The National Cervical Screening Program (NCSP) is one of Australia’s three national population-based cancer screening programs. It commenced in 1991 with the primary aim of reducing numbers of cervical cancers and deaths by detecting precancerous abnormalities before progression to cervical cancer.1
Prior to December 2017, cervical screening was undertaken through organised, population-based, 2-yearly Pap tests in women aged circa 20-69 years. From the 1st December 2017, a renewed NCSP was introduced, using the Cervical Screening Test (CST) every 5 years to detect human papillomavirus (HPV) for women aged 25–74 years. The CST is an HPV test, which is followed by a liquid-based cytology (LBC) test if oncogenic HPV is found.1
In 2017, the National Cancer Screening Register (NCSR) became the single source of cervical screening data in Australia, following the migration and consolidation of state and territory cervical screening register data. This change may affect comparisons with earlier NCSP reporting.
Higher participation in cervical screening signifies that more precancerous abnormalities can be detected leading to more treatment options and better outcomes.1 Participation is one of the 5 key performance indicators used to monitor the progress of the NCSP.
Under the performance indicator of ‘Participation’, both participation and coverage are measured. Participation refers only to a screening HPV test (primary screening or follow-up HPV test) whereas coverage covers all HPV or LBC tests for any reason. Coverage is similar to the definition of participation used in the previous NCSP, which was the proportion of females who had a Pap test for any reason and provides a more consistent indication of overall participation in cervical screening.
In this section, coverage is discussed, and measures are extracted from the National Cervical Screening Program monitoring report 2024.1
About this measure
Coverage is one of the key 5 performance indicators to monitor the progress of the NCSP. In this report, measures are extracted from the National Cervical Screening Program monitoring report 2024. The calculation of coverage in cervical screening is based on participants aged 25–74 eligible to screen who had any cervical screening test, including HPV or LBC test performed for any reason, including primary or follow-up screening, investigation of signs or symptoms, test of cure, as part of a colposcopy, or for any other reason as specified in the clinical guidelines for cervical screening.1
Current status
In the period January 2016-June 2017, 56.9% (age-standardised) of eligible women aged 20–69 years participated in the National Cervical Screening Program.1 Participation was highest among women aged in their 40s and 50s.1,6
Aboriginal and Torres Strait Islander peoples
National cervical screening participation data are not available by Indigenous status; however, a study of participation rates in Queensland showed that among Indigenous women, the participation rate in the period 2010–2011 was 33.5%, while among non-Indigenous women it was 55.7%.1,8 The incidence of cervical cancer among Indigenous Australian women is more than double that for non-Indigenous women (see the NCCI Diagnosis Indicator – Cancer Incidence).
Remoteness and socioeconomic status (SES)
Participation data by remoteness and socioeconomic status (SES) areas are available for the period 2015–2016. The participation rate varied by remoteness, with lower participation rates occurring in Remote areas and Very Remote areas (52.1% and 46.3%, respectively). The highest participation rate occurred in Inner Regional areas (56.6%).1
The participation rate also varied by socioeconomic status, ranging from 50.4% for women living in lowest socioeconomic status areas (SES 1) to 62.1% for women living in highest socioeconomic status areas (SES 5).1
International comparisons
A comparison of international participation rates suggests a relatively low participation rate for Australia; however, caution is advised when making comparisons, due to differences in target age groups and recommended screening intervals. Most other nations recommend screening intervals of 3 or 5 years; notably, Australia’s most recent age-standardised 3-year and 5-year screening rates were relatively high at 69.1% (2014–2016) and 82.2% (2012–2016), respectively.1
Trends
Since the 2004–2005 (when there was a change in methodology for determining the target population) the overall 2-year screening participation rate decreased from 59.4% to 56.0% (age-standardised). During this time, the participation rate among women in their 20s, 30s and 40s decreased, whereas among women in their 50s and 60s, participation increased.1,6
Remoteness and socioeconomic status (SES)
Participation data by remoteness are available from 2005–2006, and by socioeconomic status from 2007–2008. However, due to changes in the methodology used, only the data from 2011–2012 onwards can be directly compared. Since 2011–2012, decreases in participation rates with increasing remoteness have become more evident, particularly in Very Remote areas.1,6
Cervical cancer control in Australia
The lower, and slightly decreasing, level of screening in younger women should be considered in the context that the new Medical Services Advisory Committee (MSAC) recommendations include a starting age of screening of 25 years, and that younger women tend to screen at longer intervals.1 In addition, women under the age of 25 have a substantially lower risk of cervical cancer due to the commencement in 2007 of HPV vaccination (the National HPV Vaccination Program).8
The period since commencement of routine national cervical screening, and the subsequent introduction of Australia’s National HPV Vaccination Program, has seen the age-standardised mortality rate for cervical cancer in Australia decrease by more than 50%, from 4.0 per 100,000 women in 1991 to 1.9 per 100,000 in 2016.5,9
About the data
This measure shows the proportions of eligible women aged 20–69 years participating in cervical screening through the NCSP for rolling 2-year periods.
Numerator: Number of eligible women aged 20–69 years screened in a 2-year reporting period.
Denominator: Average number of female residents aged 20–69 years for the 2 years, adjusted to include only women with an intact cervix using age-specific hysterectomy fractions. Reporting periods 1996–1997 to 2003–2004 use hysterectomy fractions derived from the 2001 ABS National Health Survey; reporting periods 2004–2005 to 2015–2016 use hysterectomy fractions derived from the AIHW National Hospitals Morbidity Database.1
Methodology
Remoteness
For the period 2011–2012 onwards, women were allocated to a remoteness area using the postcode supplied at the time of screening, using the Australian Statistical Geography Standard (ASGS) 2011. For the periods 2007–2008 to 2010–2011, women were allocated to a remoteness area using the ASGS 2006. For the periods 2005–2006 and 2006–2007, women were allocated to a remoteness area using the ASGS 2001.
Socioeconomic status
For the period 2011–2012 onwards, women were allocated to a socioeconomic group using their residential postcode according to the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Disadvantage for 2011. For the periods 2007–2008 to 2010–2011, women were allocated to a socioeconomic group using their residential postcode according to the SEIFA Index for 2006.
Other data quality issues
The most recent year for data available by country is as follows:
Sweden, 3 years & 5 years (by age) | 2017 |
Ireland, 5 years | 2017 |
United Kingdom, 5 years | 2018 |
New Zealand, 3 years | 2018 |
Norway, 5 years | 2017 |
Finland, 5 years | 2017 |
Denmark, 3 years | 2016 |
Canada, 3 years | 2015 |
Netherlands, 5 years | 2017 |
Chile, 3 years | 2016 |
Australia, 2 years | 2016 |
- Data sourced from OECD.Stat10
- Rates are not age-standardised. Rates for Canada and Finland are estimated rates.
- Rates for Ireland, New Zealand and United Kingdom are provisional values.
- Different methodologies were used for Finland, Ireland, Netherlands and Sweden.
- Participation rates are for the relevant nation’s recommended screening intervals: Canada, Chile, Denmark, New Zealand 3 years; Finland, Ireland, Netherlands, Norway, United Kingdom 5 years; Sweden 3 years (23–49 years of age), 5 years (50–60 years)
- Programme age-range targets are: Australia (20-69 years); Chile (25–64 years); Denmark (23–65 years), Finland (30–60 years), Ireland (25–60 years), Netherlands (30–60 years), Norway (25–69 years), Sweden (23–49 years) United Kingdom (25–64 years for England and Wales, 20–60 years for Scotland, and 20–64 years for Northern Ireland)
Data sources
- Australian Institute of Health and Welfare cervical screening publications, 2004–2005 to 2019: https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2018/contents/table-of-contents
- OECD.Stat: http://stats.oecd.org/
International data
Participation rates are for the relevant nation’s recommended screening interval: Canada, Chile, Denmark, New Zealand 3 years; Finland, Ireland, Netherlands, Norway, United Kingdom 5 years; Sweden 3 years (23–49 years of age), 5 years (50–60 years). Programme age-range targets are: Australia (20-69 years); Chile (25–64 years); Denmark (23–65 years); Finland (30–60 years); Ireland (25–60 years); Netherlands (30–60 years); Norway (25–69 years); Sweden (23–49 years); United Kingdom (25–64 years for England and Wales, 20–60 years for Scotland, and 20–64 years for Northern Ireland).10
References
Activity in this area:
Data
Australian Institute of Health and Welfare. AIHW cervical screening publications: Accessed September 2019. https://www.aihw.gov.au/reports-statistics/health-welfare-services/cancer-screening/reports
Social Health Atlases of Australia: Population Health areas - Cervical screening: Accessed March 2019. http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-population-health-areas
Policy
Australian Government Department of Health. National Cervical Screening Program Renewal: Evidence review– November 2013. Accessed May 2017. http://www.health.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Review%20of%20Evidence%20notated%2013.06.14.pdf
References:
1. Australian Institute of Health and Welfare 2019. Cervical screening in Australia 2019. Cat. no. CAN 124. Canberra: AIHW.
2. Australian Government Department of Health. National Cervical Screening Program. Accessed May 2016; http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1
3. Australian Institute of Health and Welfare 2017. Cancer in Australia 2017. Cancer series no.101. Cat. no. CAN 100. Canberra: AIHW.
4. Australian Institute of Health and Welfare 2018. Cancer data in Australia. Cancer series. Cat. no: CAN 122. Canberra: AIHW. Accessed February 2019; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data
5. Australian Government Department of Health 2013. Medical Services Advisory Committee recommendations. Accessed May 2016; http://www.health.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Review%20of%20Evidence%20notated%2013.06.14.pdf
6. Australian Institute of Health and Welfare 2018. Cervical screening in Australia 2018. Cat. no. CAN 111. Canberra: AIHW.
7. Whop, L. J., Garvey, G., Baade, P., Cunningham, J., Lokuge, K., Brotherton, J. M. L., Valery, P. C., O'Connell, D. L., Canfell, K., Diaz, A., Roder, D., Gertig, D., Moore, S. P. and Condon, J. R. 2016. The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000-2011). Cancer, 122: 1560–1569.
8. Smith, M. and Canfell, K 2016. Impact of the Australian National Cervical Screening Program in women of different ages. Medical Journal of Australia 205 (8): 359-364.
9. Cancer Australia 2019. Cervical cancer in Australia. Accessed April 2020. https://www.canceraustralia.gov.au/cancer-types/cervical-cancer/cervical-cancer-australia-statistics
10. The Organisation for Economic Co-operation and Development (OECD) Statistics - OECD.Stat. Accessed September 2017; http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT