Note: In December 2017, the Cervical Screening Test replaced the ‘Pap test’ in the National Cervical Screening Program. The data provided in this indicator relate to participation in the Program for ‘Pap test’ screening.
Cervical screening is an important measure for the prevention and early detection of invasive cancer of the cervix. Australia commenced an organised program of routine cervical screening of the female population in 1991. An indicator of the performance of this joint initiative of Australian and state and territory governments – the National Cervical Screening Program (NCSP) – is the proportion of eligible women (i.e. those who have not had a hysterectomy) in the population aged 20–69 years, who had at least one ‘Pap test’ in a 2-year period.1,2 From 1 December 2017, the Cervical Screening Test which detects the human papillomavirus (HPV) and is recommended to occur every 5 years was adopted. With the ‘Pap test’ program ending, the latest data reported here is for an 18-month period from January 2016 to June 2017. A high participation rate is necessary for the NCSP to achieve its major objective of reducing cervical cancer incidence among Australian women.1
About this measure
Cervical cancer is the 14th most commonly diagnosed cancer in Australian women, excluding non-melanoma skin cancers (see the NCCI Diagnosis Indicator – Cancer incidence).3 It is projected that in 2019, 951 females will be diagnosed with this disease, and that it will cause 256 deaths.4 It is also estimated, using these data, that the risk of a female in Australia dying from cervical cancer by her 85th birthday is about 1 in 494.4
Infection with one or more high-risk types of human papillomavirus (HPV) is the primary cause of cervical cancer.1 Infection interferes with the normal functioning of cervical cells, predisposing to precancerous abnormalities. Cervical screening has used cytology testing of cells sampled through the Papanicolaou smear, or ‘Pap test’, to detect precancerous abnormalities, which facilitates intervention before cancer develops.1
In 2013, the Medical Services Advisory Committee (MSAC) announced recommendations for a renewed NCSP based on 5-yearly cervical screening of women 25 to 69 years of age, using a primary HPV test with partial HPV genotyping, followed by an exit test for women between 70 and 74 years of age.5 The new test has higher accuracy and is expected to improve early detection of cervical cancer, and survival. The new NCSP commenced on 1 December 2017.1 This means that the present indicator will need to be adapted to align with the new recommendations from that date.
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://cervical-cancer.canceraustralia.gov.au/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