PICCSI employs self-collected human papillomavirus (HPV) testing for Fijian women, to rapidly detect the virus that causes the majority of cervical cancers via point-of-care PCR testing.
Test results are returned within 45 minutes, showing whether a patient is HPV positive for a high-risk type of HPV. For those who test positive and require treatment, this can be provided on the same day.

The treatment removes pre-cancerous cells and is administered by the skilled Australian volunteer team, spearheaded by Melbourne-based obstetrician gynaecologist Dr Nicola Fitzgerald.

Dr Fitzgerald’s volunteer team is comprised of gynecologists, midwives, gynecology nurses, gynecologist trainees, and a GP, along with non-clinical administration staff.

Dr Fitzgerald commented on the importance of pre-cancerous cell detection and removal for Fijian women,

“In countries like Australia, cervical cancer diagnoses are more accessible, and treatments like chemotherapy and radiation are available. However, in the Pacific region, options for radiation as a treatment option are limited, unless individuals can afford to travel abroad to receive treatment.

This means that many women in the Pacific do not receive adequate treatment following a cervical cancer diagnosis.

This was the primary driver behind the development of PICCSI. It allows us to detect and treat women in the pre-cancerous stage, before they develop cervical cancer and the need for radiation or chemotherapy is required. In this way, the project has transformed access to cervical health services for Fijian women.”

This year’s PICCSI program took place in five different rural centres across Fiji from 7th-11th August, with a total of 302 Fijian women being screened for cervical cancer. The testing resulted in a positive HPV rate of 17%, and 25% of those women received pre-cancerous cell removal treatment.

Partnering with the Australian Centre for the Prevention of Cervical Cancer (ACPCC), who provide one of the testing machines for the program, and local partners Fiji National University and the Department of Obstetrics and Gynaecology at Lautoka Hospital, PICCSI addresses critical gaps in cervical cancer prevention and treatment in the Pacific region.

Local women aged 30-50 years were invited to be screened, with three PCR testing machines provided to the program by ACPCC and the Fiji Ministry of Health, allowing 12 cervical samples to be tested per hour.

In addition to providing PCR technology, ACPCC provides ongoing pathology services, training, technical support, and result interpretation to the program on a volunteer basis.

PICCSI aims to address several key challenges faced by Fijian women in accessing the healthcare they need, such as travel and financial considerations, healthcare workforce capacity, and infrastructure.

John Crothers, Executive Officer of Pathology Awareness Australia commented, “Collaborating with our Pacific neighbours to combat cervical cancer is a commendable initiative. Cervical cancer remains a significant health challenge, particularly in regions with limited resources and access to advanced healthcare.

By joining forces, sharing expertise, and implementing preventative measures such as HPV vaccination and early screening programs, we can make a substantial impact on reducing the burden of this preventable disease in countries such as Fiji. It’s an opportunity to not only save lives, but also to strengthen the bonds of solidarity and support within our broader healthcare community.”

Prior to this screen, test and treat program, there could be delays of up to 8 weeks in obtaining test results. Combined with transportation and family challenges, this has contributed to high rates of patients who received abnormal results remaining untreated.

Dr. Fitzgerald emphasised, “There is an urgent need to improve cervical cancer screening and treatment accessibility for Fijian women. At PICCSI, we are laying the foundation for a broader Pacific-wide screening program. Our objectives extend beyond immediate care, as we aim to boost awareness of cervical cancer screening, involve local practitioners, and gather data to advocate for a nationwide screening program in Fiji.”

PICCSI’s impact has been profound since its inception in 2018, delivering prompt testing, diagnosis, and treatment. In each five-day mission, 300-400 women are screened, with an average of 10-15% requiring treatment each time. By offering immediate results, follow-up rates have significantly improved compared to delayed result models.

Dr. Fitzgerald concluded, “PICCSI showcases the collaborative spirit of healthcare professionals across borders. By providing accessible, immediate, and sustained care, we are contributing to the larger goal of cervical cancer prevention in the Pacific.”

The post Fiji fights cervical cancer with the help of Australian pathology volunteers first appeared on Know Pathology Know Healthcare.

The cervical screening program was renewed in 2017 and now offers a Cervical Screening Test (CST) to women aged 25-74 every 5 years. This pathology test detects Human Papillomavirus (HPV) which is a virus known to cause the majority of cervical cancers.

The two most high-risk types of HPV are 16 and 18, although some other types do carry a risk, but at a much lower level.

For anyone who tests positive for HPV, pathology laboratories also perform cytology testing, where the cells are examined under a microscope to look for changes that could cause cancer.

This video answers common questions about Cervical Screening Tests

Based on all the data gathered by the pathology team, a patient will be referred for the most appropriate next step.

The changes to the guidelines that came in on 1^st February 2021 largely affect people who test positive for HPV that is not type 16 or 18, and then test positive again when they are tested 12 months later.

If the cytology results show that they do not have cancer or changes to their cells that are a high-grade, precancerous condition, these patients can then be followed up again with another CST in 12 months, instead of being referred for a colposcopy.

A colposcopy is when a doctor performs a more detailed examination of the cervix using a special instrument called a colposcope.

When the program was first changed over from the old pap smear test to the Cervical Screening Test that looks for HPV, the approach taken was to be extra cautious and refer all patients who returned an abnormal result for a colposcopy just in case.

Evidence from the renewed cervical screening program was reviewed by a group of experts including the Cancer Council Australia Clinical Guidelines working party, and they determined it is not necessary for most patients in this category to be referred for colposcopy.

Instead, they will be asked to have another CST in 12 months. This is because an estimated 67% of HPV infections resolve by 12 months¹ through the body’s own immune response. People with these test results are at low risk of developing cancer or a high-grade precancerous condition within that timeframe and therefore do not need a colposcopy at this stage.

This is beneficial to patients because there will be less people waiting for a colposcopy, so those who need the procedure should receive it more quickly. It also reduces the number of unnecessary colposcopies being performed.

Dr Lara Roeske is a member of the Cancer Council Australia Cervical Cancer Screening Guidelines Working Party and co-author of the National Cervical Screening Guidelines. Dr Roeske told newsGP:

 ‘The risk for these women is extremely low. In fact, it’s under .02%,’ Dr Roeske said.

‘When the clinical guidelines for the renewed NCSP were released in 2016, there was really a cautious approach adopted, which meant there was universal referral for colposcopy.

‘But what the data is showing very clearly is the majority of women will either clear this infection, or they’ll have a persistent infection without serious abnormality developing in the cervix, and they can be monitored.’

 However, there are some people who are considered to be in a higher risk category meaning, if they test positive for HPV at their 12-month follow up test, this recommendation won’t apply to them and they can still be referred for a colposcopy.

This includes;

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

Anyone with questions about cervical screening or cervical health should talk to their GP in the first instance. For more information about the changes visit the Department of Health’s website.

References

1. https://wiki.cancer.org.au/australia/Clinical_question:Oncogenic_HPV_types_not_16/18

The post Cervical screening guideline changes – what do they mean for patients? first appeared on Know Pathology Know Healthcare.

Find out if you need a test

In November 2017, the National Cervical Screening Program updated the two-yearly ‘Pap Smear’ to the five-yearly Cervical Screening Test, an improved version which tests for the Human Papillomavirus (HPV), a virus present in most cases of cervical cancer. This test allows for earlier detection of changes that could lead to cancer.

The Cervical Screening Test is recommended for all women aged 25–74, every five years. If you had your last Cervical Screening Test before November 2017, you are now overdue. Please speak with your healthcare provider if you believe you are eligible for the Cervical Screening Test.

HPV and cervical cancer are usually asymptomatic, particularly in the early stages. Women who have symptoms such as abnormal bleeding should talk to their doctor right away.

The post What happens to your cervical screening test? first appeared on Know Pathology Know Healthcare.

Australia is a world leader in cervical cancer prevention and is on track to eliminate cervical cancer by 2035.  Although the pandemic has disrupted healthcare for many people, this goal is still achievable with participation in screening and immunisation programs.

The high quality and innovation in Australia’s pathology laboratories has been key to reaching this enviable point.

Join the conversation to ask the experts your questions about how we can beat cervical cancer.

The post Your chance to ask the experts on cervical cancer this International Pathology Day first appeared on Know Pathology Know Healthcare.

How has healthcare been different for you during lockdown?

During lockdown, I was able to have phone consultations or telehealth appointments with both my GP and my gynaecologist.

A year ago, I had my first surgery for irregular cervical cells following on from my Cervical Screening Test and it was there I found out that I had AIS (Adenocarcinoma in situ – a precancerous condition) and SIL (squamous intraepithelial lesions – abnormal cells on the cervix) . Thankfully, after the second surgery, I received clear margins and was required to have my six-month check-up in June of this year. It was a slightly different experience to normal, as we all had to wear masks and when I had my blood test and cervical scan, that was the same procedure required. I had purchased a face mask from the chemist for my first appointment and at the second appointment, I was provided with a mask.

I feel that the healthcare I received was exceptional for the circumstances of COVID-19, but I’m glad that I did still connect with the medical professionals who have been looking after my journey whilst both in lockdown and with some restrictions. I’m glad that I didn’t delay my appointments or put off making them due to the circumstances. I also had a psychology video consultation in April and that was a huge help as well.

If I can urge anyone to do something this year, it’s to ensure that you stay on top of your regular check-ups. I put off my Cervical Screening Test for too long and I am so grateful that my body at the time gave me some warning signs, your health truly is your wealth.

How have you overcome any barriers to healthcare?

I overcame barriers by communicating with my medical professionals, sending an email or making a phone call to book an appointment and discuss what my best options were. For some appointments, they would be done via phone, and others had to be in person.

What would be your advice to other patients on managing their health during lockdown?

My advice to patients on managing their health during lockdown would be to make sure that you listen to your body, ensure that your medical appointments are up to date and don’t put off important appointments. My next medical appointments to make will be my annual breast-screening, mole scan and dermatologist appointment and also with my dentist and optometrist before the end of the year.

I am planning on keeping all of my medical appointments in a hard copy diary next year, so I am more organised than ever. I currently rely on my memory and my phone or email and SMS updates for my reminders. My Health Record is also very helpful.

You can read more about Rachael’s story here

The post The face behind the mask – meet the patient first appeared on Know Pathology Know Healthcare.

The Medicare Benefits Schedule (MBS)² data indicates in March 2020, when COVID-19 restrictions began, testing numbers dropped to almost half the number performed the previous year.

Although test numbers were expected to drop this year with the program changing from a two-yearly to a five-yearly test, the number of women having their test is still much lower than anticipated³.

In November 2017, the National Cervical Screening Program (NCSP) changed to test for the Human Papillomavirus (HPV), a virus present in most cases of cervical cancer. This test allows for earlier detection of changes that could lead to cancer and so is recommended every five years.

The MBS data reveals that only 174,000 women had a CST from March 2020 to June 2020, when COVID-19 restrictions were in place. This figure is dwarfed by the half-a-million tests that were performed during the same period in 2019.

Adjunct Professor Annabelle Farnsworth, pathologist and Medical Director at Douglass Hanly Moir Pathology, and Director of Cytopathology and GynaePath, said;

“Nearly all cases of cervical cancer are caused by an infection with HPV. In most cases an HPV infection shows no symptoms and that is why regular screening tests are so important. Sadly, cervical cancer is a cancer of young women, so it’s vital that women have their tests from the age of 25. There is no doubt early detection saves lives. Australia was on track to eradicate cervical cancer by 2035 and we want to ensure we achieve that goal.”

“We expected a drop in testing this year due to the new program changeover, but at the beginning of the pandemic we saw a drop in pathology testing across the board, and we have not seen the numbers of CSTs increasing to show that missed tests are being rectified. We do not know when the pandemic will be over so it is important that people understand they cannot put their CST on hold indefinitely. Measures are in place to ensure people can catch up on their screening safely during the COVID-19 pandemic.”

A study by Cancer Council NSW⁴ predicted that disruptions due to COVID-19 would result in between 270,000 and 1,000,000 women missing a screening test in 2020.

Gold Coast mum Bec Gear (34) is a passionate advocate for cervical cancer awareness. She put off her CST for 12 months while in the process of moving back to Australia from New Zealand, and was later treated for cervical cancer;

Ms Gear said: “I was due for my test when living in New Zealand and I decided to wait until I was back in Australia. When I got back, I found other excuses to put it off but eventually a post I saw on social media prompted me to go and get tested. I was lucky that I caught the cancer at an early stage, I shudder to think how bad it could have been. It really worries me to see how many women have missed their CST this year. I understand that we are living in a pandemic, but cervical screening could save your life.”

“If you have never had a CST before or if you are overdue to have one, now is the time to catch up and get it done. Talk to the other women in your life about it too, that simple reminder could save someone you love.”

According to a recent study by the University of Melbourne⁵, the number of women aged 18 to 44 who needed to see a healthcare professional but chose not to has been on the increase.

At the beginning of June 2020, 18.3% of women in that age group who needed to see a healthcare professional chose not to. This rose to 20.2% in late June 2020, and further increased to 22.2% in August of this year.

This is a worrying trend and is also a missed opportunity for healthcare providers to remind women about cervical screening and check they are up to date.

Joe Tooma, CEO of the Australian Cervical Cancer Foundation (ACCF), said:

“In a normal year, around 46% of Australian women are not up to date with their cervical screening. We all know that 2020 has not been a normal year so that drop in screening has been amplified. Many people may not be aware that cervical cancer can affect younger people, we hear many stories like Bec’s from women in their twenties and thirties who have delayed their screening tests.

This is why cervical screening is offered between the ages of 25 and 74. Women in that age group who have not had a CST in the last two years are now overdue, so it’s time to catch up, make an appointment and get a CST.”

Image credit: Nigel Hallett / The Courier Mail

References

1. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2818%2930183-X/fulltext
2. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=PN.0.22&qt=noteID&criteria=cervical%20screening
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845438/
4. https://www.health.gov.au/resources/publications/modelled-analysis-of-hypothetical-impacts-of-covid-19-related-disruptions-to-the-national-cervical-screening-program
5. https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0007/3478633/ri2020n23.pdf

The post COVID disruption leaves Australia’s cervical cancer goals hanging in the balance first appeared on Know Pathology Know Healthcare.

Find out if you need a test

In November 2017, the National Cervical Screening Program updated the two-yearly ‘Pap Smear’ to the five-yearly Cervical Screening Test, an improved version which tests for the Human Papillomavirus (HPV), a virus present in most cases of cervical cancer. This test allows for earlier detection of changes that could lead to cancer.

The Cervical Screening Test is recommended for all women aged 25–74, every five years. If you had your last Cervical Screening Test before November 2017, you are now overdue. Please speak with your healthcare provider if you believe you are eligible for the Cervical Screening Test.

HPV and cervical cancer are usually asymptomatic, particularly in the early stages. Women who have symptoms such as abnormal bleeding should talk to their doctor right away.

The post Ask a cytologist: key questions answered about cervical screening tests first appeared on Know Pathology Know Healthcare.

Eva Peron

Eva Peron’s life has all the touchstones of high drama. Born in a poor village she left for Buenos Aires to pursue an acting career when she met and married future Argentine President, Juan Peron. No shrinking political violet, she ran the ministries of labour and health. Her life’s story has proven irresistible – spawning endless books, films, television series and the musical Evita.

After fainting at a public event in 1950, it was discovered she had advanced cervical cancer. She died soon after in 1952, aged 33. The basis of cervical cancer is the Human papilloma virus (HPV), which today can be picked by an HPV pathology test. Replacing the pap smear test in 2017, the HPV test can be taken every 5 years.

Vivien Leigh

Vivien Leigh made her name in two of Hollywood’s great mid-century blockbusters, Gone with the Wind and A Streetcar Named Desire. Shortly after starring in Gone with the Wind and marrying Laurence Olivier, she was diagnosed with tuberculosis, a condition she had recurrent bouts of and which killed her at age 53.

Today, a quarter of the world’s population carry the Mycobacterium tuberculosis bacteria that leads to tuberculosis, but only 5-10% will get sick. Those with weakened immune systems or with already damaged lungs are most susceptible. There are several tests available for tuberculosis which is treatable with a course of medication.

Freddie Mercury

The best-known Zoroastrian in the world – also known as the lead singer and songwriter of rock outfit, Queen – Freddie Mercury died as a result of AIDS in 1991 at 45 after being diagnosed with the condition in 1986. His life was unfortunately just out of sync with the development of HIV medicines, the first experimental AIDS vaccine tested in the US declared safe in 1991.

While Freddie might not have benefitted from early detection of HIV given the medical treatment for HIV was not yet developed commercially, today, anyone else can have an HIV test, and if found positive can seek treatment before it develops into AIDS.

Al Capone

Ultimately nabbed by the United States government for tax evasion and given an 11-year spell in the Atlanta Penitentiary and Alcatraz, Al Capone made his fortune during the Prohibition as a Chicago mobster. It was up like a rocket and down like a stick for Capone. By the ripe age of 33 he was in prison, being released 8 years later.

But his freedom wasn’t what it might have been. At some stage Capone contracted syphilis and upon his release in 1947 was suffering syphilitic dementia. A simple syphilis test for the pathogen Treponema pallidum would have revealed the condition and a course of penicillin would have cured him.

Wolfgang Amadeus Mozart

A workhorse to the end, Wolfgang Amadeus Mozart was still composing his last masterpiece ‘Requiem’ on his deathbed when he struck a final, sour note, dying at the age of 35, having produced an unbelievable body of work. The cause? As happens in old cases, theories abound, but it’s argued that new evidence points to the cause of death as being kidney damage caused by strep throat.

There was an epidemic of strep throat in 1791. The culprit, the Streptococcus pyogenes bacteria. A simple Rapid antigen or throat culture test can detect strep throat and then a course of antibiotics is all you need to clear it up. Unless it was death by pork chop, as suggested here. Either way his premature death was a tragic conclusion for Wolfy and the human race. 

That the world was deprived of the unique talents of so many people is sad but also points to how far we’ve come in the detection of medical conditions.

‘Today, we’re extremely fortunate that we can pick up on conditions early so that appropriate medical treatment can begin,’ says microbiologist, Dr Petra Derrington.

‘With the developments in testing and medical treatments over the last century or so, conditions that once proved fatal, need not be the tragedies they once were.’

The post Celebs who might have been saved by a pathology test first appeared on Know Pathology Know Healthcare.

The Human Papillomavirus (HPV) vaccine, co-developed by Aussie legend Professor Ian Frazer, and first administered in Australia on 29 August 2006, is now provided for free to all 12 to 13 year old Australian children as part of the National HPV Vaccination Program.

The link between the virus infection and cervical cancer was first suggested by Australian pathologist Dr Colin Laverty in 1978, but it was another twenty years before Professor Frazer and his partner Dr Jian Zhou would go on to develop Gardasil, the HPV vaccine used globally today.

One in two of us will be infected with HPV in our lifetime. What’s worse is that HPV causes more than 70 percent of all cervical cancer cases (as well as increasing the risk of vulva, penile, anal, and throat cancers).

The recent review of the HPV vaccine has found that since 2006, with more than 187 million doses administered across 130 countries, the number of new cases of cervical cancer in women has halved and the number of HPV infections has fallen by as much as 90% in some areas.

“Observations from over the past 10 years are that the HPV vaccines, if delivered effectively to the majority of 10-12 year-old-girls in the developing world from today forward, should lead to the global elimination of new cervical and other HPV associated cancers by 2050,” Professor Frazer said.

Read more about how Australia has led the fight against cervical cancer here.

The post Australian-developed HPV vaccine has halved cervical cancer rates in just ten years first appeared on Know Pathology Know Healthcare.

The University of Sydney graduate was the first person in the world to confirm that the human papillomavirus (HPV) was much more common in the cervix than previously thought and in 1978 he hypothesized that this virus could be a cause of cervical cancer.

The role of human papillomavirus in cervical cancer

Pap smears as a method for detecting cervical cancer had been around since 1928. Fifty years later, though, it was Dr Laverty who recognised that cellular abnormalities, known as koilocytes, were much more common in Pap smears than previously realised. He also noted that in the majority of cases clinical warts were absent, even on careful clinical examination.

A researcher was employed and an electron microscopic technique was devised which confirmed Laverty’s suspicion that HPV particles were present in these koilocytes. Dr Laverty was the first person in the world to publish findings that proved atypical, potentially premalignant cells in pap smears in women without actual genital warts, were papillomavirus infected. This in turn led to his hypothesis in 1978 that HPV was possibly involved in the development of cancer in cervical cells.

In the years that followed, Laverty’s suggestion that HPV could be involved in the causation of cervical cancer was confirmed. And that meant, theoretically, a vaccine could be developed against cervical cancer.

A vaccine against cervical cancer

The prospect of a vaccine against cervical cancer was significant. Unlike most viruses though, HPV cannot be cultured without living tissue, and therefore development of a vaccine was not straightforward.

In the early 1990s another legend of Australian medicine, Dr Ian Frazer, alongside Chinese virologist Jian Zhou, began work on finding a solution to this.

They used molecular biology to synthesize particles in vitro that could mimic the virus and developed this into a protein from which the HPV vaccine would ultimately be made. After three years of design they had the makings of a vaccine against HPV. In 1998 Frazer completed the first human trials for Gardasil, the vaccine still used in Australia today.

The Australian HPV Gardasil vaccination program was introduced in 2007 for young women, and in 2012 for young men, meaning younger generations of Australian women have a much lower risk of cervical cancer. The vaccine protects against HPV 16 and 18 – the two subtypes responsible for 70% of cervical cancers.

So what’s next?

At the time of Laverty’s discoveries, the only way of confirming the presence of HPV was via electron microscopy. Today, though, new methods have been developed to detect the molecular material (such as DNA) of high risk strains of HPV. And this is changing how cervical cancer screening is being undertaken in Australia.

The current screening test looks for abnormal cells in a sample taken from the cervix. Abnormal cells could indicate cancer, precancerous cells, or other changes in the body such as a virus or infection.

The new test, however, allows doctors to know if a woman is at higher risk of cervical cancer before abnormal cells can be detected, by looking for HPV DNA. Plus it can distinguish between strains that are ‘high risk’ (ones associated with cancer) and ‘low risk’ (associated with warts, for example) meaning less unnecessary follow up procedures for women not at risk of developing cervical cancer.

And we’re sure Dr Laverty would have been thrilled to learn of the latest estimates that suggest that this new test method combined with the HPV vaccination program could reduce cervical cancer rates in Australia by 15%.

The post How Australians have been leading the fight against cervical cancer since 1978 first appeared on Know Pathology Know Healthcare.