Cervical Cancer and HPV

There are over 100 subtypes of the human papillomavirus (HPV), with more than 40 affecting the anogenital area.

Almost all cases of cervical cancer are caused by oncogenic HPV types. Types 16 and 18 are most commonly associated with cervical cancer, detected in more than 70% of cases in Australia. Persistent infection with oncogenic HPV types and subsequent cervical cell changes are associated with an increased risk of developing cervical cancer.

HPV infections of the genital epithelium are thought to be sexually transmitted through skin to skin or mucosa to mucosa contact. Therefore, it is important to note that different types of sexual contact can lead to transmission, including; genital skin-to-skin contact, vaginal sex, oral sex and anal sex.

While HPV infections are normally cleared naturally by the immune system, in some cases, an HPV infection that is not cleared by the body can cause abnormal cervical cell changes. If left undetected and/or untreated, these changes can develop into cervical cancer.

Less than 10% of new HPV infections will persist, and it is persistent infection and subsequent cervical cell changes that are associated with an increased risk of developing cervical cancer. However, this usually takes a long time, often up to 10 to 15 years. Invasive cervical cancer is rare and only develops in a small proportion of women with high grade abnormalities.

Often there are no symptoms of cervical cancer. However, any woman or person with a cervix who presents with any of the following symptoms should have further investigations, in accordance with the National Cervical Screening Program.

• Abnormal vaginal bleeding, including;
  • Post coital
  • Intermenstrual
  • Postmenopausal
• Abnormal vaginal discharge
• Deep dyspareunia

The National Cervical Screening Program is one of three cancer screening programs that exists in Australia. Population-based screening refers to a test that is offered to everyone within a target group and involves a test that looks for changes or early signs of a disease when a person does not have any symptoms.

There are two options for all asymptomatic women and people with a cervix aged 25-74 years to have a routine Cervical Screening Test (CST). These options, which are both accessed through a healthcare provider, include:

• A clinician collected cervical sample; or
• A self-collected vaginal sample

Self-collection tests for the presence of human papillomavirus (HPV) only. Therefore, if HPV is detected, the participant will need to return for a clinician collected cervical sample or be referred for colposcopy.

If the participant chooses self-collection, the participant should be educated on how to correctly complete the test, with resources such as the National Cervical Screening Program’s How to take your own sample for a Cervical Screening Test available.

A participant’s Cervical Screening Test (CST) result indicates their risk of developing significant abnormalities within the next 5 years. Asymptomatic people with no human papillomavirus (HPV) detected on their CST should be invited to have another CST in 5 years.

Management can be guided by using the National Cervical Screening Program’s Cervical Screening Pathway, for both clinician collected and self-collected tests.

Routine cervical screening should be encouraged in all women and people with a cervix.

Any woman or person with a cervix who has symptoms should have further investigations, please see 'Clinical presentation' above for more details.

The National Cervical Screening Program Clinical Guidelines do not suggest partners of those who have a human papillomavirus (HPV) infection need to modify their routine testing.

As determined by the individual case, for screening participants please refer to the National Cervical Screening Program Clinical Pathway.

Human papillomavirus (HPV) is not a notifiable disease.

Most women and people with a cervix who develop cervical cancer in Australia have either never screened or do not screen regularly. Priority groups in Australia who are less likely to engage in cervical screening include but are not limited to:

• Aboriginal and/or Torres Strait Islander people
• People from culturally & linguistically diverse backgrounds
• People that have experienced female genital cutting/mutilation
• People with disabilities
• People with a cervix who identify as LGBTQIA+
• People who live in remote and very remote areas
• People who experience socio-economic disadvantage
• People who have experienced violence and/or sexual assault
• Postmenopausal women

For more information about barriers to participation, along with strategies to support cervical screening in these groups, please see the National Cervical Screening Program’s healthcare provider toolkit.

Under the National Immunisation Program, a single dose Gardasil 9 vaccination is offered to year 7 school students and to all genders, with a catch-up dose available through to age 25.

HPV vaccines do not protect against all types of HPV known to cause cervical cancer, therefore HPV vaccinated women and people with a cervix should still have a Cervical Screening Test (CST) every 5 years.