In this fifth report on Australia’s progress towards the elimination of cervical cancer as a public health problem, progress is evident towards elimination across most indicators but falling HPV vaccination and cervical screening participation rates demand urgent attention.  

Overall cancer incidence rates appear to be following the pattern anticipated as part of the program’s transition from cytology to HPV screening (indicator 1). After a transient increase, as the more sensitive HPV screening test led to earlier detection of some cancers, there is a signal that incidence rates may now have begun to turn around (6.3 per 100,000 in 2021, compared to 6.6 per 100,000 in 2020). It will be important to continue to monitor this in coming years, to confirm that this is the beginning of a downward trend as predicted by modelling.  

There were no cervical cancer cases diagnosed in women aged <25 years in 2021 – the first time that this has occurred in data going back to 1982. This remarkable achievement is almost certainly due to the impact of HPV vaccination. Across women screened at all ages, biopsy confirmed pre-cancer (HSIL) detection rates have also declined, by 21%, most likely reflecting a lower detection of disease among participants returning for their second round of HPV-based screening. Lower rates are expected, as most prevalent disease was detected and treated in the first round (age-standardised rate per 1,000 women screened was 7.5 in 2024, compared to 9.6 in 2019, the corresponding year in the first round of HPV screening) (indicator 3). 

For the same reason, HPV prevalence is also lower than the corresponding year in the first round of HPV screening (indicator 4). In HPV types other than 16/18, not yet affected by HPV vaccination, relative prevalence rates are 6.9% lower in 2024 than in 2019. Prevalence of HPV 16/18 is very low (absolute rates of 1.4% in 2024), and the relative reduction in the prevalence of HPV 16/18 compared to the corresponding year in the first round of HPV screening has been even more pronounced (28.4%), due to the ongoing impact of HPV vaccination (as well as the first round of HPV screening) on circulating types. HPV 16/18 was detected in just 1.0% of 25–29-year-old screening participants and was equally low amongst Indigenous women (1.0%, 32.6% reduction since the corresponding year in round one when it was 1.5%). In contrast, the prevalence of HPV types other than 16/18 still peaks amongst 25-29 year-old women, as expected, while we await impact of nonavalent HPV vaccinated cohorts turning 25 years, from around 2030.

Whilst the impact of previously high HPV vaccination rates across a large cohort of Australian girls and women are being seen on these outcomes, HPV vaccine coverage by age 15 has continued to decline in recent years, from its peak of 85.7% in 2020 (86.6% in females, 84.9% in males) to 79.5% in 2024 (81.1% in females; 77.9% in males) (indicator 5).  Inequity in coverage continues to increase, notably for Indigenous adolescents, in very remote and remote areas, and by jurisdiction of residence. These declines are likely multifactorial and relate to ongoing challenges in delivering school-immunisation programs in the current environment, with competing priorities for schools, students and parents, significant absenteeism, challenges in electronic communication and consent processes, and in the context of declines in vaccine coverage across the vaccine schedule both locally and globally.  It is now urgent that large scale national action is taken, supported by sufficient investment, to address these ongoing vaccine coverage declines. A cross sectoral whole of government approach is likely required to commit to turning around and restoring vaccine coverage rates across the schedule as part of the implementation of the new National Immunisation Strategy 2025-2030.

This report builds on the findings from 2024, confirming that the proportion of women aged 35-39 years who have had at least one HPV test in their lifetime continues to increase (indicator 6). This proportion is now 85.0% nationally, exceeds or is close to 80% in all areas, and it is approaching 95% in the Northern Territory. The proportion appears to be increasing relatively more quickly in some areas, including very remote, remote and outer regional areas and more disadvantaged areas, highlighting self-collection's potential to improve equity and reach underserved populations.  Being screened at least once in a lifetime substantially reduces an individual’s cervical cancer risk, so this finding indicates a need to focus on the 15% of the population in this age window who have never had an HPV test, towards scaling up to 90% coverage for this indicator.

In contrast, the proportion of screen-eligible people who are up-to-date with screening has now declined for the second consecutive year (from 76.5% at the end of 2022, to 75.8% then 74.2% at the end of 2023 and 2024, respectively) (indicator 7). Therefore, in spite of the wider availability of self-collection, there are now more than 1 in 4 women overdue for cervical screening, although self-collection looks to have improved equity by improving the relative performance in remote areas, Tasmania and the Northern Territory in particular.  

A similar pattern has been seen in the program-defined participation measure (which looks at screening across specific windows of time), which fell from 81.1% over 2018 - June 2023, to 78.8% in 2019 - June 2024 and 78.1% in 2020 - June 2025. Both the up-to-date measure and program-defined participation measure allow for up to 5.5 years between screens, so the decline cannot be explained by minor delays in attending. 

There is a need to overcome the remaining access and acceptability barriers and understand the drivers of this decline in screening that, in the last two years, has occurred despite wide availability of self-collection demonstrably improving access for previously unscreened and under-screened women.  Out of pocket fees to access primary care, and a shortage of availability of providers and appointments in many areas, may be increasing barriers to accessing screening for many people. Innovative and flexible models of cervical screening delivery will be required to turn these declines around.

Prevalence of oncogenic HPV and rates of high-grade disease reinforce that Aboriginal and Torres Strait Islander people have a significant potential benefit from cervical screening, thus re-emphasising the need to ensure that screening services are meeting their needs throughout the screening pathway. Colposcopy attendance by time since referral was lower for Aboriginal and Torres Strait Islander people across 3, 6 and 12-month time points, suggesting systemic access barriers. The 90% high-grade disease treatment goal was not met for either Aboriginal and Torres Strait Islander people or non-Indigenous people. 

Cancer survival improved in 2017-2021 compared to the previous period (5-year relative survival 76.8% in 2017-2021, compared to 73.9% in 2012-2016) (indicator 11).  Data shows an ongoing disparity for Indigenous women in overall survival (64.3% at 5 years, compared to 74.6% in non-Indigenous women; relative survival not available by Indigenous status) that needs to be addressed. Staging data are needed to more accurately understand survival.

Please note that updated cancer treatment data for the 2025 report are pending.

We note that data remain unavailable to fully assess progress towards elimination for Aboriginal and Torres Strait Islander women, as well as other priority groups, including women from culturally and linguistically diverse backgrounds. However, we are optimistic that Australia can address the ongoing challenges identified in this report by effectively implementing the national strategy for the elimination of cervical cancer as a public health problem, noting its important emphasis on improving data quality and completeness, and focus on equity.

Below is a table showcasing Australia's progress towards the elimination of cervical cancer against WHO targets.