How is cervical cancer screening discussed with clients at a sexual health clinic in Melbourne, Australia?

Keywords: cancer, cervical cancer, gynaecology, HPV, human papillomavirus, prevention, screening, sexual health, women health.

The establishment of the National Cervical Screening Program (NCSP) provided free Papanicolaou (Pap) smears to women in Australia until 2017.¹ A significant change in the program was the replacement of the Pap smear with the Cervical Screening Test (CST).² Pap smears assessed cytological changes and screening was recommended every 2 years previously. Whereas, the CST screened for the presence of human papillomavirus (HPV) and the rescreening interval was extended to 5 years.

This study aimed to understand what specific terminology was used by clinicians at the Melbourne Sexual Health Centre (MSHC) when they discussed cervical cancer screening with female clients. MSHC is the major publicly funded sexual health clinic in Victoria, Australia, which provides free HIV and STI testing and treatment to clients. While MSHC does not routinely perform Pap smears or CSTs, we asked clients to report their last Pap smear or CST as part of routine clinical care.

Between 5 and 24 November 2021, we conducted a paper-based survey among clinicians working at MSHC. We included all doctors and nurses who provided clinical consultations to female clients at MSHC and had ever discussed cervical cancer screening with female clients. This survey collected basic demographic information about clinicians, the most common term(s) used by the clinician when discussing cervical screening, and how they perceived clients’ understanding of cervical cancer screening. Completion and return of the questionnaire were taken as implied consent to participate. This project was approved by the Alfred Hospital Ethics Committee (553/21).

Overall, the survey was distributed among 52 clinicians, and 40 (76%) participated (Table 1). Most participants (65%, n = 26) were females, doctors (58%, n = 23), and had practised for over 15 years (63%, n = 25).

Table 1.  Demographic characteristics of 40 clinicians participating in the survey.

All 40 clinicians had discussed HPV screening with their female clients in the past 12 months (Table 1). All clinicians used the term ‘CST’ when discussing cervical cancer screening with clients; however, almost half (48%, 95% CI: 33–63%, n = 19) would also use the term ‘Pap smear’ during these discussions.

These 19 clinicians reported they used different terminology for different clients, and several mentioned that women who are older or born outside Australia were more familiar with ‘Pap smear’. Half of the clinicians who responded to our survey stated that clients used the two terms interchangeably (52%, 95% CI: 38–67%, n = 21). However, almost two-thirds of clinicians (63%, 95% CI: 47–76%, n = 25) believed that clients did not understand the difference between Pap smears and CST.

There have been few studies assessing the impact of the change to the NCSP. Our findings reflect those of Dodd et al., who found that Australian women had limited knowledge about the changes to the NSCP.³ Our study provides an insight into how clinicians view clients’ understanding of these changes. Most clinicians believed that clients were confused about the two tests. Further steps should be taken to improve understanding, such as disseminating written information through pamphlets and websites. Using appropriate language with clients to facilitate a clear understanding can also be beneficial.

Our study has several limitations. First, this study only recruited clinicians from a single sexual health clinic in Melbourne. As a result, these findings may not be generalisable across other centres. Second, our findings are based on clinicians’ perceptions; however, it is unclear whether this is an accurate reflection of client understanding.

Findings from our study provide an insight into how clinicians discuss cervical cancer screening with clients at our clinic. The interchangeable use of the terms ‘Pap smear’ and ‘CST’ could predispose clients to an incomplete understanding of their differences. In turn, this could affect the information gathered from clients and the effects of the education we provide. It is possible that client understanding is quite poor, and greater efforts could be taken to ensure women are provided with adequate information about the changes.

All data analysed during this study are included in this article.

EPFC and CKF are Editors of Sexual Health but played no role in the editorial handling orreview of this manuscript. All other authors have no conflicts of interest to declare.

EPFC is supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900).

EPFC and TRP convinced the study idea. EA, CKF, HW, AM, HZ, EPFC and TRP designed the questionnaire. KM and RW assisted with the study design. EA performed data analysis and wrote the first draft of the paper. EPFC and TRP provided supervision to the project. EA, CKF, HW, AM, HZ, KM, RW, EPFC and TRP were involved in data interpretation, revising the manuscript for important intellectual content and approved the final version.