Australia is within reach of eliminating cervical cancer as a public health problem, a milestone achieved through decades of investment in prevention strategies. A new report from the NHMRC Centre of Research Excellence in Cervical Cancer Control details the country’s remarkable progress, driven by a national screening program, widespread HPV vaccination, and increasingly sophisticated testing methods. However, recent declines in vaccination and screening rates are raising concerns among public health officials, threatening to stall momentum in the fight against this preventable disease.
The success story began in 1991 with the launch of the National Cervical Cancer Screening Program, which initially relied on Pap tests – also known as cytology – to detect precancerous cell changes. This program demonstrably reduced cervical cancer incidence and mortality by approximately 50%. In 2007, Australia became the first country in the world to implement a national HPV vaccination program, targeting young people to prevent infection with the human papillomavirus, the primary cause of most cervical cancers. The impact was swift and significant, leading to a substantial decrease in both HPV infection rates and the number of cervical pre-cancers.
A Shift to More Effective Screening
In 2017, Australia further refined its approach to cervical cancer prevention by transitioning from Pap tests to HPV tests. These newer tests specifically look for the presence of high-risk HPV types, particularly types 16 and 18, which are responsible for around 70% of cervical cancers. Individuals who test positive for these types can then be closely monitored by healthcare providers, allowing for early intervention and treatment. This shift is projected to reduce cervical cancer rates by an additional 20–30%.
The preventative arsenal was further strengthened in 2018 with the introduction of a nine-valent HPV vaccine, offering protection against nine types of HPV that can cause cancer. This expanded coverage built upon earlier vaccines, which protected against four HPV types, including the prevalent types 16 and 18. The combined effect of these measures has positioned Australia as a global leader in cervical cancer prevention.
Towards Elimination: National Goals and Current Status
Building on this foundation, Australia launched a national elimination strategy in 2023, setting ambitious five-year goals. These include achieving a 90% HPV vaccination rate for both girls and boys, screening 70% of women aged 25–75 every five years, and ensuring treatment for 95% of detected pre-cancers and cancers. The recent report indicates that Australia is making strides towards these targets, with several encouraging findings.
Cervical cancer rates are slowly but steadily declining. In 2020, there were 6.6 cases per 100,000 women, decreasing to 6.3 cases per 100,000 women in 2021. Perhaps most remarkably, no cases of cervical cancer were diagnosed in women under the age of 25 in 2021, a result researchers attribute directly to the success of the HPV vaccination program. HPV infection rates, particularly with types 16 and 18, are significantly lower in younger women, with only 1% of women aged 25–29 testing positive for these high-risk types. Approximately 85% of women aged 35–39 have undergone HPV testing at least once, a crucial step in reducing individual risk.
A Concerning Trend: Declining Vaccination and Screening Rates
Despite this progress, the report highlights a worrying trend: declining vaccination and screening rates since the onset of the COVID-19 pandemic. HPV vaccination coverage among young people decreased from 85.7% in 2020 to 79.5% in 2024. Julia Brotherton, Professor of Cancer Prevention Policy at the University of Melbourne and a co-author of the report, emphasized the safety and effectiveness of the vaccine, stating, “Parents should reckon of this as a gift they can supply their child to protect them for their lifetime. And I urge all young people who missed out at school, for whatever reason, to talk to their GP, nurse or pharmacist about accessing their free catchup dose.”
Screening rates have also fallen in recent years, with more than one in four women now overdue for cervical cancer screening. Megan Smith, co-author and Associate Professor at University of Sydney’s Cancer Elimination Collaboration, noted that while improvements are being seen in some age groups, particularly those aged 35-39, significant gaps remain. “With 15 percent of that age group having never had a screening test in their lifetime, and only 50 percent of 25- to 29-year-olds being up to date with screening, we need to promote tailored strategies such as HPV self-collection,” she explained.
Addressing Health Inequities
The report also underscores the importance of addressing health inequities in cervical cancer prevention. Indigenous Australians and those living in remote areas experience disproportionately higher rates of cervical cancer and mortality. In fact, Indigenous people have nearly double the cervical cancer rate of the national average, and their death rate from the disease is also significantly higher. Dorothy Machalek, an epidemiologist at the Kirby Institute and another co-author, stressed the need for targeted interventions. “Our national elimination strategy is centered on achieving cervical cancer elimination for all. But our report continues to show that some groups are at high risk of being left behind unless we act now. We need to focus our efforts on collecting better and more timely data so we can better develop effective solutions.”
The report recommends several key steps to sustain progress, including revitalizing school vaccination programs, improving access to vaccination and screening for Aboriginal and Torres Strait Islander adolescents, piloting innovative screening methods, and enhancing national health data systems. Cervical cancer is a preventable disease, and Australia’s success demonstrates the power of sustained investment and consistent public health messaging. However, the recent declines in vaccination and screening rates serve as a cautionary tale, mirroring trends observed in other countries, including the United States.
The next update on Australia’s progress towards cervical cancer elimination is expected in late 2026, when updated data on vaccination and screening rates will be available. Continued vigilance and a renewed commitment to prevention efforts are crucial to ensure that Australia remains on track to achieve its ambitious goal.
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