Paying for pap smears

[GoldenRose]

So I was at my GP today and he informed me that I’m due for my next pap smear next month but because I’m under 25 medicare will no longer cover it and I will have to pay $65 and that the test has changed so it’s now every 5 years compared to 2. He recommended that I still get one just to have that peace of mind which I agree with but am I not really at risk of cervical cancer then because I’m under 25?

Do you think that having to pay for pap smears now is fair? I’m not sure how I feel about the new system, I think I will still get the test done because I’d rather be safe than sorry but I feel like it may deter some people from getting routinely tested. Or is it not really a big issue because the risk is lower for those under 25?

[Aunt_Flo]

I also had to pay when they were transitioning between tests. I got the regular test, but the new test as well as my gynaecologist told me it was more accurate.

Age is a risk factor for cervical cancer and with that in mind, as well as high vaccination rates for HPV, I think it’s fair to charge people under 25.

It would reduce the amount of (more than likely) unnecessary testing that wouldn’t serve a benefit to the patient.

That said, it’s unfortunate that someone under the age of 25 who experiences new symptoms, like unexplained bleeding, has to pay just to have them investigated.

[curiousss]

so so so UNFAIR @goldenrose!!! This happened to me, My doctor forgot i was under 25 and told me i needed to do a cervical screening. I did and thank goodness i did because the test ended up coming back abnormal. But because I was under 25 and the test was abnormal (so they had to test it further) i was forced to pay more money ($100). I was so annoyed but also thankful i did test because now i have to go back in one year for a re screen and i’m only 22.

[Butterfly01]

i didnt have to pay for my pap smears and im under 25, no ones ever mentioned to me about having to pay. ive had abnormal readings though so maybe its a risk thing or something

[GoldenRose]

It’s good to see some different perspectives and experiences on this!

I see what you mean @aunt_flo how it may be a waste of time and resources when the risk is a bit lower for those under 25. Although, both @curiousss and @butterfly01 had abnormal readings and they’re both under 25 so I do see how it may cause some issues, like what if someone who may have an abnormal reading but can’t afford to pay for the test and then the problem is left untreated and possibly develops into something worse?

@butterfly01 that’s interesting! Yeah maybe there is some option for those with abnormal readings.

[aphrodite9]

Hi everyone, it’s been great to hear all your input into this!

I totally get the frustration among some people with having to pay for a test. I also think its important to note the changes made to the screening program were based on really rigorous review of the research base to make screening more effective. Evidence suggests the new program will reduce incidence of cervical cancer by 20% – which is really great! This is largely because the CST (HPV test) is more sensitive than the Pap test was.

@goldenrose I can understand the concerns that came to mind for you initially. Actually though, the evidence shows that if you’re under 25 and have never been screened, or never had an abnormal Pap test before, it’s safe to wait until you’re 25 to have your first test. They found that low grade pre-cancerous lesions are usually resolved naturally by your immune system, so it’s not worth the risks of getting treatment for these minor cell changes.

I’m also under 25 and have had a CIN I detected before, but a follow-up test 12 months later showed it resolved itself. Hypothetically though, if I hadn’t been screened and my abnormality did progress to a higher grade lesion, the evidence tells us it that even under the new program it would still have been picked up in time at 25. The only significant exception to this might be for someone who had a much earlier than average sexual debut, but mine was at 15 yrs.

There is more information about it all here: https://www.cancer.nsw.gov.au/cervical-screening-nsw/about-cervical-screening/information-for-women-under-25

[aphrodite9]

Oh I should add that like @butterfly01, my recent follow-up tests were free and bulk-billed! Thats because no matter what your age is, Medicare does cover the tests when a doctor requests them for someone who has had a previously detected HPV infection or previously detected cervical pre-cancerous lesion, in line with the clinical management guidelines.

When it comes to payment, there’s also an important distinction to make between “screening tests” and “diagnostic tests”. Screening tests are for people with no symptoms, and thats where if you wanted one before 25 and didn’t meet the screening program requirements you would probably have to pay yourself. However if you have symptoms suggestive of cervical cancer or have any other indication for having the test, a doctor can order the co-test diagnostically (HPV test & cytology). This is covered by Medicare no matter what your age.

Unfortunately it looks like this wasn’t the case for @curiousss – I can only guess that’s because you weren’t initially symptomatic so your doctored wouldn’t have requested it as a diagnostic test. But I agree it seems unfair that you had to pay $100 when you did have an abnormality, that really sucks!

Here’s where I found detailed information about what cervical and vaginal tests are included under the Medicare Benefits Schedule http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-NCSP

[GoldenRose]

@aphrodite9 ok good to know, thanks for clearing that up! It’s good to know that our immune system can resolve lesions naturally and that it’s safe to wait until we’re 25.

[kitkat]

@aphrodite9 that is such a good thorough answer, thank you! answered questions I didn’t even know I had, and I thought the government was coming at the change from quite a different perspective. Personally I’m lucky that I’m able to pay for tests, which I get more regularly than recommended despite being under 25 because of a family history, but that’s great background. One other thing though is that I think if you fit different risk profiles based on chatting with your GP or OBGYN, they can specifically request it to be bulk billed? But it’s not default – I think it depends on you having certain ‘red flags’ that mean they think you should be screened beyond the ‘standard recommendations’. That’s been the case with me anyhoo.

[aphrodite9]

Glad to hear it was helpful @kitkat!
And yep I think you’re right, if a doctor perceives you as being at higher risk of cervical pre-cancer or cancer it seems like there is scope for it to be covered by Medicare

[GoldenRose]

@kitkat oh that’s so good that it can be bulk billed if you are at a higher risk! Thanks for all the great info @aphrodite9!

[tea]

Thank you so much for clarifying everything @aphrodite9! It’s good to know there’s a distinction between screening tests and diagnostic tests – I never knew!

I don’t think it’s fair tbh. I agree that it would be beneficial for deterring unnecessary testing from happening but what if you couldn’t afford the test? I think it should be up to the GP’s discretion on whether or not to charge you, similar to bulk billing practices.

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