Disease Outcome Indicators

Cervical cancer incidence is the measure used by the WHO to determine whether elimination has been achieved (1).

In 2021, 957 women were diagnosed with cervical cancer in Australia, an incidence rate of 6.3 per 100,000. Cervical cancer incidence over the 5-year period 2017-2021 was 6.4 per 100,000 nationally (Figure 1.1). Incidence varied between groups, and rates (over the period 2017-2021) were nearly three times as high as the elimination target among Aboriginal and Torres Strait Islander women (11.7 per 100,000 women), therefore, a 66% reduction is needed to achieve cervical cancer elimination. Rates over the period 2017-2021 were at least twice as high as the elimination target in women living in outer regional or remote areas. There is a socioeconomic gradient in cervical cancer incidence, with the incidence rates becoming higher with increasing levels of socioeconomic disadvantage. 

In 2021, cervical cancer rates (6.3 per 100,000) declined from a peak of 6.6 per 100,000 in 2020 and 6.5 per 100,000 in 2018 and 2019 (Figure 1.2). This suggests that, following the anticipated transient increase in diagnoses after the 2017 transition to primary HPV screening—when the greater sensitivity of the test initially led to the detection of greater numbers of prevalent cancers—incidence rates may now be showing the first signs of decline.  In most demographic groups, cervical cancer incidence rates in 2017-2021 were broadly similar to those in recent preceding 5-year periods, although in some groups there was an apparent increase (Queensland, South Australia, outer regional). Conversely, rates appear to have decreased over multiple recent time periods in some groups (people living in remote areas, Tasmania, ACT).  

Among Aboriginal and Torres Strait Islander women, cervical cancer incidence rates in 2017–2021 were lower (11.7 per 100,000) than in the preceding five-year period, 2016–2020 (12.3 per 100,000). Data for earlier 5-year periods were not available, so comparisons over a longer time frame were not possible.   

The impact of HPV vaccination on cervical cancer incidence would be expected to occur gradually over time and affect younger age groups first. In 2021, no cervical cancer cases were diagnosed in women aged <25 years, down from one case in 2020.  While rates in this age group are unstable due to very small numbers, they show a clear downward trend consistent with the expected impact of HPV vaccination. These trends should, however, still be interpreted with caution, particularly given the increase in the recommended start age for screening on 1 December 2017 from 20 to 25 years, and declining screening attendance among those aged 20-24 years in the years leading up to this. In other settings, a similar change in the recommended start age has led to a decrease among those aged <25 and an initial increase in cancer incidence in those aged 25-29 years, as screen-detection of some cancers shifts from occurring at age 20-24 to age 25, coinciding with their first screen (3). In Australia, however, cervical cancer incidence in women aged 25–29 years has continued to decline steadily—from 9.3 per 100,000 in 2013 to 3.4 per 100,000 in 2021—highly suggestive of the preventive effects of vaccination. Among women aged 30–34 years, a transient increase was observed in 2018–2019 (13.1 and 14.4 per 100,000, respectively), followed by a decline to 9.7 per 100,000 in 2021, consistent with the expected short-term effects of the transition to HPV-based screening and potentially also the maturing impact of vaccination. Among women aged 35 years and older, rates have not decreased in the period of the HPV screening program (Figure 1.3). 

Source: AIHW Australian Cancer Database, published in AIHW 2025 (4) for 2021 rates. All other rates supplied by AIHW.

In many population groups, very few cases occur in a year, and so rates are subject to random fluctuation. For this reason, in order to report on and compare cancer incidence across a range of population groups, most data are reported across a 5-year period. Age-standardised rates are lower than those reported elsewhere for Australia, for example in routine AIHW reports, because the age-standardising method and standard population recommended by WHO for measuring cervical cancer elimination has been used in this report (2015 World Female Population), to enable comparison with the WHO target and internationally (1,5). In previous elimination progress reports, cervical cancer incidence has been based on age-specific rates published in AIHW reports (6). This limited our capacity to report by state and territory, as the age-specific rates required to age-standardise to the WHO benchmark were not published for all age groups in every jurisdiction. The current report instead relies on age-standardised rates directly computed and supplied by AIHW according to the WHO methodology. These were recalculated for 5-year periods back to 2011-2015, and therefore age-standardised rates for earlier time periods may differ from those in earlier elimination progress reports, due to updated data.

Results by Indigenous status are based on six jurisdictions (NSW, Vic, Qld, WA, ACT and NT) where data quality was considered sufficient for analysis. Overall rates in these jurisdictions (6.3 per 100,000 women; including those whose Indigenous status was unknown) was slightly lower than the national rate (6.4 per 100,000 women) over the period 2017-2021. Following the release of the 2021 Census-based estimates of the Aboriginal and Torres Strait Islander population by the Australian Bureau of Statistics (ABS), the AIHW's First Nations Health and Welfare Group has been working with relevant agencies and advisory groups to examine options and agree on an approach for national reporting. To maintain national consistency across government reporting, the Productivity Commission, AIHW and ABS have collectively agreed to adopt the same approach on the use of a consistent denominator. The agreed approach is that 2021 Census-based backcast estimates and projections should generally be used as the denominator for rates. The AIHW has decided to limit analyses back to the year 2016 due to the extent of non-demographic change between Census population estimates. For this reason, the Aboriginal and Torres Strait Islander and non-Indigenous data for periods which include years prior to 2016 have not been published for incidence. 

Aboriginal or Torres Strait Islander identification was based on whether a person had ever self-reported their status, as recorded by six state and territory cancer registries (NSW, Vic, Qld, WA, ACT and NT) (6).

There is currently a delay of approximately four to five years in the availability of national cancer incidence data stratified by population groups in Australia. This delay limits our ability to conduct timely reporting of cervical cancer incidence in Australia against the primary WHO elimination target. Additionally, rates calculated over a 5-year period will inherently take longer to reflect changes. Within these contexts, it is not surprising that cervical cancer rates in most population groups have not reduced substantially compared to the previous report.  More generally, it will take some time for all-ages rates to be impacted by HPV vaccination, due to the long time between a vaccine delivered in early adolescence, a prevented HPV infection, and the cancer that otherwise would have occurred.   

Year-by-year changes over the period 2017 to 2021 also reflect the change to the screening program, when there was expected to be a transient increase in detection of cancer, due to the more sensitive test detecting some prevalent cancers (noting this represents a success of the new program since earlier detection leads to downstaging of cancer and improved survival), before ultimately declining (2). Potentially, the reduction in 2021 compared to 2020 may represent the beginning of this anticipated decline; data over a longer period are required to confirm this.   

In 2021, no cervical cancer cases were diagnosed among women aged under 25 years. This is the first time this has occurred since national data collection began in 1982. It is likely to represent the impact of HPV vaccination, which has made infection with the most carcinogenic HPV types 16 and 18, and the predominant causes of cervical cancers that occur at a young age (7), increasingly rare in young people (see Indicator 4).  While rates remain unstable due to very small numbers, they show a clear downward trend consistent with the expected  impact of HPV vaccination. By the end of 2021, all women aged under 25 years would have been eligible for HPV vaccination at age 12–13 years through the school-based program. Women aged 25–29 years would also have been eligible for vaccination in schools, including the initial two-year catch-up program introduced in 2007. Cervical cancer rates in those aged 25–29 years appear to have declined steadily since 2013, highly suggestive of HPV vaccination impact. Among women aged 30–34 years in 2021, observed trends reflect a combination of factors. While some in this cohort were vaccinated, in many cases, this likely occurred after already being exposed to a cancer-causing HPV type, which reduces the vaccine’s effectiveness. In addition, some women would not have been eligible for vaccination if they migrated to Australia after the initial catch-up program. Finally, the transition to HPV-based screening and associated increases in cancer detection also contribute to the observed trends. The modest rise in cervical cancer rates among women aged 35 and older over the past five years reflects that most were beyond the age of eligibility for vaccination when the program began. Trends in this group are therefore largely driven by screening rather than direct vaccine effects, but they can be a useful comparator when interpreting patterns in younger age groups.

1 World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020. Available at: https://www.who.int/ publications/i/item/9789240014107

2 Hall MT, Simms KT, Lew JB, et al. Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia. PLoS One 2018; 13(2): e0185332

3 Sasieni P, Castanon A. Dramatic increase in cervical cancer registrations in young women in 2009 in England unlikely to be due to the new policy not to screen women aged 20-24. Journal of Medical Screening. 2012;19(3):127-132. doi:10.1258/jms/2012/012081

4 Australian Institute of Health and Welfare. Cancer data in Australia. Cat. no: CAN 122 Canberra: Australian Government. Available at: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data 

5  Canfell K, Kim JJ, Brisson M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 2020; 395(10224): 591-603

6 Australian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2023. Cat. no: CAN 157 Canberra: Australian Government

7 Brotherton JML, Tabrizi SN, Phillips S, et al. Looking beyond human papillomavirus (HPV) genotype 16 and 18: defining HPV genotype distribution in cervical cancers in Australia prior to vaccination. Int J Cancer. 2017 Oct 15;141(8):1576-1584. doi: 10.1002/ijc.30871. 

Reducing premature mortality from cervical cancer is the overarching aim of the WHO elimination strategy, so cervical cancer mortality has been identified as a key impact indicator in the global strategy to accelerate elimination (1). Cervical cancer mortality will capture two important aspects of cancer control that will not be reflected in cervical cancer incidence rates: downstaging (due to screening) and the WHO target of treating 90% of women diagnosed with cervical cancer.

In 2023, there were 265 deaths from cervical cancer, a rate of 1.5 per 100,000. Cervical cancer mortality was 1.4 per 100,000 women in 2019–2023. In jurisdictions with sufficient data quality for Indigenous status, mortality rates among Aboriginal and Torres Strait Islander women were 4.3 per 100,000—3 times higher than the overall rate for those jurisdictions (1.4 per 100,000). Mortality rates increased with increasing levels of socioeconomic disadvantage and were lowest in Victoria (1.1 per 100,000), followed by NSW and WA (1.3 per 100,000 each). Mortality rates were higher than the national average in inner and outer regional areas of Australia (1.6 per 100,000 and 1.8 per 100,000, respectively). There were fewer than 20 deaths from cervical cancer recorded in each of the NT and remote or very remote areas; therefore, age-standardised rates were not able to be published. Historically, mortality rates have been higher in the NT and very remote areas than other areas (Figure 2.1).  Over time, there were small fluctuations in the rolling averages between 2013 and 2023 (Figure 2.2). Over a longer period, annual mortality rates have declined steadily (Figure 2.3).

Source: National Mortality Database, extracted data supplied by AIHW (2025) and published in AIHW 2025 (2). 

In many population groups, very few deaths occur in a year, and so rates are subject to random fluctuation. In order to report on cancer mortality across a range of population groups, data are reported across a 5-year period (the most recent 5-year period for which data are available). National age-specific rates were sourced from the most recent national report (2). Age-standardisation is performed across all ages using the 2015 World female population, consistent with the methodology recommended for incidence as part of the WHO elimination strategy (1,3). As a result of this difference in methodology, mortality rates in this report are not comparable to AIHW reports. 

The Indigenous status variable is not of sufficient quality for analysis for records from Victoria, Tasmania or the ACT; therefore, data by Indigenous status are reported for NSW, Qld, WA, SA, and NT combined, and the overall total in those jurisdictions is also reported (which includes those whose Indigenous status was unknown). The populations used for the calculations were based on the 2021 Census estimates for 2016–2021 and projections for 2022-2023. Following the release of the 2021 Census-based estimates of the Aboriginal and Torres Strait Islander population by the ABS, the AIHW's First Nations Health and Welfare Group has been working with relevant agencies and advisory groups to examine options and agree on an approach for national reporting. To maintain national consistency across government reporting, the Productivity Commission, AIHW and ABS have collectively agreed to adopt the same approach on the use of a consistent denominator. The agreed approach is that 2021 Census-based backcast estimates and projections should generally be used as the denominator for rates. The AIHW has decided to limit analyses back to the year 2016 due to the extent of non-demographic change between Census population estimates. For this reason, the Aboriginal and Torres Strait Islander and non-Indigenous data for periods which include years prior to 2016 have not been published for mortality. 

Aboriginal or Torres Strait Islander identification was based on whether a person had ever self-reported their status, as recorded by five state and territory Births Deaths and Marriages registries (NSW, Qld, WA, SA and NT) (4).

Cervical cancer mortality is relatively low in many groups but many of the groups with higher rates correspond with those with a higher incidence (increasing rates with increasing level of socioeconomic disadvantage). There is considerable overlap in the groups previously identified as having the highest mortality rates (Aboriginal and Torres Strait Islander women, women living in the NT and women living in very remote areas).  However, visibility into rates for the NT and very remote areas is now limited, as the AIHW has more strictly enforced existing data suppression guidelines in the release of deaths data. Interpretation of trends is challenging due to small numbers, particularly in small areas such as the ACT, NT and Tasmania; and remote and very remote areas.  

Reductions in cervical cancer mortality over time will reflect a range of factors, including improved prevention, earlier detection (downstaging), improvements to treatment, and providing more women with optimal treatment. 

National mortality data are reported more promptly than national cancer incidence data.

1 World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020. Available at: https://www.who.int/ publications/i/item/9789240014107.   

2 Australian Institute of Health and Welfare. Cancer data in Australia. Cat. no. CAN 122, AIHW 2024. Available at: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data.     

3 Canfell K, Kim JJ, Brisson M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 2020; 395(10224):591-603.   

4 Australian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2023. AIHW National Mortality Database: https://www.aihw.gov.au/about-our-data/our-data-collections/national-mortality-database/deaths-data  

Cervical screening aims to detect specific types of cervical disease (known as high-grade see Methods tab for details), which are recognised as precursors of cervical cancer, so that women can have treatment to prevent progression to cancer. High-grade abnormalities of the cervix include cervical intraepithelial neoplasia (CIN) that has been graded as moderate (CIN 2) or severe (CIN 3), or for which the grade has not been specified, as well as endocervical dysplasia and adenocarcinoma in situ (1).

This indicator measures the proportion of women screened who are found to have high-grade disease as defined by a high-grade disease result on biopsy/histopathology. It will be determined by the underlying proportion with high-grade disease in the screened population, the accuracy of the screening method used, and the subsequent diagnostic steps and follow up undertaken with women found positive on the screening method.

Nationally, detection of high-grade cervical disease fell in both 2024 and 2023 from previous years. In 2024 it was 7.2 per 1,000 screened women aged 25-74 years, falling further from 2023 when it was 7.8 (age adjusted rate 7.5 per 1,000 in 2024 and 8.2 in 2023) (Figure 3.1a (2024) and Figure 3.1b (2023)). In contrast, the rate was almost twice that at 14.2 per 1000 in 2022, the final year of the previous 5-year screening interval. The rate of CIN3 detection in 2024 was 4.3 per 1,000 (age adjusted 4.5 per 1,000 and 59.9% of all high-grade disease detected). AIS was detected at a rate of 0.2 per 1,000 (2.9% of all high-grade disease) falling from 0.3 per 1000 in 2023 (Figure 3.2a (2024) and Figure 3.2b (2023)). Women residing in the two most socioeconomically disadvantaged quintiles had a high-grade detection rate higher than the national average (quintiles 1 and 2 at 8.0 and 7.8 per 1,000 screened respectively in 2024). The rate of high-grade detection per 1,000 screened women increased with increasing remoteness of residence, ranging in 2024 from 7.0. in major cities to 10.5 in very remote areas). NT remained the jurisdiction with the highest detection rate at 10.6 per 1,000 screened women in 2024, with Victoria having the lowest rate at 5.9 (Figure 3.1a).

Detection of high-grade cervical disease overall fell progressively with age in 2024, whereas CIN3 remained highest in the 30–34-year-old age group at 8.0 per 1,000. AIS peaked in the 35-39 year old age group in both 2023 and 2024 at 0.6 and 0.4 per 1,000 screened women respectively (Figure 3.2a, 3.2b). The age group with the highest proportion of high-grade disease that was CIN3 was the 60-64-year-old age group (2024 63.7%, 2023 65.4%) and the lowest proportion was in those aged 25-29 at 55.1% in 2024 and 55.7% in 2023. The age group with the highest proportion of high-grade disease that was AIS was the 35-39 -year-old age group in 2024 (at 4.1%) and in 2023 was the 40-44 year old age group (at 5.4%).

Amongst women who ever identified as Aboriginal and Torres Strait Islander aged 25-74 years, in 2024, the crude rate was 13.4 per 1,000 (12.1 age adjusted). Because of the significantly younger age distribution of the Aboriginal and Torres Strait Islander population, it is important to account for age differences in estimating overall rates. Rates peaked in the 30-34 year old age group at 19.2 per 1,000 and were lowest in the 60-64 year old age group at 4.0 per 1000 (rates not published for those aged 65-74 due to small cell counts).

Source: Analysis of NCSR data (NCSR RDE 11/07/2025); data prepared by the Screening Analysis and Monitoring Unit of the Australian Institute of Health and Welfare.

High-grade cervical disease was defined as a histology result of S3.1 (High-grade intraepithelial lesion (HSIL) not otherwise specified (CIN NOS)), S3.2 (HSIL (CIN 2)), S3.3 (HSIL (CIN 3)), E3.1 (Endocervical dysplasia), E3.2 (Adenocarcinoma in situ) or E3.3 (Mixed carcinoma in situ/adenocarcinoma in situ) (2).

Crude rates are presented, except for the national high grade and CIN3 rate, due to the small number of cases preventing calculation of age standardised rates. Cell suppression impacted some age groups for AIS and for stratifications by State/Territory, remoteness and socioeconomic status. Age-standardised rates were the number of women with a high-grade abnormality detected by histology per 1,000 women screened, age-standardised to the Australian 2001 Standard Population (3).

Aboriginal or Torres Strait Islander identification was based on whether a person had ever self-reported their status, as recorded in the National Cancer Screening Register (4).

In the last 6-month period where data were available for the previous Pap based screening program (January-June 2017), the crude high grade detection rate for women aged 25-74 years was 6.6 per 1,000 screened women and highest in the 25–29-year-old age group (at 14.4 per 1,000 screened) (5). In the first five year interval of the HPV screening program, rates peaked in 2020 and 2021 (at 16.5 per 1000 screened), as was predicted by modelling (6), both due to the move to HPV based screening with its higher sensitivity and because women attending were all at relatively higher risk of high-grade disease: women screening in 2020 and 2021 were either entering the program at age 25, were attending because they were under surveillance for a previous positive HPV test, or else were overdue for screening (due to the transition from the previous 2 yearly screening interval). In late 2022, those who started HPV screening in December 2017 when the program first commenced became eligible for their second-round screen. The data presented here for 2023 and 2024 include the second-round screens of regular screeners who moved from the two-year cytology program screening cycle when due to have their first HPV screen in 2018-2019. As such, the markedly lower high grade detection rate per 1,000 screened (7.2 in 2024 (7.5 age adjusted) compared to 9.8 (9.6 age-adjusted) in 2019, the corresponding year in the first round of HPV screening) is likely a consequence of the detection and treatment of prevalent lesions in the first round.  Women offered HPV vaccination as catch up as adults (aged 18-26 in 2007) were aged 35 to 43 in 2024.

There is known under-enumeration of histopathology reports held in the NCSR, as safety net follow-up (and attempts to retrieve not yet notified histopathology) cease when an MBS item number consistent with cervical histology is located (indicating the woman has received further assessment). Additionally, due to teething issues during initial register implementation, 2018 data is known to be incomplete. It is likely that high grade rates estimated from the early years (2018-2019, age standardised high grade rate of 8.1 and 9.7 per 1000, peaking at age 25-29 years) may more significantly underestimate the true high-grade detection rate, with reporting to the register improving over time, so data for these years in particular should be interpreted with caution. 

There was evidence of variation in high grade detection rate by remoteness of residence, with women in remote areas having higher rates, and by socioeconomic quintile of residence, with women living in the least disadvantaged quintile having lower rates. Women residing in Queensland, Tasmania and NT had higher rates than in other jurisdictions in 2024.

When interpreting data for Aboriginal and Torres Strait Islander participants, it is important to note that under identification of Aboriginal and Torres Strait Islander status remains a significant challenge for the NCSP. Identification in the NCSR is contingent upon Indigenous people being respectfully asked to identify as Aboriginal and/or Torres Strait Islander, feeling comfortable and safe to do so, agreeing to its recording in their Medicare record or as part of their cervical screening test request, inclusion of this field on the pathology request form, transmission of these data to the NCSR and its accurate recording therein. Indigenous status was not known for 20.8% of screening participants in the 5-year period 2019-2023(4). Therefore, the rates of high grade disease detection are representative only for those participants who identified as Indigenous rather than for being rates inclusive of all Aboriginal and Torres Strait Islander participants. If those who have identified are different in demographic or other characteristics to those who have not, then these rates will be non-representative of the actual rate.

The available data suggests higher rates of disease detection amongst those people attending cervical screening who identify as Aboriginal or Torres Strait Islander women compared with overall national estimates, noting the large absolute and relative fall in age adjusted detection rates moving into the second 5-year screening interval (from 2021 peak of 20.7 per 1000 to 12.1 per 1000 in 2024). However, comparisons should be interpreted cautiously since factors influencing the likelihood of developing high-grade cervical disease, such as smoking, have not been controlled for. Some age-standardised rates are presented where they can be estimated given cell suppression rules but may not completely control for the strong influence of age on HPV prevalence and disease: the Aboriginal and Torres Strait Islander population has a notably younger age structure (median age of 24.0 years in 2021) than that of the overall population (median age of 38.4 years in 2021) (7). This finding is, however, consistent with available data from the previous cervical cytology program and with the higher rates of cervical cancer experienced by Indigenous people. (8,9) It is also an important finding as it suggests a greater potential to benefit from screening and underscores the critical importance of providing culturally appropriate and supportive screening services along the screening pathway. Now that self-collection offers a way to screen that may be more accessible and acceptable for many Indigenous people (10), priority needs to be given to ensuring the cultural safety and accessibility of follow-up care, including both public and private colposcopy services. Every gynaecologist and colposcopy provider in Australia must be appropriately trained and actively committed to providing culturally safe care for Aboriginal and Torres Strait Islander participants.

1 Australian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2021. Cancer Series 134. Cat. no: CAN 141 Canberra: AIHW; 2021.

2 Australian Institute of Health and Welfare (2023) National Cervical Screening Program data dictionary: version 1.2, catalogue number CAN 153, AIHW, Australian Government.

3 Australian Bureau of Statistics. Australia 2001 Standard Population for Use in Age-Standardisation. 2003. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Mar%202013?OpenDocument 

4 Australian Institute of Health and Welfare (2024) National Cervical Screening Program monitoring report 2024, catalogue number CAN 163, AIHW, Australian Government.  

5 Australian Institute of Health and Welfare 2019. Cervical screening in Australia 2019. Cancer series no. 123. Cat. no. CAN 124. Canberra: AIHW

6 Hall MT, Simms KT, Lew JB, et al. Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia. PLoS One 2018; 13(2): e0185332.

7 Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians; 2021. Available from https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/30-june-2021  

8 Australian Institute of Health and Welfare (2023) National Cervical Screening Program monitoring report 2023, catalogue number CAN 157, AIHW, Australian Government.

9 Whop LJ, Baade P, Garvey G, Cunningham J, Brotherton JML, Lokuge K, Valery PC, O’Connell DL, Canfell K, Diaz A, Roder D, Gertig DM, Moore SP, Condon JR. Cervical abnormalities are more common among Indigenous than other Australian women: a retrospective record-linkage study, 2000-2011. PLoS One. 2016 Apr 11;11(4):e0150473. doi: 10.1371/journal.pone.0150473. eCollection 2016.

10 Whop L, Butler T, Lee N, Cunningham J, Garvey G, Anderson K, Condon J, Tong A, Moore S, Maher C, Mein J, Warren E, Brotherton J. Aboriginal and Torres Strait Islander women’s views of cervical screening by self-collection: a qualitative study. Australian and New Zealand Journal of Public Health. 2022 Apr;46(2):161-169. doi: 10.1111/1753-6405.13201. 

The ability to achieve cervical cancer elimination is dependent upon the contribution to reduction in the prevalence of oncogenic HPV types made through HPV vaccination. Monitoring infection prevalence in settings where this is feasible provides a direct measure of the extent to which this reduction is achieved and maintained over time.

In 2024, 1.4% of women aged 25-74 years who were screened were positive for HPV16/ 18, the Group1a and b carcinogenic HPV types prevented by vaccines utilised in the National HPV Vaccination Program. Positivity for HPV16/18 was 2.0% for Aboriginal and Torres Strait Islander women. Positivity decreased modestly from the lowest to the highest SES and decreasing remoteness areas. Minor variations were observed by state and territory (Figure 4.1).

HPV16/ 18 positivity was unchanged from 2023, but marginally lower than in previous years (2018 through 2022). This pattern was evident across socioeconomic quintiles, remote areas, and in most states and territories. By age group, 2024 positivity was lowest at 1.0% for women aged 25–29, decreasing from 1.7% in 2019. For older age groups, positivity was also very low and reasonably stable over time (although there were relative increases in 2020 and 2021; Figure 4.2a).

Among Aboriginal and Torres Strait Islander women, HPV16/18 positivity was also low in 2024, at 1.0%, for women aged 25–29, decreasing from 1.5% in 2019. For older women, positivity increased marginally to 3.5% among those aged 55-59 before falling with increasing age (Figure 4.2a). 

Overall positivity for any oncogenic HPV type was 7.3% in 2024. HPV positivity was 12.1% for Aboriginal and Torres Strait Islander women, 10.8% among women living in very remote areas and 10.4% among women in the NT. HPV positivity was influenced by types other than HPV16/18 (Figure 4.1).

HPV positivity was modestly higher in 2024 than in 2023, with increases driven by non-16/18 types. Across all years, positivity was similar across socioeconomic groups, but the highest positivity was evident for women living in very remote areas and the NT. By age group, positivity overall and for HPV (not 16/18) was highest among women aged 25–29 years and decreased with increasing age. This pattern was consistent within and between years (Figure 4.2b and Figure 4.2c).

In 2024, positivity for the additional five HPV types targeted by the nonavalent HPV vaccine (HPV31, 33, 45, 52 or 58) and the remaining HPV types not targeted by vaccination (HPV35, 39, 51, 56, 59, 66 or 68) were 2.8% and 4.7% respectively, with little variation over time. Positivity was generally highest for women aged 25-29 and decreased with increasing age (Figure 4.3 and Figure 4.4).

Source: Analysis of NCSR data (NCSR RDE 11/07/2025); data prepared by the Screening Analysis and Monitoring Unit of the Australian Institute of Health and Welfare.

Results were derived using the standard method for calculating population prevalence (positivity): the sum of women with at least one positive result for a given HPV group divided by the total count of participants with a primary screening HPV test.

Aboriginal or Torres Strait Islander identification was based on whether a person had ever self-reported their status, as recorded in the National Cancer Screening Register (1). 

In 2024, national HPV prevalence remained lower than in 2021-22, primarily due to many individuals undergoing a timely second HPV screening round following a negative test five years earlier. Lower positivity rates were expected (and observed in previous trials) during the second round of screening, reflecting more recent infections, while the first round detects both recent and long-standing infections. The exception is the 25-29 age group, primarily consisting of individuals attending their first HPV screening round. As a result, positivity rates in this group are expected to reflect the background rates of HPV infection over time and may be more stable than in other age groups, particularly for non-vaccine targeted HPV types. 

The consistent decline in HPV16/18 in the 25-29 age group reflects the impact of Australia’s quadrivalent HPV vaccination program on reducing infections (2,3) and an increasing proportion of 25–29-year-olds who were offered HPV vaccination in their first year of high school. The patterns for HPV16 or 18 in some other age groups may also reflect some impact of HPV vaccination. However, they are also influenced by screening effects, including extended intervals and people attending for their second-round test. In 2024, women offered HPV vaccines in the catch-up program began to reach age 44 in the second half of the year, and those in the school-based program are aged up to 34 years. The impact of the nonavalent vaccine is not apparent because cohorts offered this vaccine at the target age 12-13 are not yet at screening age. 

The slight increase in HPV positivity in 2024 compared with 2023, driven mainly by non-16/18 types, likely reflects the high uptake of self-collected samples rather than a true rise in infection. Vaginal self-collected samples generally have a higher HPV detection rate than cervical samples, although this may also be influenced by the characteristics of women who choose self-sampling, particularly those who were previously under-screened (4). Nevertheless, positivity in 2024 and 2023 was still lower than previous years. This pattern likely reflects the lower positivity among women taking part in their second round of screening.

Data for Aboriginal and Torres Strait Islander women suggests a higher HPV prevalence compared with national estimates. However, crude positivity comparisons should be interpreted cautiously since factors like age have not been controlled. HPV positivity peaks amongst young women in the years following sexual debut, and the Aboriginal and Torres Strait Islander population has a notably younger age structure (median age 24.0 years in 2021) than that of the overall population (median age 38.4 years in 2021) (5). Other contributing factors include potential differences in participation rates in cervical screening. There are also known differences in the prevalence of some other risk factors, such as smoking, due to the long-lasting impacts of colonisation, including the use of tobacco by colonial settlers as a form of payment for labour, goods and access to land (6). 

HPV16/18 positivity was very low for Aboriginal and Torres Strait Islander women in birth cohorts offered HPV vaccination, similar to the national population, highlighting the success of Australia's school-based HPV vaccination program in achieving comparable impacts.

Surveys before the start of the vaccination program among women attending cervical screening suggested a similar prevalence of HPV16/18 in Indigenous compared with non-Indigenous women at all ages but a higher prevalence of other oncogenic types among Indigenous women aged 31 to 40 years (7) that appeared to be driven by other risk factors such as smoking. A survey conducted after the vaccination program had begun found declines in prevalence similar to those observed in non-Indigenous women, with an HPV16/18 prevalence among Indigenous women aged 18–26 of 1.4% in 2014-15 (8). A study of women aged 18-35 years recruited in 2015–2018 found that the prevalence of HPV16/18 was very similar in Indigenous and non-Indigenous women (2.3% versus 1.9%, respectively) (9).

Indigenous status was unknown for approximately one fifth of screening participants (1). Therefore, HPV positivity is representative only for those participants who ever identified as Aboriginal and/or Torres Strait Islander rather than being rates inclusive of all Aboriginal and Torres Strait Islander participants. Reporting of Indigenous status is expected to improve over time with the updated National Pathology Accreditation Advisory Council (NPAAC) requirements, which reinforce the importance of laboratories consistently capturing and submitting Aboriginal and Torres Strait Islander status where known (10). However, as Indigenous status is not a mandatory field on pathology request forms, some under-reporting is likely to remain.

Figure 4.3 and Figure 4.4 were derived from a smaller subset of women whose samples were tested on a subset of assays that provide further discrimination within non-16/18 HPV types. This subset represents only 1% of all screening tests conducted in the program. Compared with national data for 2024, this group had slightly lower positivity for HPV16/18 (1.0% vs 1.4%) and higher positivity for oncogenic HPV types other than HPV16/ 18 (6.9% vs 6.2%).

All calculations of HPV positivity were based on data reported to the NCSR. NPAAC requirements for laboratories undertaking cervical screening specify that all HPV test results must be reported to the NCSR (10). This means that when a test returns a positive result for HPV16/18 and a non-16/18 type, both results must be documented. However, there is no requirement for reporting of the two sub-categories of non-HPV16/18 positive results, so the data reported in Figures 4.3 and 4.4 may be incomplete.

1 Australian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2023, catalogue number CAN 157, AIHW, Australian Government. 

2 Brotherton JM, Hawkes D, Sultana F, et al. Age-specific HPV prevalence among 116,052 women in Australia’s renewed cervical screening program: A new tool for monitoring vaccine impact. Vaccine 2019; 37(3): 412-6.

3 Machalek DA, Garland SM, Brotherton JML, et al. Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18- to 35-Year Old Australian Women 9 Years Following Implementation of Vaccination. The Journal of Infectious Diseases 2018; 217(10): 1590-600.

4 Lee A, Hawkes D, Sweeney D, Wyatt K, Nightingale C, Chalmers C, Saville M. “Exponential uptake of HPV self‑collected cervical screening testing 2 years since universal availability in Victoria, Australia.” BMC Medicine. 2025;23:389.

5 Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians; 2021. Available at: https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/30-june-2021 

6 Greenhalgh, EM, Jenkins, S, van der Sterren, A, Knoche, D, & Winstanley, MH 8 Tobacco use among Aboriginal and Torres Strait Islander peoples. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2023. Available at: https://www.tobaccoinaustralia.org.au/chapter-8-aptsi 

7 Garland SM, Brotherton JM, Condon JR, et al. Human papillomavirus prevalence among Indigenous and non-Indigenous Australian women prior to a national HPV vaccination program. BMC Medicine 2011; 9: 104.

8 McGregor S, Saulo D, Brotherton JML, et al. Decline in prevalence of human papillomavirus infection following vaccination among Australian Indigenous women, a population at higher risk of cervical cancer: The VIP-I study. Vaccine 2018; 36(29): 4311-6.

9 Shilling, H, Garland, SM, et al. Human papillomavirus prevalence and risk factors among Australian women 9-12 years after vaccine program introduction. Vaccine 2021, 39(34), 4856–4863.

10 Australian Commission on Safety and Quality in Health Care. Requirements for cervical screening (Third edition 2025). Sydney: ACSQHC; 2025. Available at: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/requirements-cervical-screening-third-edition-2025