Australia is on track to be the first country to eliminate cervical cancer by as early as 2028.
Thanks to advances in cancer research and successful vaccination and screening programs, our children no longer need to fear cervical cancer.
Cervical cancer is one of the most preventable and treatable forms of cancer. Almost all cases of cervical cancer are caused by a common sexually transmitted infection called HPV (human papillomavirus).
We've made significant progress
Australia has been at the forefront of preventing cervical cancer for decades. Today, its cervical cancer rates are amongst the lowest in the world.
Australia has had a national cervical screening program since 1991, which halved cervical cancer rates in the first decade and is the reason for our relatively low rates. In December 2017, Australia moved to a five-yearly HPV-based cervical cancer screening.
In 2007, it was the first country to introduce a national HPV vaccination program for adolescent girls, with a vaccine that protected against 70-75% of cervical cancers . Six years later, the program was expanded to include adolescent boys.
In 2018, Australia introduced the next-generation HPV vaccine, which protected against seven HPV types that caused around 90% of cervical cancers.
Key challenges to eliminating cervical cancer
While Australia has one of the lowest rates of cervical cancer globally, there are many women that our screening program is missing. It's these women who are at risk of cervical cancer. To change this, screening participation needs to increase – but it has been decreasing for around a decade. As at the end of 2019, only around 52% of women were up to date with cervical screening.
Aboriginal and Torres Strait Islander women experience cervical cancer at the same rates as developing regions of the world, despite having access to the screening program.
Barriers to screening for Aboriginal and Torres Strait Islander women include:
- limited access to health care - physical and financial barriers, or limited access to care that is culturally safe and appropriate
- issues relating to health care providers, such as limited female practitioners or previous negative experiences
- beliefs around cancer, including stigma
- low awareness about cervical screening, or a lack of culturally appropriate information
- impacts of colonisation.
To achieve elimination, cervical cancer incidence must be reduced by around 70 per cent in Indigenous women in Australia, but we are a long way from reaching that target. HPV vaccination will help - vaccine uptake is high in Indigenous girls - but will take decades, because of the long time between acquiring an infection and cancer.
Overcoming barriers to screening
There are ways we can increase all women's access to HPV screening and reduce the risk of cervical cancer.
Offering self-collection to all women
Self-collection, in which a woman collects her own sample, could help address several of the barriers to screening as it's quick, simple and accurate. It also gives women choice and control.
Currently, self-collection is currently only offered through the National Cervical Screening Program to women aged 30 or older who have never participated in cervical screening or are two or more years overdue. Even though self-collection is currently restricted, many women are eligible – but relatively few have used it, mostly because they don't know it is available. Self-collection could be a game-changer in reaching women who aren't screening – we need to use it.
Our research has found that offering all women the option to collect their own sample would be an effective approach to further reduce cervical cancer incidence by helping to reach more women who are not participating in screening currently.
In May 2021, the government's expert Medical Services Advisory Committee recommended removing the restrictions, to give all women the choice to collect their own screening sample if they prefer. We look forward to the Government's formal review of these recommendations.
Removing inequities for Indigenous women
We need to provide Indigenous Australians with the same access and quality of care to help bridge the gap with the rest of the population.
In addition to self-collection, strategies that can overcome barriers include:
- building trusting relationships between Indigenous communities and health professionals
- overcoming logistical barriers and privacy concerns
- and openly talking about screening.
Moreover, to achieve equitable health outcomes for Indigenous peoples, strategies need to centre Indigenous leadership, knowledge, and solutions with ongoing community engagement.
If you are overdue or have never been screened, it is important to get tested. Women aged 30 or older who haven't had a screening test in the last four years are eligible for self-collection now.
