Eliminating cervical cancer among all Australians

Cervical cancer is highly preventable and Australia is set to become the first country to eliminate this disease thanks to the combined impact of cervical screening and human papillomavirus (HPV) vaccination. Not all communities have experienced improvements in cervical cancer outcomes, however, so more is needed to ensure no one is left behind in eliminating cervical cancer.

Australia is in a strong position to eliminate cervical cancer, thanks to:

• The introduction of the Australian HPV vaccination program in 2007.
• The transition of the Australian National Cervical Screening Program (NCSP), in 2017, from cytology screening for women and people with a cervix (aged 18–69 years) every two years, to primary HPV screening for eligible people (aged 25–74 years) every five years.
• The introduction of universal self-collection from July 2022, offering people their choice of screening either a self-collected vaginal sample or a sample collected by their healthcare provider.

However, increasing participation in cervical screening is crucial to achieving elimination by 2030, and among all Australians.

Participation in the NCSP decreases as remoteness increases. Recent data shows that screening rates among eligible people living in very remote areas of Australia are lower than for those residing in major cities (45.6 and 56.3 per cent respectively).

Screening rates are also impacted by socioeconomic status. Data shows that participation decreases as socioeconomic disadvantage increases and it’s estimated that only about half (49.7 per cent) of eligible people living in areas with the highest disadvantage get screened in line with recommendations. We also know that seven in 10 cervical cancers are detected in those who have not been screened as recommended or have never been screened (referred to as under-screened).

The Australian health system has taken strides to drive us closer to our elimination goal and address under-screened communities. This includes the recent introduction of self-collection as a universal option for anyone eligible for cervical screening. Self-collection offers Australians more choice and control in their health care and will help address barriers to screening for many people across the country. Yet, the availability of this new option is not enough without relevant strategies to drive implementation, awareness and uptake.

To effectively drive reductions in cervical cancer incidence among communities in regional and remote areas and lower socioeconomic communities, where we know screening rates are lower and therefore contribute to a greater risk of cervical cancer, we need our governments to:

• Support the delivery of community-led programs and campaigns that ensure eligible people know that self-collection is a choice available to them.
• Continue to drive HPV vaccine uptake among adolescents within these communities, to minimise cervical cancer incidence into the future.

By providing more choice and flexibility, self-collection is a potential gamechanger when it comes to increasing participation in cervical screening. Yet, we have a way to go to effectively drive awareness of this option in under-screened communities. By delivering targeted, community-led campaigns to promote this option and driving adolescent uptake of the HPV vaccine in under-screened communities, we can help ensure no one gets left behind when it comes to eliminating cervical cancer.