NSCP Intermediate Pathway Update

Changes to the National Cervical Screening Program's (NCSP) guidelines for the clinical management of patients at intermediate risk because of a previous positive oncogenic ‘HPV not 16/18’ test result came into effect on 1 February 2021.

New Recommendation:

Patients at intermediate risk whose 12-month follow-up result is positive for HPV not 16/18 with reflex LBC negative or pLSIL/LSIL should undertake a further HPV follow-up test in 12 months’ time, instead of referral to colposcopy.

If the second follow-up HPV test (i.e. 24 months after the initial positive test) is positive, patients should be referred for colposcopy, regardless of the LBC result.

Notable Exceptions

The review showed there are subgroups who may be at more risk of harbouring a high-grade abnormality, and who should be referred to colposcopy if HPV is detected at the 12-month follow-up, regardless of the LBC result:

  • patients two or more years overdue for screening;
  • patients who identify as Aboriginal or Torres Strait Islander; and
  • patients aged 50 years or older.

The following groups fall outside these new recommendations (follow existing NCSP guidance):

  • patients who are immunodeficient;
  • patients exposed to DES in utero;
  • patients who have a self-collected sample;
  • patients aged 70+ (attending for an exit test); and
  • patients currently undergoing Test of Cure following treatment of histological HSIL.

Why have the changes occurred?

The changes follow a recent review of national clinical program data, which showed that patients with an Intermediate Risk Result have a low likelihood of developing a histologically-confirmed high grade squamous intraepithelial lesion (CIN2/3+) or invasive cervical cancer. More information is available in the 2020 Evidence Review.

Find out more

Visit the new NCSP Clinical Guidelines online.

Read the National Cervical Screening Program ‘Changes to the clinical management of women at intermediate risk – Frequently Asked Questions’ fact sheet.