Impact

From National Cancer Control Policy


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Impact

Cervical cancer is the 14th most common cancer affecting Australian women. Australia has one of the lowest rates of cervical cancer and incidence in the world. In 2013 in Australia there were 813 new cases of cervical cancer[1]. In 2014 there were 223 deaths attributable to cervical cancer[1]. The lifetime risk of a woman developing cervical cancer before the age of 85 years is one in 168[1].

Cervical cancer mortality rates are four to five times higher for Aboriginal and Torres Strait Islander women than for non-Indigenous Australian women[2]. This has been attributed to low participation in cervical screening[3]. In some Australian states and territories Aboriginal and Torres Strait Islander women’s participation rates have improved in response to efforts to increase accessibility and provide more culturally-acceptable programs.

Worldwide, cervical cancer is the seventh most common cancer, and the fourth most common cancer in women, with an estimated 528,000 new cases in 2012[4]. Cervical cancer caused 266,000 deaths worldwide in 2012[4].

The large majority of cervical cancer cases (around 85%) and deaths (87%) occur in less developed regions[4]. Incidence rates are lowest in Australia/New Zealand and western Asia[4]. Cervical caner mortality varies 18-fold between the different regions of the world, with rates ranging from less than two per 100,000 in Australia to more than 20 per 100,000 in Melanesia, and middle and eastern Africa[4].

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%[5]. 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[6], which are present in about 70% of cervical cancers.

Cervical cancer incidence and mortality in Australia both halved between the introduction of the National Cervical Screening Program in 1991 and 2002, and have since remained stable at around nine new cases and two deaths per 100,000 women[7]. Australia’s cervical cancer mortality rate is now among the lowest in the world[4][8].

The majority of the decline in invasive cervical cancer rates in developed countries is due to a reduction in squamous cell carcinoma (SCC). In contrast, the incidence of adenocarcinomas has not declined, largely attributed to difficulties in detecting these types of cancer through cervical screening[9][10]. In Australia this previously rare cancer now comprises over one in five of all cervical cancers diagnosed[7]. 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 carcinoma) in women aged 20–69, by year, 1982 to 2008

Cervical cancer incidence.PNG

Source: AIHW 2014[7]

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Economic impact

The cost of the National Cervical Screening Program (NCSP) and associated treatments for cervical cancer was estimated at $195 million in 2010 (excluding administrative program overheads)[11]. This included the costs of primary and follow-up smears ($108 million), colposcopy and histological evaluations ($21 million), treatment for pre-cancerous lesions ($46 million) and treatment for women with invasive cervical cancer ($21 million)[11]. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities[11].

The Australian Institute of Health and Welfare estimated health system expenditure on the NCSP in 2008–09 to be $125 million, increasing from $88 million in 2000–01[12]. However it should be noted that this figure does not include all downstream diagnostic and treatment costs, as in the above analysis.

The National Cervical Screening Program Renewal economic evaluation report estimated the program would cost $215 million in 2015 if screening recommendations remained the same[13].

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References

  1. 1.0 1.1 1.2 Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. [homepage on the internet] Canberra: AIHW; 2017 Feb 3 Available from: http://www.aihw.gov.au/acim-books/.
  2. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2012. Canberra: AIHW; 2012. Report No.: Cancer series no. 74. Cat. no. CAN 70.
  3. Condon JR, Armstrong BK, Barnes T, Zhao Y. Cancer incidence and survival for indigenous Australians in the Northern Territory. Aust N Z J Public Health 2005 Apr;29(2):123-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15915615.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. Lyon, France: IARC; 2013 Dec Available from: http://globocan.iarc.fr/.
  5. Bekkers RL, Massuger LF, Bulten J, Melchers WJ. Epidemiological and clinical aspects of human papillomavirus detection in the prevention of cervical cancer. Rev Med Virol 2004 Mar;14(2):95-105 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15027002.
  6. de Sanjosé S, Diaz M, Castellsagué X, Clifford G, Bruni L, Muñoz N, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis 2007 Jul;7(7):453-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17597569.
  7. 7.0 7.1 7.2 Australian Institute of Health and Welfare. Cervical screening in Australia 2011–2012. Canberra: AIHW; 2014. Report No.: Cancer series no.82. Cat. no. CAN 79. Available from: http://aihw.gov.au/publication-detail/?id=60129546865.
  8. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011 Mar;61(2):69-90 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21296855.
  9. Sasieni P, Castanon A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009 Jul 28;339:b2968 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19638651.
  10. FUTURE I and II Study Group, Ault KA, Joura EA, Kjaer SK, Iversen OE, Wheeler CM, et al. Adenocarcinoma in situ and associated human papillomavirus type distribution observed in two clinical trials of a quadrivalent human papillomavirus vaccine. Int J Cancer 2011 Mar 15;128(6):1344-53 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20949623.
  11. 11.0 11.1 11.2 Lew JB, Howard K, Gertig D, Smith M, Clements M, Nickson C, et al. Expenditure and resource utilisation for cervical screening in Australia. BMC Health Serv Res 2012 Dec 5;12:446 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23216968.
  12. Australian Institute of Health and Welfare. Health system expenditure on cancer and other neoplasms in Australia 2008-09. Canberra: AIHW; 2013 Dec 16. Report No.: Cancer series 81. Cat. no. CAN 78. Available from: http://aihw.gov.au/publication-detail/?id=60129545611.
  13. Medical Service Advisory Committee. National Cervical Screening Program Renewal: Executive summary. Commonwealth of Australia; 2013 Nov. Report No.: MSAC application no. 1276. Available from: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/754127911763F571CA257B8A001ADDC5/$File/WebAccessiblility_Combined_Executive_summary__Final_27Nov2013_SentToDoHA.pdf.

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