Screening Coverage Indicators

Vaccination against HPV will take decades to reduce overall cervical cancer incidence, due to the time taken for vaccinated cohorts to reach the age at which they would have developed cancer and also to make up a large enough proportion of the population to affect overall incidence rates. Cervical screening is therefore important to expedite elimination of cervical cancer (1,2,3). The WHO strategy to accelerate the elimination of cervical cancer sets a target of screening women at least twice, at around age 35 and 45 years (1). Based on data from Victoria, around 40% of the women diagnosed with cervical cancer had never been screened, whereas being screened even once substantially reduces a woman's risk of cervical cancer (4,5). This emphasises the importance of this indicator, even though more frequent screening is recommended in the NCSP, but it is not routinely reported elsewhere for Australia.

Since primary HPV screening has only been recommended in Australia since 1 December 2017, it has only recently become possible for people aged 45-49 years to have had at least two HPV tests that are at least 5 years apart, at least one when aged 30-39 years, and at least one when aged 40-49 years. The second part of this indicator therefore sits at zero for the first five years of the HPV screening program, but it is anticipated to begin slowly increasing from 2023. Previous elimination reports included an interim measure of having been screened at least twice, including at least one primary HPV test and at least one cytology test prior to 1 December 2017 at least two years apart, but as comparison with the intent of the WHO target is now possible, this interim measure has been discontinued.

By the end of 2024, 85.0% of females aged 35-39 years had been screened at least once with an HPV test, and this proportion exceeded 80% in all categories reported on, except for inner regional areas (where it was 79.7%). It was not possible for those aged 45-49 years to have been screened twice with a high-performance test, at least once within each of the target age ranges (30-39 years and 40-49 years), until at least 2023. By the end of 2024, 5.9% of those age 45-49 years had met this target, increasing from 1.2% at the end of 2023 (Figure 6.1b). The proportion of women aged 35-39 who have been screened at least once with an HPV test varies most by state/ territory (from 83.0% in WA to 94.7% in NT) and, to a lesser extent, by remoteness of residence (from 79.7% in inner regional areas to 88.6% in remote areas) and area-level SES (from 80.9% in the middle quintile to 90.0% in the least disadvantaged quintile). 

The proportion of females aged 45-49 who have been screened at least twice with an HPV test is still small in all areas, but has reached at least 5.0% in all areas, apart from the most disadvantaged SES quintile, where it is 4.9%. 

As expected, the proportion of eligible females aged 35-39 years who have had at least one HPV test has increased with each year since the HPV screening program began, from 31.0% at the end of 2018, to 85.0% by the end of 2024 (Figure 6.2). This increase has been seen in every population group for which data were available to report on. The difference between the states/ territories with the lowest and highest uptake has generally widened somewhat over time, but in recent years this has been due to the very high rates seen in NT. The difference has also widened, to a lesser extent, by remoteness area (difference 4.5% in 2018 vs 8.9% in 2024) but the areas with highest and lowest rates have changed over time. Since around 2022, this proportion of 35-39-year-olds with at least one HPV test has increased relatively more in outer regional, remote and very remote areas, and relatively less in inner regional areas, than in Australian overall.

Source: Analysis of NCSR data (NCSR RDE 11/07/2025, extracted July 2025); data prepared by the Screening Analysis and Monitoring Unit of the Australian Institute of Health and Welfare. Remoteness areas and socioeconomic areas were allocated based on the participant’s address at the end of the period, primarily using an SA2 2021 correspondence. Where this was not available, a postcode correspondence was used. The correspondences produced by the Australian Bureau of Statistics (ABS) can now be found on data.gov.au by searching for: ‘ASGS’, the 'year', and ‘correspondences’ (ABS 2021).

The population eligible for screening comprise the estimated resident female population, minus an estimate of the number of females who have had a hysterectomy, consistent with routine AIHW reports (6-8). For this reason, the term females is used in this indicator whenever referring to proportions that rely on ABS estimates of the female population. Data to calculate the screen-eligible population by single year of age were not available. The ABS population estimates used are those based on the 2021 Census (7,8), and for end-2024 are extrapolated from mid-2023 and mid-2024 (the most recent available data).

This WHO indicator was designed to be a minimum target for low and lower-middle income countries and does not necessarily reflect the preferred approach for higher income countries. Nevertheless, being screened at least once substantially reduces a woman’s risk of cervical cancer (5,6) and so this measure is useful to monitor as a minimum but is not routinely reported elsewhere for Australia. The WHO target for this measure was set for 2030; modelling used to inform the WHO targets assumed that screening uptake would scale up further after this time (to 90%) (2,3). As Australia has a well-established screening program, it could be expected to reach the 2030 target and scale screening up to reach the 90% target earlier than other countries. Some areas in Australia have reached (NT, areas in the least disadvantaged quintile) or are approaching (remote areas) 90% for the first part of the measure.

Data on Indigenous status are not yet sufficiently complete on the NCSR to allow reporting by Indigenous status. Given cervical cancer incidence rates are much higher among Indigenous women, and cervical screening is critical to reduce cervical cancer incidence in the short-term, understanding and reporting screening coverage in Indigenous women is critical to achieving timely elimination among Indigenous women. Earlier studies of the cytology-based screening program, based on analyses of ad hoc linked data for Qld, NSW, and the NT (9,10), found that Indigenous women were less likely to have been screened in the previously recommended interval of two years, and over a longer interval of five years. A measure of being ever-screened is also not available for Aboriginal and Torres Strait Islander women, but modelling suggests that rapid scale-up to ensure every Aboriginal and Torres Strait Islander woman is screened at least once is key to achieving cervical cancer elimination in line with the target timeframe (11).

The proportion of females aged 35-39 years who have had at least one HPV test was expected to increase over time, although all screen-eligible females would have been due to attend for their first HPV test by 31 December 2019, and so the proportion would be expected to increase more slowly after this time, especially after the first 5 years of the program in 2022. This generally was the case, although the increases did not slow down to the same extent in remote, very remote and outer regional areas; in the most disadvantaged areas, or in the NT, Tasmania, ACT and NSW. This may be related to providing self-collection as a choice for all people eligible for screening (from July 2022) and possibly also the national screening campaigns which took place in the latter half of 2024, as a relatively large proportion of screening tests in remote and very remote areas and in Tasmania and the NT are self-collected (~50% in each case in 2024), although this is not true to the same extent in NSW, the ACT or outer regional areas (12). The impact of self-collection on screening is challenging to untangle from other effects, in particular extending the screening interval from 2 to 5 years.

Since primary HPV screening has only been recommended in Australia since 1 December 2017, it has only recently become possible for those aged 45-49 years to have had at least two HPV tests that are at least 5 years apart, at least one when aged 30-39 years, and at least one when aged 40-49 years. It was therefore known and expected that this proportion must be zero until at least 2023 and could only start to increase after then. This proportion is still small, but Australia is now starting to move towards achieving the WHO screening target. 

The hysterectomy prevalence estimates that are used to derive the population eligible for cervical screening are from an AIHW analysis of National Hospital Morbidity Database, and so consistent with previous AIHW and elimination reports: however, these estimates are not broken down by state/territory, remoteness area, or area-level SES. Potentially the prevalence of hysterectomy does vary across these strata, so using national age-specific estimates may under- or over-estimate the population who are eligible for screening in some cases, which would in turn potentially over- or under-estimate results for this indicator.

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 Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low income and lower-middle-income countries. Lancet 2020; 395(10224): 575-90.

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 Smith M, Lew JB, Simms K, et al. Impact of HPV sample self-collection for underscreened women in the renewed Cervical Screening Program. Medical Journal of Australia 2016; 204(5): 194e1-e9.

5 Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. New England Journal of Medicine 2009; 360(14): 1385-94.

6 Australian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2025. Canberra: AIHW; 2025. Available at: https://www.aihw.gov.au/reports/cancer-screening/ncsp-monitoring-report-2025 

7 Australian Bureau of Statistics. Regional population by age and sex. Canberra: ABS; 2025. Available at:  https://www.abs.gov.au/statistics/people/population/regional-population-age-and-sex/latest-release.

8 Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA), Australia. 2021 Available at: https://www.abs.gov.au/statistics/people/people-and-communities/socio-economic-indexes-areas-seifa-australia/2021 

9 Zhang X, Condon J. Cancer screening in the Northern Territory 2019. Department of Health, Darwin, 2019. Available at: https://digitallibrary.health.nt.gov.au/prodjspui/handle/10137/7938

10 Whop LJ, Garvey G, Baade P, et al. The first comprehensive report on Indigenous Australian women’s inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000–2011). Cancer 2016; 122(10): 1560-9.

11 Smith MA, Killen J, Jamieson LM, O'Farrell X, Nguyen DTN, Garvey G, Canfell K, Whop LJ. Reaching and Expediting Cervical Cancer Elimination in Aboriginal and Torres Strait Islander Women: The Impact of Scaling Up Prevention Measures. Available at SSRN: http://dx.doi.org/10.2139/ssrn.5398615

12 National Cancer Screening Register. Quarterly update on cervical screening self-collection uptake (October 2025). Available at:  https://www.health.gov.au/sites/default/files/2025-10/update-on-cervical-screening-self-collection-uptake.pdf 

Cervical screening is important to expedite elimination of cervical cancer, as HPV vaccination requires several decades to have its full effects across the population. As Australia has a well-established screening program with screening recommended aligned with the broader WHO screening recommendations (1) but more frequently than in the WHO elimination strategy (2), the proportion of women screened according to Australian recommendations is additionally reported. Since 1st December 2017, Australia has recommended 5-yearly primary HPV screening starting at age 25 and an exit test to occur between the ages of 70-74 years; prior to this, 2-yearly cytology was recommended for women aged 20-69 years (starting at age 18-20 years or two years after first sexual intercourse, whichever was later). Women were due to attend for their first HPV test two years after their last negative routine cytology test, or when they turned 25, whichever was later. Results are age-standardised, to remove variability between groups that is driven by differences in their age distribution. 

Source: Analysis of NCSR data (NCSR RDE 11/07/2025, extracted July 2025); data prepared by the Screening Analysis and Monitoring Unit of the Australian Institute of Health and Welfare. Remoteness areas and socioeconomic areas were allocated based on the individual’s address at the end of the reporting year, primarily using an SA2 2021 correspondence. Where SA2 was not available, a postcode correspondence was used. The correspondences produced by the Australian Bureau of Statistics (ABS) can now be found on data.gov.au by searching for: ‘ASGS’, the 'year', and ‘correspondences’ (ABS 2021). 

The population eligible for screening in this report comprise the estimated resident female population, minus an estimate of the number of females who have had a hysterectomy, consistent with routine AIHW reports (3-5). For this reason, the term females is used in this indicator whenever referring to proportions that rely on ABS estimates of the female population. The ABS population estimates used are those based on the 2021 Census (4,5), and for end-2024 are extrapolated from mid-2023 and mid-2024 (the most recent available data). Hysterectomy prevalence from AIHW analysis of National Hospital Morbidity Database (3).  

Percent is age-standardised across females aged 25-74, using the Australia 2001 standard population (6). 

The current report includes those with a test within a period of up to 6 months longer than the recommended interval (5.5 years for a HPV test, 2.5 years for cytology, the latter affecting findings in 2018 and 2019 only), consistent with the methodology updated in 2025. This approach is consistent with the methodology used in other screening programs internationally and allows some flexibility for those attending slightly after 5 years, potentially after receiving a reminder.  Estimates for 2018-2023 have been recalculated using this updated methodology and so differ from results for this indicator in previous reports. 

Cervical screening is important to expedite elimination of cervical cancer, as HPV vaccination requires several decades to have its full effects across the population. As Australia has a well-established screening program with screening recommended aligned with the broader WHO screening recommendations (1) but more frequently than in the WHO elimination strategy (2), the proportion of women screened according to Australian recommendations is additionally reported. Since 1 December 2017, Australia has recommended 5-yearly primary HPV screening starting at age 25 and an exit test to occur between the ages of 70-74 years; prior to this, 2-yearly cytology was recommended for women aged 20-69 years (starting at age 18-20 years or two years after first sexual intercourse, whichever was later). Women were due to attend for their first HPV test two years after their last negative routine cytology test, or when they turned 25, whichever was later. Results are age-standardised, to remove variability between groups that is driven by differences in their age distribution. 

Two screening indicators reflecting the Australian program are now included in this report: the proportion who are up to date with screening (which can therefore be used to identify the proportion who are overdue for screening; indicator 7A), and the proportion of those with an HPV test when they were aged 25-74 years, directly corresponding to the measure used in NCSP Monitoring Reports produced by AIHW from 2025 on (indicator 7B). The latter has been included for the first time in this elimination progress report in order to have these two estimates of participation presented together, so they can be contextualised.  Both indicators use a period of 5.5 years to encompass timely cervical screening.

Nationally, 78.1% of eligible females had an HPV test over the period 1 January 2020 to 30 June 2025 when aged 25-74 years (age-standardised to the Australia 2001 Standard Population). Data were not available to report on this measure for Aboriginal and Torres Strait Islander women. There was some variation across different areas of Australia (Figure 7.3). The widest variation was by age, where it ranged from 64.3% of those having a test when aged 70-74 years to 82.3% when aged 50-54 years (Figure 7.4), and then by SES, where it varied from 70.2% in the most disadvantaged areas to 87.2% in the least disadvantaged areas. This proportion reached 80% or more in those aged 25-29 years, 45-49 and 50-54 years, the ACT, and the two least disadvantaged quintiles. There was some variation by remoteness (range: 70.0% in very remote areas to 78.6% in major cities), but relatively little variation by state and territory (76.9% in NSW to 80.5% in the ACT).

Compared to the previous comparable time period (1 January 2019 – 30 June 2024), the proportion with an HPV test has decreased nationally (from 78.8% to 78.1%) and in many categories.  Increases in the proportion with an HPV test over a 5.5 year period were observed in very remote areas, among those aged between 55 and 74 years, and  in Tasmania and the NT.

This is the third full 5.5-year period of the HPV screening program and so second time trends for this indicator could be compared with those in a previous 5.5-year period. In most demographic groups for which we have stratified data, there has been a second consecutive decline in the proportion with an HPV test over a 5.5 year period, although notably this proportion has increased in each time period among those aged 65-69 and 70-74 years.  The decrease seen in most (but not all) groups is likely a return to a longer-term decline in screening rates that was seen across the period 2007-2016, in particular among those aged less than 50 years (but which was obscured from 2019 to 2022, due to the transition to a longer screening interval and results not being available for this measure).  It may also be due to rising challenges in accessing primary care, including cost (3).

Source: Analysis of NCSR data (NCSR RDE 11/07/2025, extracted July 2025); data prepared by the Screening Analysis and Monitoring Unit of the Australian Institute of Health and Welfare. Remoteness areas and socioeconomic areas were allocated based on the individual’s address at the time of the test, primarily using an SA2 2021 correspondence. Where SA2 was not available, a postcode correspondence was used. The correspondences produced by the Australian Bureau of Statistics (ABS) can now be found on data.gov.au by searching for: ‘ASGS’, the 'year', and ‘correspondences’ (ABS 2021). 

Females with an HPV test in the relevant 5.5 year time period include individuals with an HPV test (test for any reason) and who are aged 25-74 years at the time of the test. The population who are eligible for screening comprise the estimated resident female population, minus an estimate of the number of females who have had a hysterectomy, consistent with routine AIHW reports (4-7). For this reason, the term females is used in this indicator whenever referring to proportions that rely on ABS estimates of the female population. The ABS population estimates have been updated to use those based on the 2021 Census (5,6). Hysterectomy prevalence from AIHW analysis of National Hospital Morbidity Database (4). As this indicator calculated age and residence as at the time of the test (rather than at the end of the period, as in Indicator 7A), a specific test needs to be selected for any individuals who have more than one test in the 5.5-year period.  The methodology updated in 2025 selects the last test for the purposes of these calculations (however, the first test will be retained for tracking initial engagement via sub-analysis in other reports (4)). Additional information on methods can be found in the NCSP Monitoring Report prepared by AIHW, from which these results are drawn (4).

Percent is age-standardised across females aged 25-74, using the Australia 2001 standard population (7).

This measure includes those with an HPV test within a period of 5.5 years (6 months longer than the recommended interval), based on the methodology updated in 2025. This approach is consistent with the methodology used in other screening programs internationally and allows some flexibility for those attending slightly after 5 years, potentially after receiving a reminder.

Data on Indigenous status are not yet sufficiently complete on the NCSR to allow reporting by Indigenous status. Given cervical cancer incidence rates are much higher among Indigenous women, and cervical screening is critical to reduce cervical cancer incidence in unvaccinated cohorts, understanding and reporting screening coverage in Indigenous women is critical to achieving timely elimination among Indigenous women. There have been earlier studies of cervical screening coverage in Indigenous women, in the pre-renewed NCSP, based on analyses of ad hoc linked data for Qld, NSW, and the NT (8-10). In all three of these jurisdictions, Indigenous women were less likely to have been screened in the previously recommended interval of two years, and over a longer interval of five years (data for five years only reported for Qld and NSW).

Both parts of indicator 7 (7A up to date with screening, and 7B AIHW definition of participation) measure engagement with screening in line with the NCSP Guidelines, but in different ways.  For the first time, both measures are included, to contextualise and highlight how these two estimates of participation provide different but complementary information.  Both indicators use a period of 5.5 years to evaluate timely cervical screening and include people with an HPV test regardless of the reason for the test.  The results have different interpretations, however, as described in the illustrative example below: 

• Indicator 7A.     At the end of 2024, 50.0% of those aged 25-29 years at the end of 2024 were up to date with screening (and therefore 50.0% were overdue for screening) [up to date with screening measure in this report]. This measure can be directly used to infer the proportion who are overdue at the end of the period and so can be used to inform decisions about groups that may need further reminders or support to attend screening, or where outreach or promotional activities may be most needed.  It does not directly provide information about people’s age (or where they lived) at the time of their test; rather it identifies these aspects at the end of 2024.
• Indicator 7B.    80.5% of those who were aged 25-29 over January 2020 to June 2025 had an HPV test when they were aged 25-29 years. [screening participation in AIHW reports from 2025]   This measure provides a retrospective assessment over a 5.5-year period in terms of people who were screened and the age they were (and where they lived) at the time of their test, so can provide information about engagement with screening in the past.  It cannot be used directly to quantify how many people are overdue, their current age, or where they now live.

The estimates in this section are not directly comparable with estimates in routine AIHW reports published from 2020 to 2024, as the estimates here include HPV tests performed for any purpose (including for symptoms, follow-up of a previous abnormality, at colposcopy, or any other purpose, consistent with AIHW reports up until 2019), to capture all of those who are engaged with screening or being followed up in some way. The updated definition of participation in the 2025 NCSP Monitoring Report by AIHW (and now also included in this annual progress report) includes HPV tests for any purpose (analogous to the measure reported in reports in 2019 and earlier relating to the cytology program, and also similar to the measure referred to as coverage in AIHW reports from 2020 to 2024, except that coverage in those reports also included cytology tests).  

The hysterectomy prevalence estimates that are used to derive the population eligible for cervical screening are from an AIHW analysis of National Hospital Morbidity Database, and so consistent with other reports, however these estimates are not broken down by state/territory, remoteness area, or area-level SES. Potentially the prevalence of hysterectomy does vary across these strata, so using national age-specific estimates may under- or over-estimate the population who are eligible for screening in some cases.

1 WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. Geneva: World Health Organization; 2021. Available at: https://www.who.int/publications/i/item/9789240030824

2 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  

3 Australian Bureau of Statistics. Access to health services: Equitable access to quality health and care services [internet]. Canberra, 2025.  Available at: https://www.abs.gov.au/statistics/measuring-what-matters/measuring-what-matters-themes-and-indicators/healthy/access-health-services   

4 Australian Institute of Health and Welfare. National Cervical Screening Program monitoring report 2025. Canberra: AIHW; 2025. Available at: https://www.aihw.gov.au/reports/cancer-screening/ncsp-monitoring-report-2025 

5 Australian Bureau of Statistics. Regional population by age and sex. Canberra: ABS; 2025. Available at: https://www.abs.gov.au/statistics/people/population/regional-population-age-and-sex/latest-release 

6 Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA), Australia Canberra: ABS; 2021. Available at:  https://www.abs.gov.au/statistics/people/people-and-communities/socio-economic-indexes-areas-seifa-australia/2021

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

8 Whop LJ, Baade P, Garvey G, et al. Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011. PLoS One 2016; 11(4): e0150473  

9 Whop LJ, Garvey G, Baade P, et al. The first comprehensive report on Indigenous Australian women’s inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000–2011). Cancer 2016; 122(10): 1560-9

10 Dasgupta P, Cramb S, Baade P, et al. Regional variation in cervical cancer screening participation & outcomes among Aboriginal and non-Aboriginal Australian women: New South Wales (2006-2013). 2018. Available at: https://apo.org.au/node/258511