Cervical screening and HPV primary screening in New Zealand

What is cervical screening?

Cervical screening is a preventative health measure designed to detect changes in the cells of the cervix. While cervical screening itself doesn’t detect cancer, the process identifies abnormal cells that, if left untreated, could turn cancerous over time.

The shift from smear (Pap) tests to HPV screening

In September 2023, New Zealand healthcare transitioned from the traditional cervical sample (smear test) to a more effective HPV (human papillomavirus) screening test. The previous smear test involved collecting cells from the cervix to detect abnormalities. However, the new HPV test specifically screens for the presence of DNA from high-risk strains of HPV, which are responsible for the majority of cervical cancers.

Why the shift to HPV screening?

• Improved prevention: According to international research, HPV screening provides 60-70% more protection against invasive cervical cancer than cytology screening.
• Early detection: The test identifies high-risk HPV strains before any cell changes occur, allowing for earlier intervention.
• Less intrusive: The new test is less invasive and also offers a self-test option, which may improve cervical screening participation.
• Longer screening intervals: If no high-risk HPV is detected, screening intervals can be safely extended to every five years (instead of every three years) except for immune-deficient individuals.

HPV and cervical cancer

Over 95% of cervical cancer cases are linked to human papillomavirus infections, making HPV the leading cause of cervical cancer worldwide. 

HPV is a common virus, spread via intimate skin-to-skin contact and sexual activity, that most people will be exposed to at some point in their lives. In many cases, the body’s immune system will clear the infection naturally. However, for some individuals, particularly those with high-risk strains, the virus can persist and cause cell changes on the cervix, which may eventually lead to cancer if untreated.

Aside from cervical cancer, HPV is also linked to other diseases, including vulvar, vaginal, anal, mouth, and throat cancers.

Importance of regular screening

Since the 1990 establishment of the National Cervical Screening Programme (NCSP) in New Zealand, cases of cervical cancer have reduced by 50% and deaths by around 60%, highlighting the preventive value of regular screening. The new test aims to improve these statistics by detecting HPV early, closely monitoring cell changes, and treating them accordingly to prevent cancer from developing.

HPV screening tests in New Zealand

In New Zealand, there are two methods for HPV screening: the vaginal swab and the cervical sample (smear or Pap test). These tests are essential for women and those with a cervix aged 25-69 who have had sexual contact.

Both the vaginal swab and smear test offer effective ways to screen for HPV, giving women the option to choose the method that feels most comfortable and suitable for their needs. 

Who should get screened?

Cervical screening detects pre-cancerous changes in the cervix and early signs of cancer. You should get screened starting at age 25 if you:

• have a cervix or vagina (women as well as non-binary and trans individuals)
• have ever had sexual contact
• do not show symptoms like unusual bleeding, spotting, vaginal discharge, pain during sex, or continuous pelvic or lower back pain.

Even if you have had the HPV vaccination, it’s important to continue regular cervical screening. The vaccine does not protect against all HPV strains or new infections, and screening helps ensure that any cell changes are caught early.

If you’ve undergone a hysterectomy, ask your healthcare provider whether you still need regular cervical screenings.

Until when to get screened

Individuals aged 65 or above can exit the screening program if they are: 

• aged 69 or above with an HPV not detected result
• aged 65 or above (67 or above if immune deficient) who have had an HPV not detected result and no subsequent abnormal cytology or histology results
• aged 70-74 who were never screened, were under-screened, haven't had a negative test in 5 years (3 years for immune deficient) before age 70, and with an HPV not detected result.

How often to get screened

Individuals with an HPV not detected result should still have screenings every five years. Those with weakened immune systems need to screen more frequently, i.e., every three years. This includes individuals with conditions such as HIV, those who have had solid organ or haemopoietic stem cell transplants, or those on long-term immunosuppressive medications.

If you are showing cervical cancer symptoms, you should see a healthcare provider as soon as possible, before or instead of screening.

Tips for screening

• During pregnancy: It’s safe to get screened during pregnancy, though some women prefer to wait until after giving birth.
• After pregnancy: Health New Zealand Te Whatu Ora recommends screening at least six weeks after giving birth.
• During your period: It’s recommended to avoid screening during heavy bleeding, as it may affect the accuracy of results. However, light bleeding is generally not a problem.
• Post-menopause: Screening is just as important for older women, and many may find it more comfortable to ask for a smaller speculum or use oestrogen cream beforehand.

What your HPV test results mean

When you undergo an HPV screening test, the results will fall into one of several categories. Understanding what these results mean and what steps to take next will help you manage your health.

• HPV not detected: No high-risk HPV strains were found. There’s no need for further action right now, but continue regular screenings as per the recommended schedule (after 5 years, or 3 years if immune deficient). This is important because even with a negative result, HPV can be contracted later, so ongoing monitoring is advisable.
• HPV 16 or HPV 18: If these high-risk HPV types are detected, you will be referred for a colposcopy to check for cervical cell changes. 
• HPV Other (type/number may be stated): If another type of HPV is found in your vaginal swab, you’ll go back to your healthcare provider for a cervical sample test, unless you had opted for this during your primary screening.
• Invalid or unsuitable for analysis: A sample may be unusable if it leaks or is contaminated. You will be advised to repeat the test. 

Finding HPV in your test results does not mean you have cervical cancer. Most individuals with HPV will never develop cervical cancer, as the virus often clears on its own without causing any harm. Regular screening and early detection help manage potential risks before they escalate.

How much does cervical screening in NZ cost?

In New Zealand, the cost of cervical screening varies, from free to $60, depending on the clinic or medical centre. 

If you have medical insurance, check whether your plan includes a health screening allowance and if you can have your test covered.

Government-funded programmes

While cervical screening isn’t fully funded for everyone in New Zealand, there are initiatives which make it more affordable. The National Cervical Screening Programme provides some government funding, particularly for those who may face barriers to accessing healthcare. 

Am I eligible for free screening?

You might qualify for a fully-funded cervical screening if you are due for screening, do not show relevant symptoms, AND are: 

• aged 30 or above and never screened, or underscreened, i.e., have not had a test for 5 years after a cytology exam (3 years for immune deficient individuals), 7 years since the last HPV screening (5 years for immune deficient individuals)
• aged 25-69 and hold a Community Services Card
• Māori or Pasifika 25-69 years old
• aged 70-74 and never screened, have not had an HPV not detected result five years before age 70, or have not had two consecutive normal cervical cytology results between 62 to 69 years old
• required to have follow-up tests. 

Aside from women and other individuals with a cervix, those who have had a total hysterectomy may also be covered for free screenings if they meet the criteria above.

All follow-up testing if deemed medically required is fully funded, regardless of your initial screening eligibility.

The best way to find out if you are eligible for a free or reduced-cost cervical screening is to contact your local healthcare provider or clinic. Many clinics provide clear information about their fees and any available subsidies, so it’s worth checking if you can get assistance to cover the costs.

Start your move against cervical cancer with Policywise

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^{Disclaimer: This article is for general information only. Nothing in this blog or on this website is intended as medical, dietary, or financial advice. Although we aim to update our content regularly, you are advised to consult a Policywise adviser, health professional, or an appropriate specialist before acting on any information herein. They can factor in your personal circumstances or preferences and help guide your decision-making process.}