Australia is on the cusp of eliminating cervical cancer, a feat that would make it the first country in the world to achieve this public health milestone. However, recent declines in vaccination and screening rates are threatening to stall this remarkable progress, according to a new report from the NHMRC Centre of Research Excellence in Cervical Cancer Control. The success story, built on decades of investment in human papillomavirus (HPV) prevention and robust screening programs, serves as both an inspiration and a cautionary tale for global health efforts.
A History of Prevention
Australia’s journey towards cervical cancer elimination began in with the launch of the National Cervical Cancer Screening Program. This program initially relied on Pap tests, also known as cytology, to detect precancerous cell changes in the cervix. The program demonstrably reduced the incidence of cervical cancer and related deaths by approximately 50%.
In , Australia pioneered the world’s first national HPV vaccination program, targeting young people to prevent HPV infection – the primary cause of most cervical cancers. This initiative led to a significant decrease in HPV infection rates and a subsequent reduction in the number of cervical precancers.
Further strengthening its prevention strategy, Australia transitioned to HPV testing for cervical screening in . Unlike Pap tests, HPV tests specifically identify the presence of high-risk HPV types, particularly types 16 and 18, which are responsible for around 70% of cervical cancers. Individuals testing positive for these high-risk types are then monitored more closely by healthcare providers. This shift is projected to reduce cervical cancer rates by an additional 20–30%.
The country further enhanced its HPV vaccination program in by introducing a nine-valent vaccine, offering protection against nine HPV types capable of causing cancer. Previous vaccines protected against four types, including the critical types 16 and 18.
The Elimination Strategy
Building on these successes, Australia launched a national cervical cancer elimination strategy in . This ambitious plan set specific five-year goals, including achieving a 90% HPV vaccination rate for both girls and boys, screening 70% of women aged 25–75 every five years, and effectively treating 95% of detected precancerous lesions and cancers.
The recent report highlights encouraging progress towards these goals. Data indicates a slow but steady decline in cervical cancer rates. In , there were 6.6 cases per 100,000 women, decreasing to 6.3 cases per 100,000 in . Experts anticipate this downward trend will continue.
Remarkably, no cases of cervical cancer were diagnosed in women under the age of 25 in . Researchers attribute this outcome almost entirely to the widespread adoption of HPV vaccination prior to sexual debut.
HPV infection rates, particularly among younger women, are also declining. Only 1% of women aged 25–29 tested positive for HPV types 16 or 18, a direct consequence of the successful vaccination program.
approximately 85% of women aged 35–39 have undergone HPV testing at least once, a significant step towards reducing individual cervical cancer risk.
Concerning Trends: Declining Vaccination and Screening
Despite these achievements, the report reveals a concerning trend: declining vaccination and screening rates since the onset of the COVID-19 pandemic. HPV vaccination coverage among young people decreased from 85.7% in to 79.5% in .
Julia Brotherton, Professor of Cancer Prevention Policy at the University of Melbourne and a co-author of the report, emphasized the safety and effectiveness of the HPV vaccine. “Parents should think of this as a gift they can give their child to protect them for their lifetime. And I urge all young people who missed out at school, for whatever reason, to talk to their GP, nurse or pharmacist about accessing their free catchup dose.”
Screening rates have also fallen in the past two years, with more than one in four women now overdue for cervical cancer screening.
Megan Smith, co-author and Associate Professor at University of Sydney’s Cancer Elimination Collaboration, explained, “We are seeing some improvements, including in the 35- to 39-year-old age group, even in very remote areas. But with 15 percent of that age group having never had a screening test in their lifetime, and only 50 percent of 25- to 29-year-olds being up to date with screening, we need to promote tailored strategies such as HPV self-collection.”
Addressing Health Inequities
The report also highlights disparities in access to prevention services. Indigenous Australians and those living in remote areas experience significantly higher rates of cervical cancer and mortality from the disease.
Indigenous Australians have nearly double the cervical cancer rate compared to the national average, and their death rate from the disease is also substantially higher.
Dorothy Machalek, an epidemiologist at the Kirby Institute and another co-author, stated, “Our national elimination strategy is centered on achieving cervical cancer elimination for all. But our report continues to show that some groups are at high risk of being left behind unless we act now. We need to focus our efforts on collecting better and more timely data so we can better develop effective solutions.”
Looking Ahead
The report recommends several key steps to sustain progress, including revitalizing school vaccination programs, improving access to vaccination for Aboriginal and Torres Strait Islander adolescents, piloting innovative screening methods, and strengthening national health data systems.
Cervical cancer is a preventable disease, and Australia’s success demonstrates the impact of sustained investment and consistent public health messaging. While elimination is within reach, the recent declines in vaccination and screening rates serve as a critical reminder of the ongoing need for vigilance and proactive public health initiatives – lessons that resonate globally, including in the United States.
