30 November 2021

Changes to the clinical management of screening participants at intermediate risk

Under the NCSP Clinical Guidelines published in 2016, participants who have had an intermediate risk cervical screening result i.e. HPV (not 16/18) detected, with negative reflex liquid-based cytology (LBC), possible low-grade squamous intraepithelial lesion (pLSIL) or LSIL), were recommended to have a follow-up HPV test at 12 months and then be managed as higher risk and referred for colposcopy if any HPV is detected in their follow-up test.

In light of new evidence, it is now recommended that participants with a 12-month follow-up HPV test result of HPV (not 16/18) detected, with negative LBC, pLSIL or LSIL, be regarded as still at intermediate risk and undertake a second HPV follow-up test in a further 12 months’ time.

If the subsequent test result (second follow-up HPV test following initial HPV (not 16/18) test result) again shows HPV (any type) detected, it is recommended these participants be referred
for colposcopy.

There are specific population groups who are excluded from this updated recommendation. Participants who may be at higher risk of a high-grade abnormality, despite a negative LBC or low-grade cytology result, should be referred for colposcopy if HPV (any type) is detected at 12 months. This includes the following groups:

  • participants who are two or more years overdue for screening at the time of the initial screen
  • participants who identify as Aboriginal and/or Torres Strait Islander
  • participants aged 50 years or older.

Additionally, the NCSP Clinical Guidelines outline separate guidance for other groups of participants who fall outside the new recommendation. These groups include:

  • immune deficient participants
  • participants exposed to diethylstilboestrol (DES) in utero
  • participants currently undergoing Test of Cure following treatment of histological high-grade squamous intraepithelial lesion (HSIL)
  • participants aged 70+ (attending for an exit test).

Importantly, referral for colposcopy continues to be recommended for all participants with self-collected samples at intermediate risk who test positive for HPV (any type) on their follow-up sample at 12-months after an initial HPV (not 16/18) test result on a self-collected sample.

This recommendation came into effect on 1st February 2021.

The revised Cervical Screening Pathway is outlined in the NCSP Clinical Guidelines.

You can access the communication resources on this change below, including a letter to healthcare practitioners from the Commonwealth Chief Medical Officer, Professor Paul Kelly, and frequently asked questions (FAQs) on these changes to the intermediate risk pathway.

A free online education module developed by Queensland Health, ACPCC and True Relationships & Reproductive Health is available for healthcare practitioners – click here.


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