Aims
Routine care during pregnancy provides an opportunity to offer HPV testing to women that have never engaged in cervical screening or are overdue. This study assessed implementation of screening during pregnancy (SDP) in NSW hospitals to estimate the potential impact of SDP statewide implementation.
Methods
Data sources were National Cancer Screening Register (NCSR) HPV primary cervical screening tests (CST) collected in NSW hospitals 2019–2025 from women aged 25–49, and participation rates in local health districts (LHD). NSW Perinatal Data Collection provided annual number of mothers of same age giving birth in hospitals. Data from an 18-month pilot implementing a comprehensive SDP initiative at Westmead hospital measured acceptability and achievable SDP rate. This SDP rate was then used to estimate the number of additional women who could be screened if SDP was implemented statewide, accounting for LHDs rates of CST-due/overdue and current CSTs collected in hospitals.
Results
CST collection rates in NSW hospitals were low in 2020-22 but increased to over 6,000 by 2025, with self-collection dominant. Only 2/15 LHDs had strong adoption of SDP, with 19% and 12% of women giving birth screened those two LHDs in 2025. Five LHDs had high proportions CST-due/overdue women (>20%) but low rates of SDP (2-7%). In the Westmead pilot, 48% (2492/5190) of screen-eligible women were CST-due/overdue, with 70% offered CST and 94% accepting it (65% of eligible women tested). If all LHDs performed SDP similarly, an additional 5,020 women would be screened annually, associated with 36 additional cases of high-grade lesions (7.2/1000 participants screened).
Conclusions
SDP is an acceptable and effective method for reaching women due for cervical screening and has the potential to make a strong contribution to the equitable elimination of cervical cancer by opportunistically reaching women not currently engaged in the program.