Notes on the data: Screening programs - Cervical screening

Cervical screening participation, females aged 25 to 74 years, 2018, 2019, and 2020

Policy context: Cervical cancer is a largely preventable disease in Australia. This is mainly due to primary prevention measures through the National HPV Vaccination Program which vaccinates women against the oncogenic HPV (human papillomavirus) types that cause the majority of cervical cancer, and secondary prevention through cervical screening to detect precancerous changes to cervical cells, allowing treatment before any progression to cervical cancer.

In 1991, Australia adopted an 'organised approach' to preventing cervical cancer, the National Cervical Screening Program (NCSP), which recommended and encouraged women under 70 years of age who have ever been sexually active to have Pap smears every two years. The NCSP was ‘renewed’ in December 2017. The renewed NCSP means changes to the way that women are screened. Instead of women aged 20–69 having a Pap test every 2 years, As part of the program renewal, women aged 25–74 can now have a Cervical Screening Test (CST) every 5 years. The CST is an HPV test, followed by a liquid-based cytology (LBC) test if oncogenic HPV is found. Another change is the collection of cervical screening data by the National Cancer Screening Register (NCSR), which is now the source of these data for the NCSP.

The key objectives of the Program are to reduce incidence and mortality and minimise morbidity from these cancers, and to maximise the efficiency of program delivery and its equity.

The introduction of the NCSP has contributed to the decrease in the incidence of cervical cancer over time, halving from 20.0 new cases per 100,000 women in 1990 to 9.9 new cases per 100,000 women in 2002 (for women aged 25–74); incidence has since remained at 9–10 new cases per 100,000 women. This decrease in incidence was accompanied by a decrease in the ranking of cervical cancer, from the sixth most common cancer in women in 1982 to the 12th most common in 2018 [1]. In 2018-2020, about 6 in 10 women (3.8 million women) participated in cervical screening; this represented 55.7% of women aged 25-74 eligible to have a screening test over this 3 year period [2].

In December 2017, the Cervical Screening Test replaced the Pap test in Australia. Further details of this program are available here.

References

Australian Institute of Health and Welfare (AIHW). Cancer Data in Australia. Canberra: AIHW; 2022. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/about; last accessed 12 December 2022
Australian Institute of Health and Welfare (AIHW). National Cervical Screening Program monitoring report 2021. Cat. no. CAN 141. Canberra: AIHW; 2021. Available from: https://www.aihw.gov.au/reports/cancer-screening/national-cervical-screening-program-monitoring-rep/summary; last accessed 9 December 2022

The participation rate for the 36 month period is based on the actual number of women screened as a percentage of the average of the ABS Estimated Resident Population for the three corresponding calendar years, excluding an estimate of those who had undergone a full hysterectomy. If a woman has attended more than once in the 36 months, she is counted once only, and the age is taken from the first visit.

Impact on screening during COVID-19 pandemic: The AIHW report that data show a decline in the number of cervical screening tests from the second half of March 2020. The number of tests remained low throughout April, during which there were fewer than 30,000 cervical screening tests carried out. The number of cervical screening tests increased in May and June, with a slight decrease in July and August, before increasing again in September 2020. Even with these differences, the number of cervical screening tests appear to have levelled off in July to September 2020 (see Did fewer people screen for cancer during the COVID-19 pandemic? At https://www.aihw.gov.au/reports/cancer-screening/cancer-screening-and-covid-19-in-australia/contents/did-fewer-people-screen-for-cancer-during-the-covid-19-pandemic). While there were fewer cervical screening tests in 2020 compared with 2019, the impact of COVID-19 cannot be quantified without further years of data (as 2020 is the first year impacted by the transition to 5-yearly screening).

Geography: Data available by Population Health Area, Local Government Area, Primary Health Network, Quintile of socioeconomic disadvantage of area and Quintiles within PHNs, and Remoteness Area

Numerator: Number of individual women aged 25 to 74 years screened over a 36 month period ending 31 December 2020

Denominator: Women aged 25 to 74 years (Estimated Resident Population (ABS): average of 30 June 2018, 30 June 2019, and 30 June 2020; excluding an estimate of those who have had a full hysterectomy)

Detail of analysis: Per cent

Source: Compiled by PHIDU based on data from the:

AIHW analysis of the NCSR (NCSR RDE 3.4.1 07/08/2021).
ABS Estimated Resident Population, average of 30 June 2018, 30 June 2019, and 30 June 2020; with hysterectomy fraction data derived from AIHW analysis of the National Hospitality Morbidity Database. Available at the Australian Institute of Health and Welfare 2016. Cervical screening in Australia 2013-20. Cancer series no. 97 Cat. no. CAN 95. Canberra: AIHW. Appendix C.