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Cervical cancer screening in Australia
– Reported,22 January 2013
The National Cervical Screening Program in Australia currently recommends that sexually active women between the ages of 18-70 years attend routine screening every 2 years. The publically funded National HPV Vaccination Program commenced in 2007, with catch-up in females aged 12-26 years conducted until 2009; and this may prompt consideration of whether the screening interval and other aspects of the organized screening program could be reviewed. The aim of the current evaluation was to assess the epidemiologic outcomes and cost implications of changing the recommended screening interval in Australia to 3 years.
The aims of the study were to quantify the predicted effect of a 3-yearly screening recommendation in Australia on: national rates of invasive cervical cancer cases and cancer deaths; the estimated average cumulative lifetime risk of cervical cancer in Australian women; the annual number of colposcopy and biopsy procedures nationally; the number of treatments for pre-invasive lesions nationally; and costs and cost-effectiveness. We used screening registry data from the UK to inform compliance assumptions in Australia if a move to a 3-yearly recommendation was also associated with a move to call-and-recall organisation.
A substantial body of evidence has now found that screening in women younger than 25 years of age does not substantially lower the risk of developing invasive cervical cancer, and this evidence has been critical in informing the IARC recommendations for screening. We have previously proposed that a change to the recommended age of starting screening to age 25 years could be evaluated in Australia. In the current evaluation, we have not explicitly considered the impact of raising the age of starting screening, but it will be a focus of future work, particularly in the context of HPV vaccination and of potential changes to the primary screening technology.
To our knowledge, the current evaluation of cervical screening in Australia is the first conducted in any setting which takes into account realistic levels of screening compliance in relation to the method of screening organisation. By harnessing detailed screening program data from three countries, we have been able to apply information from other screening programs to inform an assessment of future screening options in Australia. A move to 3-yearly screening is predicted to reduce the annual numbers of screening tests, diagnostic investigations and treatments for high grade precancers, without resulting in a substantial increase in incident cervical cancers or cervical cancer deaths.
CREDITS:
Prudence Creighton, Jie-Bin Lew, Mark Clements, Megan Smith, Kirsten Howard, Suzanne Dyer, Sarah Lord, and Karen Canfell
http://www.ncbi.nlm.nih.gov/
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