Australia Close to Eliminating Cervical Cancer Despite Declining Screening & Vaccination Rates

Australia is making remarkable strides toward eliminating cervical cancer, a feat once considered distant. A novel report from the NHMRC Centre of Research Excellence in Cervical Cancer Control reveals encouraging progress fueled by decades of investment in both HPV vaccination and cervical cancer screening programs. But, recent declines in participation rates in these preventative measures pose a significant threat to sustaining this momentum.

A History of Prevention

The foundation for Australia’s success was laid in 1991 with the launch of the National Cervical Cancer Screening Program. This program initially relied on Pap tests – also known as cytology – to identify precancerous cell changes, allowing for early treatment and significantly reducing the incidence and mortality rates of cervical cancer by approximately 50%. You can learn more about the National Cervical Screening Program on the Australian government’s health website.

In 2007, Australia became a global pioneer by implementing the world’s first national HPV vaccination program. This initiative led to a dramatic decrease in HPV infection rates and, a reduction in the number of cervical precancers. The HPV vaccine targets the human papillomavirus, a common sexually transmitted infection that is the primary cause of most cervical cancers.

Further advancements came in 2017 with the transition from Pap tests to HPV tests. These tests specifically detect the presence of HPV types 16 and 18, responsible for the majority of cervical cancer cases. Positive results trigger closer monitoring by healthcare providers, and this shift is projected to lower cervical cancer rates by an additional 20–30%.

The evolution of the HPV vaccine continued in 2018 with the introduction of a newer version protecting against nine HPV types linked to cancer, expanding coverage beyond the four types addressed by earlier vaccines.

The National Elimination Strategy

Building on these successes, Australia launched a national strategy in 2023 aimed at completely eliminating cervical cancer. This ambitious plan sets forth 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 successfully treating 95% of detected precancers and cancers.

The recent report indicates that Australia is making headway toward these objectives. Notably, cervical cancer rates are showing a gradual decline. In 2020, there were 6.6 cases per 100,000 women, decreasing to 6.3 cases in 2021. Experts anticipate this trend will continue.

Perhaps the most striking finding is the absence of cervical cancer diagnoses in women under 25 in 2021. Researchers attribute this remarkable outcome almost entirely to the widespread adoption of the HPV vaccine, protecting this age group before they grow sexually active. HPV infection rates, particularly among younger women, are demonstrably lower, with only 1% of women aged 25–29 testing positive for HPV types 16 or 18.

Screening rates also demonstrate positive trends, with approximately 85% of women aged 35–39 having undergone HPV testing. Regular screening significantly reduces an individual’s risk of developing cervical cancer.

Challenges to Progress: Declining Vaccination and Screening

Despite these achievements, the report highlights a concerning trend: declining vaccination and screening rates since the onset of the COVID-19 pandemic. In 2020, 85.7% of eligible young people had received the HPV vaccine, but this figure dropped to 79.5% by 2024. This decline is particularly worrying as it threatens to reverse the gains made in HPV prevention.

Julia Brotherton, Professor of Cancer Prevention Policy at the University of Melbourne and a co-author of the report, emphasizes the safety and effectiveness of the vaccine. She urges parents to view vaccination as a vital protective measure for their children and encourages young people who missed school-based vaccinations to consult with their healthcare providers about catch-up doses.

Similarly, the proportion of individuals up-to-date with their cervical cancer screening has decreased in the past two years, with over one in four women now overdue for screening. Megan Smith, co-author and Associate Professor at University of Sydney’s Cancer Elimination Collaboration, points to the need for tailored strategies, such as HPV self-collection, to improve screening participation, especially in remote areas.

Addressing Health Inequities

The report also underscores the disparities in cervical cancer prevention and outcomes across different populations. Indigenous Australians and those residing in remote areas experience significantly higher rates of cervical cancer and mortality compared to the national average. Indigenous people have nearly double the cervical cancer rate of 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, stresses the importance of focusing efforts on collecting better data to develop effective solutions for these vulnerable groups. The national elimination strategy aims to address these inequities, but targeted interventions are crucial to ensure that all Australians benefit from advancements in cervical cancer prevention.

Looking Ahead: Sustaining Momentum

The report proposes several recommendations to maintain progress toward cervical cancer elimination. These include 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. The Centre for Research Excellence in Cervical Cancer Control (C4) brings together leading researchers to address these challenges and drive further innovation in cervical cancer prevention. Learn more about the C4’s work here.

Australia’s success story demonstrates the power of sustained investment and consistent messaging in public health. Cervical cancer is a preventable disease, and elimination is within reach. However, the recent declines in vaccination and screening rates serve as a cautionary tale, mirroring trends observed in other countries, including the United States. Continued emphasis on vaccination and screening efforts is essential to safeguard the progress made and ultimately eradicate this devastating disease. The NHMRC Centre of Research Excellence in Cervical Cancer Control’s report is available on their website, offering a detailed analysis of the current situation and future directions.