Abnormal cervical screening / cervical dysplasia / abnormal cervix
Adult

Gynaecology

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Emergency Referrals

Useful Management Information

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.

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

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Invasive cancer (squamous, glandular, other). For optimum care, patient should be seen by gynaecological oncology (National guidelines suggests 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 suggests being seen at the earliest opportunity, ideally within 8 weeks) past history of positive HPV 16/18 (National guidelines suggests being seen at the earliest opportunity, ideally within 8 weeks) Atypical glandular cells/endocervical cells of undetermined significance Positive HPV non 16/18 and Atypical glandular cells/endocervical cells of undetermined significance Glandular lesions AIS or possible high grade glandular lesion any atypical glandular cells/endocervical cells of undetermined significance
Category 2 (appointment within 90 calendar days)	Positive HPV 16/18 *and* normal LBC PLSIL/LSIL Positive HPV non 16/18 and Persistant positive non 16/18 HPV or HPV other on 3 consecutive yearly test or in a person who is: 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 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 calendar days)	No category 3 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), 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) or abnormal 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)

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

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

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

Fax

(07) 5687 4497

Post

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

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Graeme Walker

Medical Director Gynaecology

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.

Abnormal cervical screening / cervical dysplasia / abnormal cervixAdult