Australia has a low incidence of cervical cancer at about 60% lower than the estimated world average. Only Western Asia is reported to have a lower incidence. The Australian cervical cancer mortality rate is lower in relative terms, at 76% below the estimated world average and at the bottom of the range alongside New Zealand and Western Europe. Australian incidence and mortality rates were comparatively stable during the 1980s, but decreased by 45% and 62% respectively during 1990-2012. This is attributed in part to introduction of an “organized approach” to cervical screening from 1991, including use of cytology registries to support service delivery. Downward momentum in incidence has slowed, however, with little change evident during 2000-2012. A reduction in screening coverage has also applied, with particularly low coverage for the lowest socio-economic quintile of the population, those living in very remote areas, and the Northern Territory. These areas all experience raised incidence rates. Aboriginal and Torres Strait Islander women have an exceptionally high incidence, at almost three times that experienced by other Australian women. So the screening and incidence picture is uneven and inequities apply. Older women, aged 55-69 years, experience a pronounced decline in screening coverage which would predispose to increased cancer risk.  

In general, the technical quality of screening appears to be high in Australia, with women screened biennially having a 93% lower incidence, and those screened at four-yearly intervals, having an 81% lower incidence than women screened less frequently. Quality of screening and follow-up services has been promoted actively by the Australian Society for Colposcopy and Cervical Pathology and the Royal College of Pathologists of Australasia. Meanwhile Commonwealth and State/Territory Governments have also promoted technical and program quality through the funding of cytology registers and ongoing monitoring of service program delivery. Policy changes have been evaluated, as for example the change in policy to limit colposcopy for low-grade lesions to those that persist. Comparing cervical cancer incidence following low-grade cytology for approximately seven years following policy change revealed similar hazard ratios compared with a reference period prior to policy change (i.e., HR 0.96, 95% CLs 0.78, 1.18, at 2 years from cytology screen).  Longer follow-up to five years after cytology screen also revealed cervical cancer incidence rates that were close to the pre-policy baseline. AIHW undertook these data compilation with the jurisdictions, and the analyses, which the Safety Monitoring Committee monitored closely, with prescribed trigger points at hand, should there be need to sound an alert.

A new Quality Safety Monitoring Committee has replaced the Safety Monitoring Committee with a broader brief to advise the Standing Committee on Screening on quality as well as safety of the Renewed Program. Quality Indicators under discussion relate to: Recruitment – participation, response to invitation & rescreening; Screening – episode results, HPV test results, HPV test/histology correlation, negative HPV tests followed by a cervical cancer; Assessment – colposcopy occurring where recommended (by genotype & LBC result, as applicable), time to colposcopy, biopsy rate in colposcopy cases, predictive value positive of colposcopy for higher risk (confirmed histological high grade or cancer), Diagnosis – histological high-grade abnormality rate in screened women, cancer incidence overall and by screening history and time since last screen, and cervical cancer mortality. Also Safety Indicators under discussion relate to: Cancer risk in screened HPV negative cases, Cytology results at 2.5 years post HPV negative screen compared with expected results, HPV results compared with expected results, Adherence to management guidelines by risk category (intermediate & higher risk), and Reviews of screen histories of cervical cancer cases by vaccination history and cancer HPV type. The indicators used for quality and safety monitoring are being developed with reference to the NCSP Quality Framework. Other Q&S issues relate to priority population groups, the use of self-collection by under-screened women, transition from jurisdiction to central Registry, workforce change, timely availability of re-engineered central Registry data, and ready data access. An overview of key Q&S issues will be included in this presentation.