Australia has an excellent record of successful prevention of cervical cancer through routine screening. Conventional cervical cytology (Pap smear), combined with effective screening registries, quality-assured pathology services, well-accepted national screening policy and clear guidelines for the management of screen-detected abnormalities, has served us well for 25 years. The success of the Australian program is demonstrated by annual incidence and mortality rates for cervical cancer that are now amongst the lowest in the world.
Although the National Cervical Screening Program has been very successful, we have some challenges. The significant false-negative rate associated with Pap tests mandates frequent screening to minimise failure to detect disease. However, a newer and more sensitive approach to cervical screening has now been established, which involves testing for the presence of the causal agent for cervical cancer, human papillomavirus (HPVHuman papillomavirus).
In 1984, Professor Harald zur Hausen demonstrated that cervical cancer is due to persisting infection of the cervix with HPVHuman papillomavirus. The knowledge that HPV causes cervical cancer has been further developed through major international epidemiological studies. It is now recognised that HPV comes in many types; some, designated as ‘high-risk’ or oncogenic types, are associated with a risk of developing cervical cancer in the future if infection persists. The worldwide evidence has also shown that the absence of cervical oncogenic HPV infection is associated with an exceedingly low risk for development of cervical cancer in the next 5 years. The development of automated laboratory tests that enable detection of oncogenic HPV infection in cervical samples thus facilitates the widespread introduction of primary HPV screening. This heralds a new era of more sensitive testing of cervical samples to assess the future risk of cervical cancer.
The discovery of HPVHuman papillomavirus’s role in causing cancer has also led to the development a vaccine to prevent cervical cancer. HPV vaccination was introduced into Australia in 2007 and young vaccinated women have already shown a falling rate of cervical abnormalities. These changes make Pap smear-based screening less efficient and the lower incidence of detected cervical abnormalities makes quality control more difficult.
Driven by all these developments, the National Cervical Screening Program has undergone a process of ‘renewal’ over the last 5 years, and this has resulted in an evidence-based decision to change from 2-yearly Pap smear tests to 5-yearly primary HPV testing. I am confident that the new 5-yearly HPV test based screening policy will provide even greater protection against cervical cancer than the previous program. The renewed program will protect up to 30% more women from cervical cancer, even whilst providing for a later starting age to commence screening and fewer screening tests over a woman’s lifetime. HPV-based cervical screening will now provide greater reassurance that all is well, without the need for further investigation in women without detected HPV infection.
This is great news for Australian women, and a testimony to the power of medical research to deliver practical outcomes for Australia. These new guidelines were developed by a team of expert clinicians and scientists. They support the new HPV-based National Cervical Screening Program by providing recommendations for the management of screen-detected abnormalities, symptoms and screening in special circumstances. I commend these guidelines to you and thank, on behalf of all Australians, the team that has evaluated the evidence and put together the recommendations for the benefit of all Australian women.
Professor Ian Frazer AC
The University of Queensland
President, Australian Academy of Health and Medical Sciences
FRS, FAA, FTSE, FAHMS
FRCP (Ed) FRACP FRCPA FRCOG FRACGP
MB ChB (Edin) MD (Melb) DSc (Edin)
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