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Updates to National Cervical Screening Program (NCSP) Guidelines

The National Cervical Screening Program Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding have now been updated to incorporate and support best clinical practice.   

The new Guidelines and supporting resources are now available at: Cervical Cancer Screening Guidelines

The changes will take effect in April 2025 to allow stakeholders to familiarise themselves with the Guidelines and update their systems. During this transition, the 2022 Guidelines remain current.

On this page:

Support for pathology laboratories

The National Cancer Screening Register (NCSR) is working to ensure a smooth transition to the updated Guidelines:

  • NCSR system updates: The NCSR will deploy changes to align with the Guidelines as part of Release 4.12 on 14 April 2025.
  • Support and engagement: We’ll continue to liaise with labs during regular scheduled meetings.

Summary of key changes

A summary pack of technical changes for laboratories is available, outlining key differences in testing requirements: Download the summary pack

Please note: This information is intended as a guide and should be read in the context of the full Guidelines.

Screening participants with HPV (not 16/18) detected on a self-collected sample who do not return until 9 months or more after the initial Cervical Screening Test can be offered a follow-up self-collected HPV test, rather than LBC.

 

Laboratories should note that the offer of self-collection at or after 9 months would be made by the referring practitioner.

On receipt of the second self-collected sample, the HPV test should be undertaken and the recommendation for further management should be made in accordance with the management of follow-up tests which is unchanged, see Flowchart 6.4.

People treated for histologically confirmed HSIL are recommended to have annual HPV tests (rather than co-tests) until tests are negative on two consecutive occasions, at which point they can return to routine screening.

 

Laboratories should note that this will open ToC for squamous disease to self-collection. People who have commenced, but not completed ToC, can access self-collection for their second HPV test.

Their previous co-test, in which HPV was not detected should be counted as part of ToC unless the cytology was (p)HSIL or glandular, in which case they should have already been referred back to colposcopy.

Those with HPV not detected and unsatisfactory or (p)LSIL cytology should have that test count as “HPV not detected” under the new ToC arrangements.

Follow-up testing after completely excised AIS (annual co-tests) can been extended to 3-yearly testing if all co-tests have been negative for 5 years, and can cease 25 years after completely excised AIS if all tests have been negative, the recommendation depends on the screening participant's age: 

  • Those aged less than 70 years can return to routine screening. 
  • Those aged 70 years or older can exit screening if they have had at least one co-test when aged 70 years or older, with no oncogenic HPV detected and LBC report of negative. 

 

Laboratories should note that these requirements do not apply to those who have had AIS and have also had total hysterectomy (see below).

Furthermore, it is not expected that return to routine screening after excision of AIS will occur before 2031, since HPV testing as part of ToC did not commence as part of the NCSP until 2006, so the 25 years of co-test follow-up will not elapse until then for the first affected patients. Laboratories may wish to defer systems changes until closer to this time.

For most patients, those with a screening history that shows no evidence of biopsy confirmed AIS or HSIL or who have completed ToC for HSIL, no further testing will be required. 

For those who have any cervical pathology (LSIL or HSIL) identified in the hysterectomy specimen, those who have never had a screening test and those who have not yet completed ToC following biopsy confirmed HSIL, will require annual HPV testing until oncogenic HPV is not detected on two consecutive occasions.

For those who have a history of biopsy confirmed AIS, or in whom AIS is identified in the hysterectomy specimen, annual co-tests are required until two consecutive tests are both negative.

 

Laboratories should consult the simplified flowchart 7.3

 

Laboratories should note that these changes to the Guidelines are included for their information.  No specific changes to laboratory processes or systems are required.

There is now an option to defer re-referral for those with HPV (16/18) detected, LBC report of negative, and normal colposcopy, if 12-month follow-up results are again HPV (16/18) detected and negative LBC: the HPV test could be repeated in another 12 months, rather than immediate referral to colposcopy.

To assist colposcopists in the situation where screening participants have HPV (16/18) detected but no LBC results are available prior to colposcopy or there is no visible lesion on colposcopy, information has been provided about the likely underlying disease risk for different combinations of test results, screening history and age, based on data from the National Cervical Screening Register.

In some circumstances, recommendations now state that endocervical curettage could be considered by those who are confident and trained in the technique and have appropriate equipment.     

The recommendation against diagnostic excision of the transformation zone (TZ) in the absence of high-grade cytology or histology has been clarified.  

Loop electrosurgical excision procedure (LEEP) is now recommended in preference to cone biopsy in some circumstances, due to the evidence of reduced post-surgical complications.   Compared with cone biopsy, LEEP is associated with a lower rate of post-surgery complications but has the same margin success rate. The evidence for effectiveness of cone biopsy or LEEP, however, has not changed.

NCSR Provider Integration Guide (PIG) updates

The Provider Integration Guide (PIG) has been updated to include:

  • New participant alerts (e.g., glandular surveillance and post-hysterectomy recommendations).
  • Updated and new result and test codes.
  • Discontinuation of older codes such as "Conventional Pap" and "Rescreen in 2 Years."

Summary of alert and code changes

New Reason for Test codes:
  • C5: HPV Test of Cure (for HPV only tests)
  • C7: Reflex LBC test after detection of oncogenic HPV in Test of Cure
Modified Reason for test (wording only)
  • HPV C2: Follow Up HPV test
New Recommendation codes:
  • M5a: Collect LBC at 6 weeks
  • M5b: Repeat HPV test within 6 weeks
  • M10: Co-test in 3 years
Labs are requested to cease using the following codes when reporting to the NCSR:
  • CP: Conventional pap test to screen for cervical cancer *
  • M5: Re-test in 6 weeks *
  • MP: Rescreen in 2 years *

* So as to facilitate labs to be able to reissue or amend old reports, it is advised to not remove the codes from your laboratory information system, but update your work instructions to not apply the code after 14 April 2024)

New alerts:
  • Glandular – 1 yearly co-testing (replaces existing glandular alert)
  • Glandular – 3 yearly co-testing
  • Glandular – Completed
  • Total Hysterectomy – Ongoing Screening

Resources and engagements

To help pathology laboratories and healthcare providers prepare for these changes, the following resources and engagements are available:

Pathology Support:
  • Webinar resource to support pathology providers
    To help pathology laboratories adapt to recent guideline updates, the ACPCC, in partnership with the Department of Health and Aged Care and the NCSR, has recorded a 25-minute webinar. Facilitated by Kelly Hughes (Department of Health and Aged Care), the session features expert insights from:
    • Professor Marion Saville AM – Chair of the NCSP Guidelines review and Executive Director, ACPCC
    • Ms Lesley Rowlands – Cervical Program Lead, Telstra Health (NCSR)
    • Ms Nicole Willmott – Laboratory Engagement Manager, Telstra Health (NCSR)
Watch the webinar
  • FAQs: 
    If you have questions after viewing this webinar, you can send them to ncspcommittees@health.gov.au. Please note that your questions may be edited for clarity and brevity. These FAQs will be updated on a weekly basis between February 17 and April 14, 2025.
Healthcare Provider Support:
  • GPEx CPD-Accredited Modules:
    Five online modules are available to educate healthcare professionals on the National Cervical Screening Program: Learn more

  • RACGP Webinars:
    The upcoming webinar will cover updates to Test of Cure, surveillance, and follow-up recommendations.