Summary

Cancer screening involves testing for signs of cancer or precancerous conditions in people without obvious symptoms. The National Cervical Screening Program (NCSP) is one of Australia’s three 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 2-yearly Pap tests for the target age group 20–69 to 5-yearly human papillomavirus (HPV) tests, followed by a liquid-based cytology (LBC) test if oncogenic (cancer-causing) HPV is found, for the target age group 25–74.

This is the sixth report to present data for the renewed NCSP. Data in this report focus on the 5 calendar years 2019, 2020, 2021, 2022, and 2023, with trend data from the year 2018.

Terminology

This report uses the terms ‘participants’ and ‘invitees’ when referring to data collected under the NCSP. These data are not restricted by sex or gender, with all cervical screening participants and invitees included in these data. For NCSP data, participants and invitees may include women, transgender men, intersex people, and non-binary people.

This report uses the term 'women' to mean ‘female' when referring to cancer incidence data and cancer mortality data as these data sources are based on sex assigned at birth. However, it should be noted that some people may not identify with this term.

Recruitment

There are two measures of participation in the NCSP – participation and coverage. Participation is restricted to only screening HPV tests, whereas coverage includes all HPV and LBC tests performed for any reason, and is a better indication of overall participation in cervical screening.

Over the 5 years 2019–2023, more than 4 million participants aged 25–74 had a screening HPV test (primary screening or follow-up HPV test), which equates to a participation rate of 63% of the eligible population.

Over the 5 years 2019–2023, more than 5 million participants aged 25–74 had an HPV or LBC test for any reason, which equates to a coverage rate of 73% of the eligible population.

Screening

Screening HPV test positivity is the proportion of valid primary screening HPV tests that detected oncogenic HPV. In 2023, for participants aged 25–74, positivity was:

  • 1% for oncogenic HPV 16 and 18 (the two types of HPV that cause most cervical cancers)
  • 6% for oncogenic HPV other than 16 and 18
  • 7% for any oncogenic HPV type.

Assessment

Participants considered at higher risk of a significant cervical abnormality are referred for colposcopy, which is the examination of the cervix using a magnifying instrument called a colposcope and is the first step in assessment.

In 2022, of the participants aged 25–74 at higher risk of a significant cervical abnormality, 59% had a colposcopy within 3 months. Median time to colposcopy was 65 days.

Diagnosis

Detection of high-grade abnormalities provides an opportunity for treatment before possible progression to cervical cancer.

In 2023, for every 1,000 participants screened, 8 had a high-grade abnormality detected by histology. In contrast, for every 1,000 participants screened, fewer than one had a cervical cancer detected. This reflects that the aim of cervical screening is not to detect cervical cancer, but to prevent it through the detection of high-grade abnormalities.

Outcomes

In 2020, 916 women aged 25–74 were diagnosed with cervical cancer, which is 11 new cases per 100,000 women in the population. 

In 2022, 204 women aged 25–74 died from cervical cancer, which is between 2 and 3 deaths per 100,000 women in the population.

Aboriginal and Torres Strait Islander participants

This is the second report to include data on cervical screening outcomes for Aboriginal and Torres Strait Islander participants for HPV screening test positivity, colposcopy rate, and high-grade cervical abnormality detection rate at the national level.

In 2023, for Aboriginal and Torres Strait Islander participants aged 25–74, positivity was:

  • 2% for oncogenic HPV 16 and 18 (the two types of HPV that cause most cervical cancers)
  • 9% for oncogenic HPV other than 16 and 18
  • 11% for any oncogenic HPV type.

In 2022, of the Aboriginal and Torres Strait Islander participants aged 25–74 at higher risk of a significant cervical abnormality, 50% had a colposcopy within 3 months. 

In 2023, for every 1,000 Aboriginal and Torres Strait Islander participants aged 25–74 screened, 13 had a high-grade cervical abnormality detected by histology, providing an opportunity for treatment prior to any possible progression to cervical cancer.

In 2016–2020, 194 Aboriginal and Torres Strait Islander women aged 25–74 were diagnosed with cervical cancer. After adjusting for age, incidence among Aboriginal and Torres Strait Islander women was 2.3 times the rate of non-Indigenous women.

In 2018–2022, 64 Aboriginal and Torres Strait Islander women aged 25–74 died from cervical cancer. After adjusting for age, mortality among Aboriginal and Torres Strait Islander women was 3.6 times the rate of non-Indigenous women.