1. Register functions in support of Renewal
Nerida Steel
Manager
WA Cervical Cancer Prevention Program

2. Key Renewal message
As of this Friday 1 December 2017 Pap smears should no longer be taken
As of this Friday Pap smears should no longer be taken, as cytology will no longer be the primary cervical screening test in Australia. As Ian has already mentioned, from this day human papillomavirus, or HPV, testing will be adopted as Australia’s primary cervical screening test.
This new test is called the Cervical Screening Test or CST. Importantly, these tests are all liquid based cervical samples, which if HPV is detected allows reflex LBC to be automatically performed on the same sample, without the woman needing to return for a further test.
The majority of Cervical Screening Tests will have a ‘HPV negative’ result and therefore will not undergo cytology testing. However, it is still of vital importance that healthcare providers continue to collect high quality cervical samples. Should samples need to undergo reflex cytology the laboratory will need to be able to assess the sample for any squamous abnormalities as well as, when possible, glandular abnormalities. This is of particular importance for samples where HPV types other than types 16 or 18 have been detected, as in these scenarios the cytology result will inform the woman’s recommended risk rating and management.

3. The National Cancer Screening Register (NCSR)
From 1 December 2017 the NCSR will commence receiving cervical test results from laboratories
To support the significant practice changes there is, as you’d expect, behind the scenes associated infrastructure and information management changes. This is of course being the establishment of a new National Cancer Screening Register, or NCSR, which will be released in two stages. The first stage will occur on 1 December 2017 when the NCSR will commence receiving cervical test results from pathology laboratories. The second will occur once all existing state and territory cervical screening registers have migrated all pre-1 December 2017 cervical test results to the NCSR and transitioned their Registry services. It is anticipated that this will occur in March 2018.
Thus, the only change for healthcare providers come 1 December is the process for a woman to opt-off the NCSR. Currently, if a woman advises that she does not want to be on the state-based register, her healthcare provider marks the pathology request form as ‘Not for Register’. In these instances the laboratory does not transmit the associated cervical test results to the relevant state-based register. From 1 December 2017 this will no longer be the case. The only people who can opt-off the NCSR are the woman, her nominated representative or her healthcare provider. If a woman wishes to opt-off of the NCSR, her healthcare provider must inform her of the impact this will have (i.e. the woman will no longer receive invitation or reminder communications from the NCSR). Post discussion, if the woman still wishes to opt-off, she may do so by contacting the NCSR directly, or by her healthcare provider advising the NCSR of this on her behalf. This can be met via phone, fax or post.
If the woman does not want to be on the WA Register, she may opt-off by advising us in writing of this directly.

4. The WA Cervical Cancer Prevention Program (WACCPP)
Registry functions
Call for screening histories
Health promotion
Education and training
Governance and quality assurance
To date the WA Cervical Screening Registry, or CSR, has provided a safety net for WA women - a reminder service should a woman become overdue for routine screening or any recommended follow-up tests. Most of these reminder letters are issued once a woman becomes three months overdue for a test. The WA CSR will continue to provide this service until stage 2 of the NCSR release (March 2018), when the NCSR assumes all Register functions.
During this time, the WA CSR will also continue to provide WA women’s cervical screening histories to pathology laboratories to support their report recommendations and to healthcare providers to support their management of women. Therefore, up until stage 2 of the NCSR release, please continue to contact us on (the single national number of the NCSP) to obtain a patient’s screening history.
To support the WA CSR in providing up to date cervical histories and in initiating appropriate reminders when women are overdue, the WA CSR will receive daily raw data extracts from the NCSR. These data extracts will include all cervical tests taken on women who reside in WA from 1 December 2017.
Once the WACCPP ceases to offer Register services in the near future, we will move our focus to implementing strategies to maximise women’s participation in screening and delivery of services to meet the objectives of the NCSP. This will be through education and training, health promotion strategies and initiatives, as well as governance and quality assurance.
Where you may notice a difference is health promotion and education with a specific focus on increasing screening in our under-screened and never-screened women. This will be achieved through strategies targeted at ‘high risk’ groups of women - women we know may be at increased risk of not participating in cervical screening.

5. NCSR Protocol of Actions
Once the WA CSR and all other jurisdictional registers have migrated their data to the NCSR and transitioned Register services, the NCSR will be responsible for, and will generate all overdue reminder communications. These overdue reminders will be similar to the ones previously issued by the state-based registers and will have similar timeframes – three months post the test due date.
In addition to these reminders, the added benefit and absolute important need in support of the new five-yearly screening program, is the commencement of invitation letters from the NCSR. These will be issued three months prior to a woman’s screening due date.
Although the NCSR will offer invitations and reminders, it is still of vital importance that healthcare providers continue to identify women due for screening in their practice and invite them to screen. The invitations for screening or follow-up tests of course needs to complement the NCSR and not duplicate these communications. As the NCSR will send invitations at three months prior to the test due date and reminders three months post when a test was due, it would be complementary for healthcare providers to invite women to screen or have a follow-up test at the time she is due. If possible, it would be beneficial to have your practice software ‘reminder system’ support these timeframes.
As I am aware that there is some confusion on timeframes, and specifically timeframes in relation to transitioning women, I would like to highlight that women will be due for their first cervical test in the renewed NCSP when they would have been due for their next Pap smear or follow-up test. Thus, women aged 25 and over with normal Pap smears are due for their Cervical Screening Test two years after their last negative Pap smear. Women of any age with an abnormality that was detected on a Pap smear should attend for a follow-up test as outlined in the 2016 Guidelines, and as Ian mentioned earlier.

6. Renewal resources
Guidelines for the Management of Screen Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines)
Available at ing
Resources for women and healthcare professionals
Available at
WA Primary Health Alliance’s Cervical Screening HealthPathway
Available at
Coming soon:
Toolkit for Engaging with Under-screened and Never-screened Women in the Renewed NCSP
A Cervical screening flipchart resource for WA Aboriginal women
A range of resources are available to support healthcare providers in their implementation of these changes into practice.
As previously mentioned, the 2016 Guidelines are accessible online and provide guidance on transitioning women to the renewed NCSP as well as management of test results in the renewed program.
A suite of resources have been developed by the Commonwealth Department of Health for both healthcare providers and women and are now available. Many – or all of you – should have received a pack with this suite of resources - has this occurred? It is important to know that some of the resources for women are also accessible in large print. The suite of resources can be accessed online and ordered from the Commonwealth. Should you require assistance in this regard, please contact us as we are happy to facilitate this process. In the near future translated resources for women will be available in 24 languages.
Also, the WA Primary Health Alliance has recently released a Cervical Screening HealthPathway. This is a fantastic practice support resource that I would encourage you to access.
There are two other resources that are in the final stage of development and will be available soon that are important to mention here.
The first is a Toolkit for Engaging with Under-screened and Never-screened women that Cancer Council Australia has developed. This resource seeks to improve screening participation amongst groups of women known to be at risk for under-screening or never-screening. This is anticipated to be released sometime in December 2017.
The second is a Cervical screening flipchart resource. In response to an identified need in WA, the WACCPP has developed this resource to support healthcare providers to have discussions with Aboriginal women and community about the importance of regular cervical screening. We are in the final stages of this resource development, and will have this available in the coming weeks. If you are interested in learning more about this resource, again please contact us.

7. Renewal education Online education developed by NPS MedicineWise
Available at
Sexual Health Quarters (formerly Family Planning WA) has online education for WA providers
Accessible at education/
Cancer Council Australia online education to support the Guidelines
Accessible at ening/E-learning
A number of educational opportunities are available. First, many of you may already be aware that NPS MedicineWise, on behalf of the Commonwealth Department of Health, have developed comprehensive education on cervical cancer, its prevention and the renewed NCSP. This is accessible online and attracts CPD points.
Sexual Health Quarters also have a cervical screening education program that provides information on the changes to cervical screening. This online program also attracts CPD points.
Lastly, Cancer Council Australia has developed online education to support healthcare providers’ understanding of the new Guidelines and how to implement this new management pathway into practice.

8. Further information
To access activities and tools to promote the Renewal in WA:
Visit
To receive updates on the Renewal implementation and cervical cancer prevention in WA :
Subscribe to the WA Cervical Cancer Prevention Program newsletter by ing
Contact the WACCPP on
If you are interested in promoting these changes to cervical screening in your practice, please visit the WACCPP website to access activities and tools. The WACCPP has a newsletter designed to share information on cervical cancer prevention and what is happening in this space in WA. Please us if you are interested in receiving this newsletter.

9. Key points On 1 December 2017:
The Cervical Screening Test will be implemented
The NCSR will commence receiving cervical test results
The WA CSR will continue to provide women’s screening histories and issue overdue reminder and follow-up letters

10. Questions?