9.5 Cervical cancer
Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80
Human papillomavirus vaccination (B)
For maximal effect, the vaccination should be given prior to the onset of sexual activity. It has no modifying effect on already acquired human papillomavirus (HPV) infections. It is available as part of the National Immunisation Program Schedule for girls and boys in year 7.81,82 HPV-vaccinated women still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.
Australia has the lowest mortality rate and the second lowest incidence of cervical cancer in the world. The success of the cervical screening program is dependent upon the recruitment of women: 85% of women in Australia who develop cervical cancer have either not had a Papanicolaou (Pap) test or been inadequately screened in the past 10 years. Women aged >50 years are still under-screened.83
Australia’s National Cervical Cancer Screening Program will change from December 2017 (the change was originally planned for May 2017 but a delay was announced in February 2017). As of that date, women aged 25–74 years, both HPV vaccinated and unvaccinated, will be invited to undertake an HPV test every five years.84 Women of any age who have symptoms (including pain or bleeding) should have appropriate clinical assessment, which may include a cervical cytology test and an HPV test. Women between 70 and 74 years of age who have had a regular screening test will be recommended to have an exit HPV test before leaving the cervical screening program.
A comparison between the current program and the one starting in December 2017 is given in Box A. In the interim, the National Cervical Cancer Screening program continues to recommend Pap test screening every two years for women who have ever had sex and have an intact cervix, commencing from 18–20 years of age (or up to two years after first having sexual intercourse, whichever is later).85
GPs are advised to check with their pathology provider about their Pap testing arrangements during the transition period as testing times may be affected and a new Medicare rebate for the liquid based cytology has been introduced.
- Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook. 10th edn (2015 update). Canberra: Department of Health, 2015.
- Skinner SR, Garland SM, Stanley MA, Pitts M, Quinn MA. Human papillomavirus vaccination for the prevention of cervical neoplasia: Is it appropriate to vaccinate women older than 26? Med J Aust 2008;188(4):238–42.
- Cancer in Australia: an overview 2012 (online version) Available at http://www.aihw.gov.au/cancer/cancer-in-australia-overview-2012/ch3/ [Accessed 10 August 2015].
- Australian Government Department of Health. National Cervical Screening Program. Canberra: Department of Health, 2015. Available at [Accessed 15 November 2015]
- National Health and Medical Research Council. Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities. Canberra: NHMRC, 2005.
- EUROGIN. Conclusions: Cervical cancer control, priorities and new directions: International charter. France, 2003.
- Monsonego J, Bosch FX, Coursaget P, et al. Cervical cancer control, priorities and new directions. Int J Cancer 2004;108:329–33.
- Buntinx F, Brouwers M. Relation between sampling device and detection of abnormality in cervical smears: A meta-analysis of randomised and quasi-randomised studies. BMJ 1996;313(7068):1285–90.
- Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Canadian Cervical Cancer Screening Trial Study Group. Human papillomavirus DNA versus papanicolaou screening tests for cervical cancer. N Engl J Med 2007;357(16):1579–88.
- Koliopoulos G, Arbyn M, Martin-Hirsch P, Kyrgiou M, Prendiville W, Paraskevaidis E. Diagnostic accuracy of human papillomavirus testing in primary cervical screening: A systematic review and meta-analysis of non-randomized studies. Gynecol Oncol 2007;104(1):232–46.
- Safaeian M, Solomon D, Wacholder S, Schiffman M, Castle P. Risk of precancer and follow-up management strategies for women with human papillomavirus-negative atypical squamous cells of undetermined significance. Obstet Gynecol 2007;109(6):1325–31.
- Arbyn M, Paraskevaidis E, Martin-Hirsch P, Prendiville W, Dillner J. Clinical utility of HPV-DNA detection: Triage of minor cervical lesions, follow-up of women treated for high-grade CIN: An update of pooled evidence. Gynecol Oncol 2005;99(3 Suppl 1):S7–11.
- Arbyn M, Buntinx F, Van Ranst M, Paraskevaidis E, Martin-Hirsch P, Dillner J. Virologic versus cytologic triage of women with equivocal Pap smears: A meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst 2004;96(4):280–93.
- Ronco G, Cuzick J, Pierotti P, et al. Accuracy of liquid based versus conventional cytology: Overall results of new technologies for cervical cancer screening: Randomised controlled trial. BMJ 2007;335(7609):28.
- Davey E, Barratt A, Irwig L, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systematic review. Lancet 2006;367(9505):122–32.
- Arbyn M, Verdoodt F, Snijders PJ, et al. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: A meta-analysis. Lancet Oncol 2014;15(2):172–83.
- Everett T, Bryant A, Griffin MF, Martin-Hirsch PPL, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2011;5:CD002834.