Abnormal cervical screening /cervical dysplasia/abnormal cervix

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Invasive cancer (squamous, glandular, other). For optimum care, patient should be seen by gynaecological oncology (National guidelines suggest being seen at the earliest opportunity for urgent evaluation)
LBC of PHSIL/HSIL
Positive HPV 16/18 and
- Unknown cytology
- Unsatisfactory LBC
- Previous treatment for PHSIL/HSIL (National guidelines suggest being seen at the earliest opportunity, ideally within 8 weeks)
- Past history of positive HPV 16/18 (National guidelines suggest being seen at the earliest opportunity, ideally within 8 weeks)
Glandular lesions
- AIS or possible high grade glandular lesion
- Any atypical glandular cells/endocervical cells of undetermined significance.

Category 2

Appointment within 90 days is desirable

Positive HPV 16/18 and
- Normal LBC
- PLSIL/LSIL

Positive HPV non 16/18 and
- On 3 consecutive years
- On 2 consecutive TESTS
  - two or more years overdue for screening at the time of the initial screen
  - identifies as Aboriginal or Torres Strait Islander
  - aged 50–69 years.

- ON A SINGLE TEST
- women aged 70+
- immune deficient women
- women currently undergoing Test of Cure following treatment of histological HSIL

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 after STI excluded/treated – 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 and after STI excluded/treated
Any abnormal result and past history of excisional treatment of AIS

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

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

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available
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 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.
Routine colposcopic examination is NOT routinely required following treatment for CIN II/III. These patients would need a speculum inspection of the cervix and a co-test (i.e. HPV and LBC as 12 months post-treatment). They do not routinely need referral to a specialist.
Clinical resources: National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding

Referral requirements

A referral may be rejected without the following information.

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 or current cervical screening results (LBC should be performed on any sample with positive oncogenic HPV)

Additional referral information (useful for processing the referral)

Body mass index (BMI)
History of smoking
HPV vaccination history
STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

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

Clinical Information (essential)

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
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use