The change is based on new knowledge about HPV's role in the development of cervical cancer, new HPV testing technology and, last but not least, the successful uptake of the HPV vaccine by 12 and 13-year-old girls and boys in our school-based vaccination program. Thanks to many years of pioneering work by scientific and clinical leaders, Australia is on the cusp of rolling out a program which will not only improve our ability to detect changes on the cervix, but also improve screening rates for women who have never had a Pap smear before. This is imperative because the women most likely to be diagnosed with cervical cancer in Australia are also most likely to have been screened less frequently than recommended or never at all. The fact that Aboriginal and Torres Strait Islander women die from cervical cancer at a rate four times higher than other women provides more than enough reason to take stock. So let us look at the science and the facts. About 40 different HPV types can cause an infection of the genital tract which for anyone who is sexually active is a relatively common occurrence, generally goes unnoticed and is usually short-lived without long-term consequences. However, 14 HPV types are "oncogenic" – they have the capability of causing cancer of the cervix. Two in particular, types 16 and 18, are responsible for more than 70 per cent of cervical cancers. Cancer occurs when HPV fails to clear and persists within the cells, eventually becoming integrated into the cellular DNA. In the new program women will be offered a HPV test every five years from 25 until 70 to 74 years of age, instead of a Pap smear every two years from age 18 to 69.

While the testing technology is different, having the test itself will be exactly the same for most women. It can determine whether an oncogenic HPV type is present in the cells and is more effective than a Pap smear at predicting whether a woman is at risk of cervical cancer. Women who are positive for higher risk types 16 or 18 will be referred straight away for further investigation while those with an intermediate risk HPV will have a repeat test 12 months later. Women with a negative HPV test can be reassured that their risk of developing cervical disease within the next five years is extremely low, lower than for a Pap smear, which is why we can safely extend the interval between tests. Some women experience anxiety about a speculum examination as a result of cultural issues or past sexual abuse which can lead to low rates of screening. In the new program, never-screened or under-screened women will be able to take a vaginal swab themselves which is then sent for testing. While this self-collected test is less accurate than a test from the cervix it will allow vulnerable women to participate in the program and benefit from it. The increased age of first screening from 18 to 25 years has raised concerns about missed diagnoses. However, cervical cancer is extremely rare in young women and the screening program has not been found to make an impact on preventing cancer deaths in women under 25. Women of any age should see their doctor if they have symptoms suggestive of cervical cancer or pre-cancer such as abnormal vaginal bleeding, especially bleeding after intercourse.

Perhaps the most compelling reason for the change in age of cervical screening is the success of the vaccination program in reducing targeted HPV types in young women. This effect will increase as we vaccinate more girls and boys, although screening from 25 remains essential for vaccinated as well as unvaccinated women to prevent cancers from the other oncogenic HPV types. We must look to the future, learn from the past and constantly monitor how we are travelling as we enter a new era of cervical cancer prevention. A HPV test every five years is more effective and just as safe as the program it replaces. We all want to reduce the number of women diagnosed with cervical cancer and, even more so, the number of women dying from it. For all these reasons it is essential to support the new program. Dr Deborah Bateson is medical director of Family Planning NSW.