This report looks at the evidence collected and assessed by the Safety Monitoring Committee established to assess whether there were adverse outcomes following the introduction of new guidelines on how women with a low-grade Pap test result or a treated high-grade cervical biopsy result should be managed.
It has been 7 years since the National Health and Medical Research Council altered its guidelines on how women with a low-grade Pap test result or a treated high-grade cervical biopsy result should be managed.
This report looks at the evidence that the Safety Monitoring Committee collected to evaluate effects of this change. This Committee was established to assess whether there were adverse outcomes following the introduction of the new guidelines.
Based on its assessment of the evidence, the Committee determined that:
- the change in management for women with a low-grade Pap test result has not led to an increase in cervical cancer
- women who complete 'test of cure' after being treated for a high-grade cervical biopsy result have a very low rate of subsequent high-grade biopsy results, and to date none have developed cervical cancer
- limited data were available to audit cancer cases but it appeared that a range of factors may have contributed to the cancers that did arise after the detection of cytological abnormalities
- attendance by women for a follow-up test within 3 months of the recommended interval is generally high, although based on the evidence, women aged less than 30 are less likely to attend within 15 months of their initial low-grade Pap test result than women aged over 30
- attendance has been lower than recommended among women with a recent low-grade Pap test result whose first follow-up test was negative, possibly due to women considering themselves 'safer' after this negative test
- overall laboratory recommendation codes were broadly concordant with the changed management guidelines, although concordance was lower for low-grade management exceptions, that is women over 30 and those who had a second low-grade abnormality. There is evidence that the use of automated decision support tools in laboratories assists them to comply with the new guidelines.
The projects undertaken under the auspices of the Safety Monitoring Committee contribute to a current picture of the safety of the NHMRC Guidelines for the management of screen detectedabnormalities in asymptomatic women introduced in Australia in July 2006, compared to the previous NHMRC Guidelines that were rescinded at that time.
Acknowledging that new evidence may come to light in future which could affect this picture, the overarching message from the evidence currently available and the methods used to assess this evidence is that the new guidelines have not led to an increase in cervical cancer in the 7 years since they were introduced.