This report was prepared by members of the NHMRC Centre of Research Excellence in Cervical Cancer Control
Julia Brotherton, Dorothy Machalek, Megan Smith, Amy Pagotto, Karen Canfell and Marion Saville with contributions from Claire Zammit, Helen Ya-Lun Liang, Deborah Bateson, Tamara Butler, David Hawkes, Alvin Lee, Kristine Macartney, Louise Mitchell, Yasmin Mohamed, Gladymar Perez Chacon, Shannon Rasmussen, Claire Vajdic and Lisa Whop.
Brotherton J, Machalek D, Smith M et al., 2024 Cervical Cancer Elimination Progress Report: Australia’s progress towards the elimination of cervical cancer as a public health problem. Published online 14/03/2025, Melbourne, Australia, at https://www.cervicalcancercontrol.org.au
For any enquiries about this report or the work of the CRE, please email us at c4.admin@sydney.edu.au
We are fortunate to work in a community with such skilled and generous colleagues to support timely sharing of information to support public health.
We would like to acknowledge the support of the Department of Health and Aged Care, the work of the Screening Analysis and Monitoring Unit of the Australian Institute of Health and Welfare, in particular Alison Budd and Rachel Sherwin, the National Cancer Screening Register, in particular Dr Farhana Sultana and the work of the National Centre for Immunisation Research and Surveillance, particularly Alexandra Hendry, in preparing data for this report. We thank the Australian Institute of Health and Welfare and the population-based cancer registries of New South Wales, Victoria, Queensland, Western Australia, South Australia, Tasmania, the Australian Capital Territory and the Northern Territory for the provision of data from the Australian Cancer Database. We also wish to thank Victoria Donoghue from the Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, for her assistance and the data team at Australian Centre for the Prevention of Cervical Cancer for their assistance with preparing the report.
We hope these reports will help harness the political will, community support and our available resources to ensure elimination is achieved and that equity in outcomes for all remains front of mind. We look forward to a time in the near future when the report documents Australia’s achievement of the elimination of cervical cancer as a public health problem.
- ABS: Australian Bureau of Statistic
- AIHW: Australian Institute of Health and Welfare
- AIR: Australian Immunisation Register
- AIS: adenocarcinoma in situ
- ASGS: Australian Statistical Geography Standard
- C4: the NHMRC Centre of Research Excellence in Cervical Cancer Control
- CIN: cervical intra epithelial neoplasia
- Compass: the Compass trial, a randomised trial of over 76,000 women comparing HPV vs cytology based screening in Australia
- HGA: High-grade abnormaility
- HPV: human papillomavirus
- IRSD: Index of Relative Socio-economic Disadvantage
- MBS/PBS: Medicare Benefits Schedule/Pharmaceutical Benefits Scheme
- MDT: Multi-disciplinary team
- NCSP: National Cervical Screening Program
- NCSR: National Cancer Screening Register
- NCIRS: National Centre for Immunisation Research and Surveillance
- NHMRC: National Health and Medical Research Council
- OR: odds ratio
- PLIDA: Person Level Integrated Data Asset
- SA: Statistical Area
- SEIFA: Socio-Economic Indexes for Areas
- SES: Socio-economic status
- WHO: World Health Organization
- Standard abbreviations for Australia’s eight States and Territories: NSW, Vic, Qld, NT, SA, WA, Tas, ACT
Please note throughout this report we generally use the term ‘women’ to refer to people eligible for or attending cervical screening or experiencing cervical cancer. However, we respectfully acknowledge that some people with a cervix do not identify as women and are equally impacted by the risk of cervical cancer. Currently only sex at birth can be reported in this report.
The terms female and male are used when they relate to data collected and coded as either female or male, e.g. ABS estimated resident populations.
The term Indigenous is used when referring to data collected to ascertain a person's 'Indigenous status'; otherwise we use the term Aboriginal and Torres Strait Islander people.
Key findings and recommendations
Executive Summary
In this fourth report on Australia’s progress towards the elimination of cervical cancer as a public health problem, we are continuing to revise and update our indicators to reflect our rapidly progressing cervical cancer prevention and control environment.
This report builds on the findings from 2023, confirming that Australia has met the WHO and Australian 2030 human papillomavirus (HPV) screening coverage targets of 70% after the first 5-year interval of the HPV-based program, and documents for the first time improvements in cervical screening uptake since eligibility of self-collection expanded in July 2022 (indicator 6). While its initial impact was small due to limited availability, data in this report show that, after self-collection was no longer restricted, the largest increases in the proportion of women aged 35-39 who have had at least one HPV test were in the Northern Territory, remote and very remote areas, and more disadvantaged areas, highlighting self-collection's potential to improve equity and reach underserved populations.
We are pleased to be able to report indicator data for three indicators for Aboriginal and Torres Strait Islander people for the first time. Note this is drawn from people who have ever identified as Aboriginal and Torres Strait Islander in the NCSR and therefore represent a subset of all Aboriginal and Torres Strait Islander participants. These indicators are those pertaining to the detection of high-grade cervical disease (indicator 3), HPV prevalence (indicator 4), and high-grade cervical disease treatment rates (indicator 9). Screening participation for Aboriginal and Torres Strait Islander remains unable to be estimated. Prevalence of oncogenic HPV and rates of high-grade disease reinforce that Aboriginal and Torres Strait Islander people have a significant capacity to benefit from cervical screening, thus re-emphasising the need to ensure that screening services are meeting their needs right along the screening pathway. The 90% high-grade disease treatment goal was not met for Aboriginal and Torres Strait Islander people or non-Indigenous people.
Despite progress, significant inequities persist. Data remains unavailable to fully assess elimination progress for Aboriginal and Torres Strait Islander women, as well as other priority groups, including women from culturally and linguistically diverse backgrounds. There are also ongoing concerns, including the fact that only half of women aged 25-29 are up to date with screening, highlighting an important gap in timely initiation of screening for this age group.
Furthermore, national HPV vaccination coverage continued to decline post pandemic to 83% in 2023, with significant disparities widening, particularly for Aboriginal and Torres Strait Islander adolescents, those in remote areas, and between jurisdictions (indicator 5). Data reported elsewhere indicates that coverage for girls aged 13 dropped in 2023 by 3% nationally and by 6% among Aboriginal and Torres Strait Islander girls, following the switch to a single-dose schedule. This decline suggests broader issues, not just pandemic-related disruptions. Coverage with other adolescent vaccines has fallen overall in Australia post-pandemic, driven by factors like reduced school visits and higher absenteeism. Globally, and in Australia, childhood immunisation rates have stalled, outbreaks of vaccine preventable diseases, such as measles and diptheria, highlighting ongoing challenges in attaining high vaccine uptake, including healthcare disruptions, logistical issues, and vaccine hesitancy. Urgent action is needed to address these inequities.
There is a 4-5 year delay in the availability of national cancer incidence data, which limits our ability to report current cervical cancer trends against the World Health Organization (WHO) elimination target. The 2016-2020 data demonstrate a modest increase in the incidence of cervical cancer, as predicted in modelling studies, due to the implementation of the more sensitive HPV based screening test. Despite these factors, cervical cancer rates in women aged 25-29 appear to have decreased, though based on fewer than 60 cases per year. This is likely due to the effects of the HPV vaccination program but could also be contributed to by the decline in screening initiation in this age group (indicator 6).
Colposcopy attendance data suggests ongoing issues with timeliness, which could be due to access problems. This report examines attendance by higher risk category derived from the underlying primary screening results as determined by the Australian Institute of Health and Welfare (AIHW) and as per national indicator reporting. We note the need for caution in interpretation at this time however because results differ (and are more favourable) if the recommendation code ‘refer to colposcopy’ (as determined by pathology labs and recorded on the NCSR) is used as the indicator of those who should attend colposcopy. Further investigation into this discrepancy is ongoing.
No national data on treatment rates for cervical cancer were available for this report, and only one new study pertaining to treatment rates with surgery or radiotherapy in New South Wales (NSW) has been identified since the previous report. The development of a method for national monitoring and reporting of receipt of treatment and optimal treatment for cervical cancer remains outstanding.
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.
Prioritise vaccination equity for Aboriginal and Torres Strait Islander adolescents
- Make reducing vaccination inequities a clear policy priority.
- Remove system-level barriers to access.
- Partner with Indigenous communities and organisations to develop and lead culturally appropriate solutions.
Resolve persistent data gaps in screening data for Aboriginal and Torres Strait Islander women
- Address system-level barriers to recording Indigenous status.
- Report existing data in ways that drive action to reduce inequities in screening.
Enable better use of existing data to so elimination indicators can be reported for more priority populations and by vaccination status
- Improve data infrastructure, including timely and enduring linkage between key national administrative datasets (Person Level Integrated Data Asset (which includes the Australian Immunisation Register and National Death Index), National Cancer Screening Register and Australian Cancer Database).
- Identify and integrate a high-quality national data source to identify LGBTQ+ and intersex individuals.
- Populate the National Cancer Screening Register with HPV vaccination data from the Australian Immunisation Register to support routine National Cancer Screening Program reporting.
Review suppression rules for small counts in reporting
- Review and refine data suppression policies to ensure small population groups are not systematically excluded and we can continue to monitor and report on remaining policy gaps as we approach elimination
- Explore alternative statistical approaches to maintain privacy while enabling meaningful reporting for priority populations and strata.
Enhance and accelerate national cancer data reporting and release
- Ensure comprehensive cancer data collection (e.g. HPV genotype/vaccination status) to support informed decision-making and targeted interventions.
- Improve timeliness of cancer data reporting so progress towards elimination progress can be tracked in real time.
Develop a cervical cancer treatment monitoring framework
- Address challenges in data linkage, timeliness, and staging data collection.
- Enhance data interoperability and integration across healthcare systems to facilitate timely access and analyses.
- Assess patient care against optimal care benchmarks to identify inequities.
- Leverage emerging clinical quality registries for gynaecological cancers.
Australia's progress towards the elimination of cervical cancer against WHO targets
|
Cervical cancer incidence |
Fewer than 4 new cases per 100,000 women |
6.6 new cases per 100,000 women in 2020. Compared to the elimination target, rates were three times as high for Indigenous women and twice as high in remote and very remote areas. |
|
HPV vaccine coverage by 2030 |
90% of girls vaccinated by the age of 15 years |
84.2% in 2023, reduced from 2022 cohort by 1.1%. Inequity in coverage has increased across available demographic variables, notably for Indigenous adolescents and by jurisdiction of residence. |
|
Screening participation by 2030 |
70% of women screened using a high-performance test by age 35 years and again by age 45 years |
By the end of 2023, 82.8% of women aged 35-39 screened at least once with an HPV test, and 79.8% of women aged 45-49 had been screened at least twice*. Uptake has increased, particularly in remote and very remote areas, the NT, and more disadvantaged areas. |
|
Treatment of cervical precancer by 2030 |
90% of women with identified precancer are treated |
84.5% and 88.7% of those with cervical precancer detected in 2022 were treated within 6 and 12 months, respectively. The proportions treated have been relatively stable over time. |
|
Treatment of cervical cancer by 2030 |
Management of 90% of women with invasive cervical cancer |
No national data are available. QLD (2016-2020) data show cervical cancer treatment rates were 95% across metropolitan, regional and rural/remote areas. A NSW study showed that 90-95% of cervical cancer patients (2009-2018) received treatment within a year, with no significant difference for Aboriginal and Torres Strait Islander patients. |
*including at least once with an HPV test and one preceding cytology test within the previous 10 years