In December 2017 the National Cervical Screening Programme (NCSP) in Australia will change from a 2 yearly conventional cytology based approach to 5 yearly HPV DNA testing. A positive partial genotyping test result for HPV 16/18 will go to reflex LBC and patient referral for colposcopy; detection of other oncogenic types will undergo reflex LBC triage. Among the myriad technical hurdles that must be cleared and human resource elements affected by this change will be a substantial reduction in the workload of cytology laboratories and the role of cytologists and pathologists. The paradigm shift in the primary screening platform has changed the role of the cytologist to a diagnostic one. Thus the experience of the cytologist in partnership with the pathologist is key to the success of the reflex and co testing follow-up investigations. It is estimated that following the changeover around 1in 5 cytologists will be retained to service the predicted LBC workload. The immediate challenge of the reshaping period for laboratories that specialise in gynaecological cytology has been to manage the opposing forces of maintaining service efficiencies while their workforce is restructured. Specific planning for the preparation of future cytologists is a challenge facing pathology laboratories, tertiary education centres that train undergraduate scientists in diagnostic cytology and professional bodies responsible for continuing education, quality assurance and performance measures.
This study aims to encapsulate the available information around the introduction and management of HPV based screening in Australia in 2017 and strategies to deal with pathology workforce issues. Estimates of the changes to the national workload indicate that cytology tests will be considerably fewer (1). Available information around anticipated changes to work practices by major public and private pathology providers in relation to the workforce transition is presented. Strategies that facilitate future diagnostic cytology training at university level and in the workplace are tabled.
The theoretical endpoint for the NCSP in Australia is prevention of all HPV related anogenital carcinoma through vaccination and improved screening outcomes. The role of cytology in this pursuit is changing but will remain a key component for the foreseeable future. Appropriate training regimens for cytologists and pathologists that will ensure ongoing diagnostic acuity are essential for service provision.
(1.Smith et al BMC Health Services research (2016) 16:147 DOI 10.1186/s12913-016-1375-9)