Australian Institute of Health and Welfare (2023) Cancer screening, AIHW, Australian Government, accessed 07 December 2023.
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Cancer screening. Australian Institute of Health and Welfare, 01 December 2023, https://www.aihw.gov.au/reports/australias-health/cancer-screening-and-treatment
Australian Institute of Health and Welfare. Cancer screening [Internet]. Canberra: Australian Institute of Health and Welfare, 2023 [cited 2023 Dec. 7]. Available from: https://www.aihw.gov.au/reports/australias-health/cancer-screening-and-treatment
Australian Institute of Health and Welfare (AIHW) 2023, Cancer screening, viewed 7 December 2023, https://www.aihw.gov.au/reports/australias-health/cancer-screening-and-treatment
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Cancer is a major cause of illness and death in Australia – there are 1.2 million people alive in Australia who are either living with or have lived with cancer (AIHW 2022a). Latest data (2014–2018) show that 7 in 10 people diagnosed with cancer survive at least 5 years after diagnosis, up from 5 in 10 around 30 years ago (AIHW 2022a).
Understanding and avoiding the risk factors associated with cancer can help to reduce the chance of getting the disease. Improvements in treatments and care are also important contributors to improvements in survival. Some cancers can be detected through screening. Cancer screening programs aim to reduce illness and death from certain cancers by allowing for early detection, intervention, and treatment.
This page focuses on cancer screening programs in Australia. See Cancer for information on cancer incidence, mortality, prevalence and survival.
Population-based cancer screening involves testing for signs of cancer or conditions that cause cancer before a person has symptoms. Early detection of cancer allows for early intervention and treatment, which can improve outcomes.
In Australia, there are national population-based screening programs for breast, cervical and bowel cancers. They are run through partnerships between the Australian Government and state and territory governments. The programs target certain groups where evidence shows that screening helps to reduce ill health and deaths from cancer.
Breast cancer screening in this section refers only to breast cancer screening undertaken through BreastScreen Australia.
BreastScreen Australia began in 1991 targeting women aged 50–69. The inclusion of women aged 70–74 was phased in from 1 July 2013. The program provides free 2-yearly screening mammograms (see Glossary) to women aged 40 and over, and actively targets women aged 50–74.
In this section, the term ‘participant’ is respectfully used to denote a person who has breast tissue that is suitable for breast cancer screening and who screens through BreastScreen Australia. Participants may include women, transgender men, transgender women, non-binary people, or other gender diverse people.
Participation in BreastScreen Australia
Over the 2 years 2021–2022, more than 1.8 million participants aged 50–74 were screened through BreastScreen Australia – 50% of the target population (AIHW 2023a).
- 35% of Aboriginal and Torres Strait Islander women aged 50–74 participated in BreastScreen Australia (25,000 participants). After adjusting for age, participation was 26% lower for Aboriginal and Torres Strait Islander women than for non-Indigenous women.
- 37% of women who spoke a language other than English at home participated in BreastScreen Australia (250,000 participants). After adjusting for age, participation was 25% lower for women who spoke a language other than English at home than women who spoke only English at home.
- After adjusting for age, participation was 31% higher for participants living in Outer regional areas than for participants living in Very remote areas (AIHW 2023a).
Detection of breast cancer
In 2021, almost 5,600 participants aged 50–74 had an invasive cancer detected through BreastScreen Australia and 59% of those breast cancers were small (≤15 mm). Small breast cancers are associated with more treatment options and improved survival (AIHW 2023a).
People with a cervix are at risk of cervical cancer and are the eligible population for cervical screening. People with a cervix may include women, transgender men, intersex people, and non-binary people, hereafter respectively referred to as ‘people’ or ‘participants’ in this section.
All cervical screening is undertaken through the National Cervical Screening Program (NCSP).
From its commencement in 1991 to 30 November 2017, the NCSP offered 2-yearly Papanicolaou smears, or ‘Pap tests’ (see Glossary) for the target age group 20–69.
Since December 2017, a renewed NCSP offers 5-yearly human papillomavirus (HPV) tests for the target age group 25–74. The cervical screening test detects the presence of cancer-causing HPV. If detected, a further examination of cells (cytology) is performed (see Glossary).
Participation in the National Cervical Screening Program
Over the 5 years 2018–2022, more than 4.7 million participants aged 25–74 were screened through the NCSP, which is an estimated 68% of the eligible population. This increased to more than 5.2 million participants and 77% when all cervical tests were included, not just screening tests (AIHW 2023b).
- After adjusting for age, participation was 16% higher for participants living in Major cities than for participants living in Very remote areas.
- After adjusting for age, participation was 20% higher for participants living in the highest socioeconomic areas than for participants living in the lowest socioeconomic areas (AIHW 2023b).
Detection of cervical abnormality
In 2022, for every 1,000 participants screened, 14 participants had a high-grade abnormality detected, providing an opportunity for treatment before possible progression to cervical cancer (AIHW 2023b). Participants aged 30–34 had the highest high-grade cervical abnormality detection rate (22 per 1,000 participants screened) (AIHW 2023b).
Bowel cancer screening in this section refers to the screening managed by the National Bowel Cancer Screening Program (NBCSP).
The NBCSP was established in 2006, offering screening to people at 2 target ages (55 and 65). In 2014, the Australian Government announced that the target ages would be expanded to offer 2-yearly screening to all Australians aged 50–74. This expansion was completed in 2020.
Over the 2 years 2019–2020, the program invited men and women turning 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72 and 74 to screen for bowel cancer using a free immunochemical faecal occult blood test (iFOBT) (see Glossary).
Participation in the National Bowel Cancer Screening Program
Over the 2 years 2020–2021, of the 6.1 million people invited, 41% participated in the program. Participation was higher for women than men (43% and 39%, respectively) (AIHW 2023c).
Since the expansion of the program from 2014, the NBCSP participation rate increased from 39% in 2014–2015 to 41% in 2020–2021 (AIHW 2023). Participation in the NBCSP varied between population groups and across areas of Australia in 2020–2021:
- The participation rate was lowest for invited people living in Very remote areas (25%) and highest for those living in Inner regional areas (43%).
- The participation rate was highest for people living in the highest socioeconomic areas (45%) and lowest for those living in the lowest socioeconomic areas (37%) (AIHW 2023c).
Detection of bowel cancer
In 2021, 6% of participants aged 50–74 who returned a valid kit had a positive iFOBT test (see Glossary). Of those with a positive result, 86% had record of a diagnostic assessment (colonoscopy) to follow up the positive screening result.
The return of NBCSP forms is not mandatory and as a result, diagnostic assessment data are incomplete. However, with the data available for participants who underwent a diagnostic assessment after a positive screen in 2021:
- 3.8% were diagnosed with a confirmed or suspected bowel cancer
- 15% were diagnosed with an adenoma (pre-cancerous tumour) (AIHW 2023c).
Participants who identified as Indigenous Australians, as well as participants who lived in Very remote areas and participants who lived in low socioeconomic areas all had higher rates of positive screens (warranting further assessment), but lower rates of follow-up diagnostic assessment, and a longer median time between a positive screen and assessment (AIHW 2023c).
National cancer diagnosis data do not reveal if a new case of cancer was identified through a screening program. This information can currently only be determined using data linkage. Linkage work conducted by the AIHW examined the effectiveness of the 3 national cancer screening programs on cancer mortality (AIHW 2018).
Key findings included:
- Women aged 50–69 who were diagnosed with a breast cancer through BreastScreen Australia between 2002 and 2012 had a 42% lower risk of dying from breast cancer by 2015 than women with breast cancers who had never been screened (AIHW 2018).
- Most cervical cancers diagnosed in women aged 20–69 between 2002 and 2012 (more than 70%) occurred in women who had never screened or who were lapsed screeners (AIHW 2018).
- People aged 50–69 who were diagnosed with a bowel cancer detected through the NBCSP between 2006 and 2012 had a 40% lower risk of dying from bowel cancer by 2015 than those with a bowel cancer who had not been invited to screen during the study period (AIHW 2018).
Further data linkage work is needed to continue to monitor cancer screening outcomes over time, and as more data become available. The AIHW is currently progressing 3 data linkage projects:
- one will examine adverse events after NBCSP-related colonoscopy
- a second will allow more complete monitoring of bowel and cervical screening programs as well as monitoring the impact of HPV vaccination
- another will provide more detailed analysis of breast screening behaviour and cancer outcomes, including among Aboriginal and Torres Strait Islander women.
The COVID-19 pandemic has affected many areas of people’s lives, including their access to, and use of, health services such as cancer screening programs. From the start of the COVID-19 pandemic in 2020 through to the first few months of 2022, many health care services suspended or changed the way they delivered services. The AIHW examined the impact of the COVID-19 pandemic on the number of cancer screening tests performed from January 2020 to September 2020 (AIHW 2020; AIHW 2021). The AIHW continued to monitor and publish quarterly the volume of activities for the 3 population-based screening programs to March 2023:
- screening mammograms conducted
- primary screening HPV tests completed
- bowel screening kits sent and returned each month (AIHW 2023d).
BreastScreen Australia services were suspended from 25 March until late April or early May 2020 due to COVID-19 restrictions. After this time breast screening resumed in a staged approach, with longer appointments and precautionary measures to ensure the safety of women and staff. The COVID-19 pandemic and suspension of BreastScreen services had a clear impact on breast cancer screening, with fewer screening mammograms performed through BreastScreen Australia between April and August 2020 than the same period in 2018 (the latest comparable year) (AIHW 2020; AIHW 2021). From May 2020, the number of screening mammograms recovered progressively to pre-COVID-19 levels until June 2021 but fell again during the second half of 2021 (July to December 2021) coinciding with further COVID-19 restrictions (AIHW 2023d).
There was no suspension of the NCSP due to COVID-19 at any time during 2020. However, the Cervical Screening Test is usually carried out by a person’s general practitioner (GP). While GP services continued during the pandemic, there was an increased use of telehealth consultations, and cervical screening tests require in-person consultations. The impact of the COVID-19 pandemic on participation in the NCSP is unclear, but there is some indication that the number of screening HPV tests may have been reduced (AIHW 2020; AIHW 2021).
There was no suspension of the NBCSP at any time during 2020. Eligible people are invited to participate with an at-home test kit, and people must leave their homes to mail their completed test kit to a pathology laboratory. Due to inconsistent weekly invitation volumes over this period, it was not possible to determine what impact the COVID-19 pandemic had on the NBCSP between January and September 2020 (AIHW 2020; AIHW 2021).
To better understand the impact of COVID-19 on cancer screening, activity data needs to be considered in the context of COVID-19 social restrictions and interruptions to services, as well as broader program-specific factors. These factors include seasonal variation in screening, changes in program methodology, and changes to data sources.
The full impact of the COVID-19 pandemic on cancer incidence and mortality requires additional data sources and cannot be known until longer-term data are available.
For more information about how the pandemic impacted cancer screening, see ‘Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.
For more information on cancer screening, see:
- National Bowel Cancer Screening Program: monitoring report 2023
- BreastScreen Australia monitoring report 2023
- National Cervical Screening Program monitoring report 2023
- Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia
- Cancer screening and COVID-19 in Australia
- Cancer screening programs: quarterly data
- Cancer data in Australia
AIHW (Australian Institute of Health and Welfare) (2018) Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia, AIHW, Australian Government, accessed 25 February 2022.
AIHW (2020) Cancer screening and COVID-19 in Australia, AIHW, Australian Government, accessed 7 September 2023.
AIHW (2021) Cancer screening and COVID-19 in Australia, AIHW, Australian Government, accessed 1 September 2023.
AIHW (2022) Cancer data in Australia, AIHW, Australian Government, accessed 1 December 2022.
AIHW (2023a) BreastScreen Australia monitoring report 2023, AIHW, Australian Government, accessed 4 October 2023.
AIHW (2023b) National Cervical Screening Program monitoring report 2023, AIHW, Australian Government, accessed 1 December 2023.
AIHW (2023c) National Bowel Cancer Screening Program monitoring report 2023, AIHW, Australian Government, accessed 16 June 2023.
AIHW (2023d) Cancer screening programs: quarterly data, AIHW, Australian Government, accessed 14 July 2023.