Abnormal cervical screening / cervical dysplasia / abnormal cervix

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Useful Management Information

Women who are in follow-up for pLSIL/LSIL cytology in the previous program (pre-renewal NCSP) should have a HPV test at their next scheduled follow-up appointment.
- If oncogenic HPV is not detected, the women can return to 5-yearly screening
- If any HPV is detected, the woman should be referred for colposcopic assessment
A single Cervical Screening Test may be considered for women between the ages of 20 and 24 years who experienced their first sexual activity at a young age (e.g., before 14 years) or who had not received the HPV vaccine before sexual activity commenced.
Adolescent patients with abnormal HPV should follow the same pathway as adult patients. Patients <25 years old should also have screening for STI as they are a high-risk group.
- Consider using oestrogen cream +/- liquid cytology in post-menopausal patients
Patients with positive non-16/18 but normal or LSIL on LBC would not need referral and only a repeat CST in 12 months.
Recall women in 6-12 weeks if they have an unsatisfactory screening report.
Specific efforts should be made to provide screening for Aboriginal and Torres Strait Islander women. They should be invited and encouraged to participate in the NCSP and have a 5-yearly HPV test, as recommended for all Australian women.
Women who have been treated for HSIL (CIN2/3) do not need a post-treatment colposcopy. These women should have a co-test (HPV and LBC test) performed at 12 months after treatment, and annually thereafter, until she receives a negative co-test on two consecutive occasions, when she can return to routine 5 yearly screening. This is called ‘test of cure’.
If, at any time post treatment, the woman has a positive oncogenic HPV (16/18) test result, she should be referred for colposcopic assessment (regardless of the reflex LBC result).
If, at any time during Test of Cure, the woman has a LBC prediction of pHSIL/HSIL or any glandular abnormality, irrespective of HPV status, she should be referred for colposcopic assessment.

Clinical Resources

National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding

Minimum Referral Criteria

Category 1	Invasive cancer (squamous, glandular, other). For optimum care, patient should be seen by gynaecological oncology within 2 weeks. LBC of PHSIL/HSIL AIS or possible high grade glandular lesion Positive HPV 16/18 *and* unsatisfactory LBC previous treatment for PHSIL/HSIL past history of positive HPV 16/18 Atypical glandular cells/endocervical cells of undetermined significance Positive HPV non-16/18 *and* Atypical glandular cells/endocervical cells of undetermined significance
Category 2	Positive HPV 16/18 *and* normal LBC PLSIL/LSIL Positive HPV non 16/18 and immediately previous CST result pLSIL/LSIL previous test positive for oncogenic HPV women aged 70-74 immune deficiency History of diethylstilboestrol (DES) exposure in utero regardless of HPV status or LBC test Abnormal appearing cervix with normal cervical screening Recurrent post-coital bleeding in pre-menopausal woman – gynaecological assessment recommended Any episode of unexplained vaginal bleeding (including post-coital) in a post-menopausal woman Unexplained persistent unusual vaginal discharge, especially if offensive and blood stained Any abnormal result and past history of excisional treatment of AIS
Category 3	No category 3 criteria
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

History of:
- any abnormal bleeding (i.e. post-coital and intermenstrual)
- unexplained persistent deep dyspareunia or unexplained persistent unusual vaginal discharge
- previous abnormal cervical screening results and any treatment
- immunosuppressive therapy
Medical management to date
Most recent and current cervical screening results (LBC should be performed on any sample with positive oncogenic HPV)

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

BMI
HPV vaccination history
STI screen result - endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
History of smoking

Send Referrals To

Smart Referrals

Coming Soon

Internal Referrals

Gynaecology (E-Blueslips), Colposcopy (E-Blueslips)

Fax

5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.