Cervical Cancer Elimination

What is Cervical Cancer?

Cervical cancer is the growth of abnormal cells in the lower, narrow part of the uterus that connects to the vagina. One of the most preventable cancers, largely because HPV vaccination and cervical screening can prevent most cases

How common is cervical cancer globally?

It is the 4th most common cancer in women globally. Around 660,000 women were diagnosed in 2022.

How many women died from cervical cancer globally in 2022?

Approximately 350,000 women. Over 94% of deaths occured in low- and middle- income countries. Over 50% of deaths occur in the Asia-Pacific region.

How many Australian women aged 25-74 were diagnosed with cervical cancer in 2023 and 2022?

2023 → 835
2022 → 204

How has cervical cancer incidence changed in Australia since the introduction of screening?

The incidence has halved since the introduction of the National Cervical Screening Program (NCSP) in 1991.

What proportion of women who develop cervical cancer in Australia have never screened or don’t screen regularly?

Over 70%

What is the most common age range for cervical cancer diagnosis?

35-50 years old

What is HPV?

Human papillomavirus, a very common virus with more than 100 types, including over 40 that affect the anogenital area. It is transmitted through sexual contact, including skin-to-skin and mucosa-to-mucosa contact.

Can HPV be transmitted between those of the same-sex

Yes. HPV transmission occurs between same-sex couples, including couples who have only ever had sexual contact with women. So regular screening is necessary

What happens to most HPV infections?

Most infections clear within 1-2 years.

What percentage of cervical cancer cases are linked to high-risk HPV?

Approx 99%. HPV types 16 and 18, together cause over 70% of cervical cancers.

How can HPV infection progress to cervical cancer?

HPV infection can either clear/regress or persist and progress to cervical cell abnormalities, which can eventually develop into invasive cervical cancer. This progression can take around 10-15 years.

Does HPV vaccination mean someone no longer needs cervical screening?

Gardasil 9 covers 9 HPV types. People with a cervix who have been vaccinated against HPV still require regular cervical screening.

What the purpose of the NCSP?

To prevent cervical cancer through early detection of HPV and cervical abnormalities. They replaced the Pap smear which primarily tested for cytology, to testing specifically for HPV and LBC

What is the current routine cervical screening interval?

Every 5 years, if oncogenic HPV or abnormalities are not detected. The old screening interval was every 2 years.

What is the current screening range?

25-74 years, the old one 18-69

What are the different ways a Cervical Screening Test can be collected?

1. Clinician-collected cervical sample for HPV testing/LBC

2. Self-collected vaginal sample for HPV testing

3. Clinician-collected co-test where indicated

What is self-collection

An eligible person collects their own vaginal sample, which is tested for HPV

Why can self-collection help increase screening participation?

It can give people greater control and choice, potentially reducing embarrassment, discomfort, anxiety, or other barriers to clinician-collected screening.

What happens if a self-collected sample detects HPV 16 or 18?

The person is referred directly to colposcopy, with LBC performed at the visit

What happens if a self-collected sample detects HPV that is not 16 or 18?

The patient is recalled for a clinician-collected LBC sample before colposcopy referral.

Can cervical screening be performed during pregnancy?

Yes. Cervical screening can safely be performed at any time during pregnancy. It is recommended pre-birth when screening is due or overdue.

What should healthcare professionals consider when a pregnant woman reports vaginal bleeding?

Consider non-obstetric causes, including possible cervical causes

Who may be offered a one-off cervical screening test between ages 20-25?

Women who experienced early sexual contact or are survivors of sexual abuse. May be recommended at 14 or younger as well.

How often do immune deficient women require cervical screening?

Every 3 years

What screening is recommended for DES-exposed women?

Annual co-testing

Why are some groups considered priority populations for cervical screening?

They are more likely to be under-screened, meaning cervical cancer may increasingly become a disease of inequity as Australia moves toward elimination.

What are the Australian priority populations?

First Nations
Culturally and linguistically diverse backgrounds

those that have experienced female genital cutting

Disabilities

LGBTQIA+ community

Rural

socioeconomic disadvantage

victims of violence and/or SA

experiencing or have experienced menopause

NSCP goals

Australian elimination target - 2035
HPV vaccination target - 90%

Screening target 70% every 5 years

Optimal treatment target 95%

What are some barriers to cervical screening for Aboriginal women?

Under-screening and late detection, along with barriers such as stigma, nervousness, shame and not wanting someone they know to perform the test,

What are some ways healthcare professionals can make cervical screening more accessible?

Offer self-collection

culturally appropriate care

non-judgemental attitude

inclusive care for LGBTIQA+

allow a friend or relative to attend

How can healthcare professionals support people who have experienced trauma or sexual assault?

Use sensitive, trauma-informed communication and tools that allow the person to communicate their experiences without repeatedly having to retell their story.