Helping Australia eliminate cervical cancer

Australia has been at the forefront of cervical cancer prevention for decades. Cancer Council researcher Professor Karen Canfell and her team have shown we are now poised to be the first country in the world to eliminate cervical cancer as a public health problem.

Cervical cancer is the fourth most common cancer affecting women worldwide. In Australia, around 930 women are diagnosed with cervical cancer every year.

The good news is, despite its devastating impact, cervical cancer is a preventable condition and Australia is right at the forefront of the important global mission to eliminate it as a public health problem.

Australia really has led the way on cervical cancer prevention. On the back of Australian research, we were the first country in the world to deliver a nationally funded HPV vaccination program.

In the 1980s, German researchers showed that most cases of cervical cancer were caused by a common virus called the Human Papillomavirus, or HPV. This Nobel Prize winning discovery underpinned the work of two Queensland-based scientists, Professor Ian Frazer and Dr Jian Zhao who, with the support of Cancer Council, set themselves the ambitious task of developing a vaccine that could protect against HPV infection and become the world’s first vaccine to prevent cervical cancer.

By 1998, the research team were successfully conducting their first clinical trials. Less than a decade later, an effective HPV vaccine had been produced and made available to Australian high school children through the National HPV Immunisation Program. This world-first program has already had a significant impact, with new infections of the vaccine-targeted HPV types amongst young Australians dropping dramatically.

Whilst the National HPV Immunisation Program will save millions of lives in the future, it is important to recognise that the vaccine can only prevent HPV infection. So, how do we also address the risk of cervical cancer in the many women who may have already been exposed to the virus? The answer is cervical screening.

Cancer Council have played a long-standing role in promoting women to get screened. In 1991 the National Cervical Screening Program was launched across Australia and using a regular pap smear test to detect abnormal cells, this resulted in a 50% drop in cervical cancer incidence and mortality over the first decade of the program. However, more recently cervical cancer rates have plateaued, and with greater understanding generated by HPV research, there was an enormous opportunity to harness new knowledge and take a new approach.

We started developing the Policy1-Cervix modelling platform over 15 years ago, before the vaccine program rolled out, with the knowledge that the vaccine would be such a game changer for both health outcomes and also cervical screening, and that policy-makers would need accurate and comprehensive predictions of outcomes.

This is where Cancer Council researcher Professor Karen Canfell stepped in. With a personal and professional interest in cervical cancer prevention, Professor Canfell set to work developing an innovative research tool that could capture the available evidence then simulate hundreds of different scenarios with the aim of identifying the one that provides the best possible outcome.

We look at hundreds of possible scenarios - for example what type of vaccine is used, how often we screen, age of screening, how women are managed in terms of positive results. These large number of scenarios are impossible to assess in clinical trials so the information provided by this modelling is essential.

The results of this modelling research showed that delivery of a targeted HPV screening program instead of using the more general pap test would reduce cervical cancer incidence and deaths by a further 20-30% over the long term in Australian women. In more good news for women, this test would only be required every 5 years, reducing the number of tests a woman will need in her lifetime.

Most excitingly of all, Professor Canfell’s team’s research showed that delivering a national HPV screening program in partnership with the national HPV immunisation program would dramatically reduce cervical cancer – making Australia one of the first countries in the world to eliminate cervical cancer as a public health problem.

Our modelling shows that the national implementation of the new screening program, alongside the delivery of a new generation of HPV vaccine, will significantly reduce risk and this has potential to eliminate cervical cancer as a public health problem within the next two decades.

Professor Canfell was especially mindful that she was breaking new ground – never before had cervical cancer screening been undertaken in a population where the HPV vaccine was also being delivered. So Cancer Council, in partnership with the VCS Foundation, established Australia’s largest clinical trial “Compass” to capture and evaluate new data on cervical screening. The outcomes will provide crucial evidence to guide health strategies both here and overseas.

Thanks to the ingenuity of our researchers and the persistence and support of organisations like Cancer Council, Australia now has the best cervical cancer prevention program in the world. Our research and researchers are now supporting global health leaders to reduce the impact of cervical cancer and save millions of lives.

The success we have achieved in the past, as well as the promise for the future, has been a great showcase for how organisations like Cancer Council can work with other researchers and governments in Australia and around the world to improve health outcomes.

The journey to eliminating cervical cancer:

1990sEarly stages of HPV vaccine developed

Professor Ian Frazer, along with his colleague the late Dr Jian Zhou, begin developing a vaccine for HPV which causes the vast majority of cervical cancer cases. Their funding includes several grants from Cancer Council

1991National Cervical Screening Program launched across Australia

Regular pap smear tests every two years ultimately helped reduce cervical cancer rates by 50% in women 25 years and over.

2005Research begins to optimise Australia’s Cervical Screening Program

Professor Karen Canfell and team start research to looking at optimising cervical cancer prevention – taking into account HPV vaccination and new screening methods.

2007Australian HPV vaccination program begins

Thanks to Ian Frazer and Jian Zhou’s research, Australia introduces the HPV vaccination program to teenage girls, to protect them against cervical cancer and other HPV related cancers.

2017: OctoberNHMRC centre of research excellence in cervical cancer control established

Cancer Council along with other leading research organisations awarded grant to further advance cervical cancer control in Australia and globally.

2017: DecemberNew cervical cancer screening program introduced

Karen Canfell’s team’s research underpins a new cervical screening program, which is introduced in Australia. The new program is predicted to reduce cervical cancer rates and deaths by at least 20% over the long term.

2018On track to eliminate cervical cancer

Karen and her team’s research shows we’re on track to become the first country in the world to eliminate cervical cancer as a public health problem thanks to HPV vaccination and the new cervical screening program.

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