.

So while the HPV test is a screening tool for squamous cell cervical cancer, it is NOT a screening tool for adenocarcinoma.


The Co-Test

In recognition of the special screening needs of DES-exposed women, the NCSP Guidelines recommend a co-test: that is, both a HPV test and LBC test.

With a co-test, at the time of examination two samples of cervical cells are taken and placed into two separate containers. One container is sent for cytology (LBC test); and the other container is sent for partial HPV genotyping (HPV test).


 Recommendation 17.1 of the NCSP Guidelines states that DES-exposed women

"...should be offered an annual co-test and colposcopic examination of both the cervix and vagina indefinitely."


Everyone appears to be confused by the changes to the revised NCSP, including doctors!  But stand your ground and insist on having a co-test.