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Publish Date: 
Wednesday, October 3, 2018 - 16:45

A global front runner in cervical cancer prevention: Australia on track to eliminate cervical cancer by 2035

New research published today has revealed that cervical cancer may be eliminated as a public health problem in Australia within the next 20 years, following the success of the world-leading National Human Papillomavirus (HPV) Vaccination Program and recent changes to the National Cervical Screening Program. 

This new research, led by Professor Karen Canfell in conjunction with Professors Ian Frazer, Marion Saville, and Associate Professor Julia Brotherton, modelled the combined effects of the quadrivalent HPV vaccine and the 2018 transition to HPV screening in Australia until 2077. 
 
Using available data from 2007 onwards, a validated platform model (Policy1-Cervix) was used to predict the number of people recognised as having invasive cervical cancer each year until 2077. 
 
Based on these findings, it was predicted that the incidence of cervical cancer will drop below the ‘rare cancer’ threshold by 2020 – fewer than 6 cases per 100,000 women each year. Looking further forward, Australia is on track for cervical cancer to reach an elimination threshold of less than 4 cases per 100,000 women each year by 2028 (2035 at the latest*) – falling to less than 1 per 100,000 each year by 2066 (2077 at the latest*).
 
Therefore, these findings indicate that cervical cancer can be eliminated as a public health problem in Australia by 2035, if participation in HPV vaccination and cervical screening is maintained. 
 
Professor Frazer, the Founding CEO of Australia’s Translational Research Institute, co-inventor of the HPV vaccine and co-author of the new study, said “We have taken major steps forward with HPV vaccination, and with the introduction of the new screening program and now this new Cancer Council research predicts that we will be the first country in the world to achieve the elimination of cervical cancer.”
 
To help achieve this elimination target, it is important to ensure:
• Women, girls and boys receive the full schedule of HPV vaccination. More information.
• Women aged 25-74 continue to have a regular cervical screening test by participating in the National Cervical Screening Program. 
 
Professor Ian Frazer (middle) with researchers at the TRI
 

More information

HPV & Cervical Cancer

For the past 20 years, it has been recognised that persistent infection with cancer-causing (oncogenic) human papillomavirus (HPV) causes the majority of cervical cancers. While in most cases, HPV infections will be cleared by the immune system without intervention within 1-2 years, it can persist in approximately 10% of women. In some cases, persistent HPV infection can lead to cervical abnormalities (pre-cancerous changes), and potentially progress to cervical cancer over 10-15 years. 
 

The HPV Vaccine

Recognising the key role of HPV in the development of cervical cancer, Professor Ian Frazer and his team at the University of Queensland developed and commercialised the HPV vaccine, Gardasil (Merck). Using this vaccine, Australia was the first country in the world to implement a National HPV Vaccination Program (NHVP) in 2007.

The original HPV vaccine (Gardasil) protected against four subtypes of HPV– types 16 and 18, which are implicated in more than 70% of cervical cancers in Australia, and types 6 and 11 which can cause genital warts.  This vaccination program was initially rolled out to girls aged 12-13 years with a catch-up programme for women aged 14-26 years until 2009. In 2013 it was extended to include boys aged 12-13 years, with a catch-up program for boys aged 14-15 running until the end of 2015.

In 2018, the quadrivalent vaccine was replaced by two doses of a 9-valent HPV vaccine, which protects against an additional 5 oncogenic HPV types (31, 33, 45, 52 and 58). 

National Cervical Screening Program: transition to primary HPV testing. 

In December 2017, the National Cervical Screening Program transitioned from a 2-yearly cytology-based Pap test to a 5-yearly primary HPV test. Under the renewed NCSP, women return for their next cervical screening test in 5 years if high-risk HPV is not detected in their sample. If high-risk HPV is detected, the sample is re-analysed to look for cell abnormalities (cytology) to inform management. In this case, women are requested to return to their health professional to discuss the result and next steps – which either involves a repeat test in 12 months or specialist referral for further investigation.

Originally implemented across Australia in 1991, the pap test-based NCSP was highly successful in reducing the incidence of cervical cancer by approximately 50%, particularly in women older than 25 years. To further build upon this progress towards preventing cervical cancer, the NCSP transitioned to primary HPV test and cytology-based triage (liquid based cytology or LBC) in December 2017.  

Research publication: Hall MT, Simms KT, Lew J, Smith MA, Brotherton JM, Saville M, Frazer I, Canfell K. The projected timeframe until cervical cancer elimination in Australia: a modelling study. The Lancet Public Health, October 2 2018. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext

*According to ranges provided in the research publication.