What exactly is the ‘new pap smear’, and why did it change?

Chances are you’ve caught wind this week of the ‘new pap smear test’, and the controversy surrounding it.

The new program was set to kick off on May 1, but was announced this week to be delayed until December 1 2017. Also haunting the new test is a barrage of online protest, directed at the Australian Government.

So what exactly is going on? And what do you need to know?

In April 2014, the Australian Government announced a new cervical cancer test would potentially be introduced.

This announcement went relatively unexplored until 2015, when the new federal budget announced major healthcare cuts, including that of pap smears. It was rumoured that women were now forced to pay $30 a pap smear – a fact that many deemed unfair.

Cast your mind back to November last year, and you might remember how more than a few people were up in arms about the #PapSmearCuts. In fact, there’s even a Change.org petition making the rounds protesting the changes.

Listen: Mia Freedman shares her most awkward pap smear story. (Post continues after audio.)

The protests around the new cervical cancer tests were about the new costs.

Previously, pap smears were free. But under the new system, patients are up for the cost of both the doctor’s visit, and the pathology fees.

“We demand pap smears and pathology services remain free of charge. These cuts are unfair to the average Australian, but will especially hurt women,” wrote the petition.

“Free and accessible pathology tests are key to ensuring early detection of cervical cancer, STI’s, UTIs and pregnancy. Late detection will lead to MORE cost to the taxpayer in the long run. These essential services are a backbone of our world class healthcare system.”

But it wasn’t entirely true.

In response, Federal Health Minister Sussan Ley – to whom the petition was directed – denied the claims.

“There are no changes proposed in MYEFO regarding the cost of either receiving or delivering a physical pap smear examination undertaken by your GP or specialist, nor their billing practices,” said Ley.

HOWEVER.

If your pathologist or doctor is not prepared to take on a small payment (between $1.40 to $3.40) as a gap payment separate from the Medicare rebate, the customer could have to pay it.

So where did $30 a test come from?

Ironically, not even the founder of the Change.org petition – 25-year-old Brigitte Garozzo –  has any idea where that figure came from.

In an interview with Triple J’s Hack program, Doctor Michael Harrison, President of the Royal College of Pathologists Australasia, said that the $30 could come from a variety of costs – and could even end up being higher.

“When you have a pathology test we can’t actually raise a bill until we’ve done the test… If we don’t bulk bill it and send straight to Medicare, we have to send an account to the patient,” he said, adding that manually sending out a paper account to a patient costs $15 or $20 alone. The fee for a pap smear therefore could come to $60 in total.

This week, it was announced the new test would be delayed.

According to the Australian Government’s National Cervical Screening Program, changes to pap smears were to be introduced on the 1st May, 2017.

But this week, the Australian Government announced that it would be pushed back until December 1st, 2017, due to “the complexity of assimilating and migrating data from eight state and territory cancer registers into one register.”

Why is the pap smear test changing?

Australia first introduced the pap smear test over 26 years ago, way back in 1991. It involves taking a scraping of cells from inside the cervix in order to test them for abnormalities that could indicate a cancer diagnosis.

At the time, it was considered the best possible method of detecting the disease. But two and a half decades on, medical research has progressed to actually find a better solution. One of the biggest findings since 1991 is the link between the Human Papilloma Virus (HPV) and cervical cancer.

What is the new test?

Sorry, ladies - for anyone hoping the invasive and *very uncomfortable* internal scraping is off the table... it’s not. The new test, called the ‘Cervical Screening Test’, will follow the same format but will test for a different thing.

The good news: this means less tests, with the AMA saying “these changes will mean millions of women can perfectly safely reduce the number of times they face the nuisance, expense, and discomfort of having Pap smears.”

Rather than getting tested every two years, you’ll only need to be tested every five. Win!

Do they think it will be more accurate?

The pap smear testing was never very accurate at picking up cervical cancer cells in women under the age of 25. This meant by the time it was detected in their older years, it was progressed to a more serious stage.

The National Cervical Screening Program website say that the changes to the program “are based on new evidence and better technology and will improve early detection and save more lives.”

Another finding in recent years is that cervical cancer cannot exist without first contracting a certain strain of the HPV virus. 12% of women will contract a strain of the virus at some point in their life, but only 15 of the 40 types of HPV are considered high risk.

So what’s the point of the HPV vaccine I had?

Most of you will remember the HPV vaccine being rolled out in 2006. It has been hugely successful, resulting in a 77% reduction in HPV types responsible for almost 75% of cervical cancer, and almost 50% reduction in the incidence of high-grade cervical abnormalities in Victorian girls under 18 years of age.

However, the vaccine doesn’t protect women against all strains of the HPV virus. So you will still need to go for regular Cervical Screening Tests to ensure you’re fully protected.

What do the experts say?

Dr Michael Gannon is the head of the Australian Medical Association, and says there is no reason to be alarmed about the new Cervical Screening Test.

“The new National Cervical Screening Program (NCSP) reflects an increased understanding of the biology of Cervix Cancer,” says Dr Gannon.

"It reflects the changes in epidemiology that will accrue from having a population of young adults (boys and girls) who should nearly all be vaccinated against cancer producing HPV (wart virus) infection.”

Dr Gannon also points out the HPV virus often leads to cervical Incompetence and preterm birth. Both issues can mean infant mortality or health concerns in premature babies, such as cerebral Palsy, chronic lung disease, intellectual impairment, hearing impairment, blindness, learning difficulties, and behavioural problems.

“The NCSP changes will thus save taxpayers millions of dollars,” says Dr Gannon, “but they are not merely a cost-saving measure. This is a well thought out, evidence-based change to Gynaecological practice, which will be a bonanza for improvements in child health.”

Will it cost me more money?

As mentioned above, going in for a cervical cancer test is going to leave you out of pocket - how much that will be, however, is unclear.

The NCSP website gives the following explanation of the new costs:

“There are two costs involved – the doctor’s consultation cost and the cost of the laboratory test. The cost of consultation will depend on the general practice or health centre you attend. A Medicare rebate is available for both the consultation fee and the laboratory test.”

However, some doctors will still bulk bill you, which means no out-of-pocket expenses.

If you have any questions, make an appointment to see your doctor. The new National Cervical Screening Program officially launches on the 1st May, 2017.
Find out more at: http://www.cancerscreening.gov.au/

Do you agree with this new way of smear testing? Tell us what you think in the comments section.