Impact

Cervical cancer is the 14th most common cancer affecting Australian women. Australia has one of the lowest rates of cervical cancer incidence and mortality in the world. In 2015 in Australia there were 857 new cases of cervical cancer.^[1] In 2016 there were 259 deaths attributable to cervical cancer.^[1] The lifetime risk of a woman developing cervical cancer before the age of 85 years is one in 162.

Cervical cancer incidence and mortality rates are three and four times higher respectively for Indigenous women than for non-Indigenous Australian women.^[2] Internationally, the large majority of cervical cancer cases (around 85%) and deaths (87%) occur in less developed regions.^[5] Incidence rates are lowest in Australia/New Zealand and Western Asia.^[5]

In Australia, lower participation in screening and higher rates of cervical cancer incidence and mortality have been reported in women with lower socio-economic disadvantage.^[6] Women from culturally and linguistically diverse communities are less likely to participate in cervical screening and are at an increased risk of cervical cancer incidence and mortality.^[7][8]

Almost all cases of cervical cancer are attributable to human papillomavirus (HPV) infection. HPV infection is highly prevalent: the estimated lifetime risk for women of one or more genital HPV infections is 80%.^[9] It is estimated that around 291 million women worldwide are infected with HPV, almost a third of whom are infected with the high-risk types HPV16 or HPV18 or both,^[10] which are present in about 70% of cervical cancers globally. In Australia, the proportion of HPV16/18 positive cervical cancer is higher than global rates at 77%.^[11]

The incidence and mortality rates for cervical cancer in Australia both halved after the introduction of the National Cervical Screening Program (NCSP) in 1991 until 2002, and have since remained stable at around nine new cases and two deaths per 100,000 women.^[1] Australia’s cervical cancer mortality rate is now among the lowest in the world,^[5][12] however this is not consistent for all population groups with mortality rates in Indigenous women similar to less developed regions.^[2][5]

The majority of the decline in invasive cervical cancer rates in developed countries is due to a reduction in squamous cell carcinoma. In contrast, the incidence of adenocarcinomas has not declined, largely attributed to difficulties in detecting these types of cancer through cervical screening using the Pap test.^[13][14] In Australia the incidence of adenocarcinoma has been increasing since the early to mid-2000s,^[15] and this cancer now comprises over one in four of all cervical cancers diagnosed.^[6] Trends in age-standardised incidence for different types of cervical carcinomas in Australia are shown in Figure 1.

Figure 1. Incidence of carcinoma of the cervix (squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and other and unspecified carcinoma) in women aged 20–69, 1982 to 2013

Source: AIHW 2017^[16]

Economic impact

The cost of the NCSP in 2017 was estimated at $223 million, excluding overheads.^[17] It has been estimated that had the renewed NCSP been in place instead of cytology-based screening, the NCSP would have cost approximately $41 million less in 2017. As the vaccinated cohort matures, the renewed NCSP becomes more favourable in terms of economic impact, as the difference in cost between the previous cytology-based program and the renewed NCSP increases further.