Cancer screening involves testing for signs of cancer or pre-cancerous conditions in people without obvious symptoms. The National Cervical Screening Program (NCSP) is one of Australia’s 3 population-based cancer screening programs. It aims to reduce cervical cancer cases, illness and deaths by detecting precancerous abnormalities before any potential progression to cervical cancer.
The NCSP is a highly successful public health initiative in Australia, halving cervical cancer incidence and mortality since it was introduced in 1991. This has been achieved through organised, population-based cervical screening to detect precancerous changes, allowing treatment before any progression to cervical cancer, thereby preventing this disease.
A renewed NCSP was introduced on 1 December 2017 that included a change from a 2-yearly Pap test for the target age group 20–69 to a 5-yearly Cervical Screening Test (CST) (an HPV test, followed by a cytology test if HPV is found) for the target age group 25–74.
Three years after its commencement, this is the second report to present data for the renewed NCSP. This report presents data against 18 of the 20 performance indicators that will be used to monitor the NCSP going forward.
The term ‘people’ is used when referring to data collected under the NCSP. In the context of this report the term ‘people’ is defined as any person with a cervix. This may include women, transgender men, intersex people, and non-binary people.
Data included in this report are for the calendar years 2018 and 2019.
Participation in the new 5-year program cannot be properly reported until after such time as there are 5 years of data available. In the interim, participation and the related measure coverage have been estimated.
Participation has been defined as the number of people who had a primary screening or 12-month repeat HPV test over a specified period of time, as a percentage of the eligible population. This is not comparable to participation rates previously reported for the renewed NCSP, as participation previously included all HPV tests performed for any reason, but is now restricted to HPV tests performed for cervical screening only.
Over the 2 years 2018–2019, more than 3.1 million people aged 25–74 had a screening HPV test, which equates to a participation rate of 46%
Coverage is defined as the number of people who had an HPV or LBC test for any reason, including primary or repeat screening, investigation of signs or symptoms, test of cure, as part of a colposcopy, or for any other reason as specified in the clinical guidelines for cervical screening. The coverage rate aligns with the definition of participation rate used under the previous NCSP that included all Pap tests performed for any reason.
Over the 2 years 2018–2019, more than 3.5 million people aged 25–74 had an HPV or LBC test for any reason, which equates to a coverage rate of 52%.
Response to invitation
Responses to invitation are restricted to invitations to screen or rescreen. As this currently excludes people aged 30–74 whose previous screen was normal, this is not indicative of all people who screen, which will only be known when these people are invited to rescreen.
Of the people aged 25–74 who were invited to screen or rescreen in 2019, 15% had an HPV test within 6 months. Primary screening tests represented the majority of these tests, with 14% of people attending a primary screening test, specifically, within 6 months of invitation.
Rescreening looks at the time between a woman’s HPV test in 2019 and their last normal Pap test in the preceding 5 years. Of the people aged 25–74 screened in 2019 who had a normal Pap test within the preceding 5 years, 78% rescreened within the appropriate time frame of 21 months to3 years after their last normal Pap test. Of the others, 2% rescreened early (before 21 months) and 20% rescreened late (after 3 years).
Risk refers to the risk for significant cervical abnormality, and is determined by the result of the CST–comprised of an HPV test and, if indicated, reflex liquid based cytology (LBC). The risk allocated to the person determines their recommendation. People considered to be at low risk are recommended to rescreen in 5 years, people considered to be at intermediate risk are recommended to have a repeat HPV test in 12 months, and people considered to be at higher risk are referred for colposcopy.
Of the 1,528,122 primary screening episodes in 2019 in people aged 25–74:
- 92% were low risk for significant cervical abnormality
- 6% were intermediate risk for significant cervical abnormality
- 2% were higher risk for significant cervical abnormality
- fewer than 1% could not be assigned a risk (due to unsatisfactory or incomplete tests).
Correlation of screening results
In 2018 there were 11,398 primary screening tests that had an cytology test that predicted a high-grade or glandular abnormality or cervical cancer, with 7,800 followed by histology within 6 months. Of these, 7,800 histology tests, 4,976 (63.8%) had a histology result of high-grade cervical abnormality or cervical cancer.
Screening HPV test positivity
All people who have a CST have an HPV test. This HPV test includes partial genotyping, which means that not only can it determine if a cancer-causing (oncogenic) HPV type is present, but it can further determine whether oncogenic HPV types 16 or 18 (the 2 types that cause most cervical cancers) are present. The result of an HPV test will be one of:
- ‘Oncogenic HPV not detected’;
- ‘Oncogenic HPV 16/18 detected’;
- ‘Oncogenic HPV (not 16/18) detected’; or
Screening HPV test positivity measures the proportion of primary screening HPV tests that detect oncogenic HPV. Of the 1,528,122 primary screening HPV tests performed in 2018 in people aged 25–74:
- 2% were positive for oncogenic HPV types 16 or 18
- 7% were positive for oncogenic HPV types other than 16 or 18.
High-grade abnormality detection rate
Detection of high-grade abnormalities provides an opportunity for treatment before cancer can develop, thus the NCSP aims to detect high-grade abnormalities in line with its broader aim to reduce the incidence of cervical cancer.
In 2019, the high-grade detection rate was 9 people with a high-grade abnormality detected per 1,000 people screened aged 25. This means that, for every 1,000 people screened, 9 had a high-grade abnormality detected, providing an opportunity for treatment before possible progression to cervical cancer.
1. Prevention of cervical cancer through organised cervical screening
2. National Cervical Screening Program
3. Performance indicator monitoring
- Performance Indicator 1: Participation
- Performance Indicator 2: Response to invitation
- Performance Indicator 3: Rescreening
- Performance Indicator 4: Screening results
- Performance Indicator 5: Correlation of screening results
- Performance Indicator 6: Screening HPV test positivity
- Performance Indicator 7: Cervical cancer diagnosed after a low risk screening test result
- Performance Indicator 8 Self-collection people positive for oncogenic HPV (not 16/18) who have an LBC test within 6 months
- Performance Indicator 9 Self-collection people positive for oncogenic HPV 16/18 who have a colposcopy within 6 months
- Performance Indicator 10 Adherence to recommendation for follow-up
- Performance Indicator 11 Follow-up results
- Performance Indicator 12: Colposcopy rate
- Performance Indicator 13: Time to colposcopy
- Performance Indicator 14: Biopsy rate
- Performance Indicator 15: Yield of high grade abnormalities on biopsy among people who attend colposcopy after higher risk screening results
- Performance Indicator 16: Positive predictive value of colposcopy
- Performance Indicator 17a: High-grade cervical abnormality detection rate
- Performance Indicator 17b: Cervical cancer detection rate
- 3.5 Outcomes
- Performance Indicator 18: Cervical cancers diagnosed by time since last screen
- Performance Indicator 19: Incidence of cervical cancer
- Performance Indicator 20: Mortality from cervical cancer
Appendix A: Additional data tables
Appendix B: HPV vaccination coverage
Appendix C: Data sources
Appendix D: Classifications
Appendix E: Statistical methods
End matter: Acknowledgments; Abbreviations; Symbols; Glossary; References; List of tables; List of figures; Related publications;