Australia Close to Eliminating Cervical Cancer Despite Declining Vaccination & Screening Rates

Australia is nearing the potential elimination of cervical cancer, a milestone achieved through decades of preventative measures, but recent declines in vaccination and screening rates are threatening to reverse that progress, according to a new report from the NHMRC Centre of Research Excellence in Cervical Cancer Control.

The report highlights Australia’s pioneering role in cervical cancer prevention, beginning with the launch of the National Cervical Cancer Screening Program in 1991. This program, which initially focused on regular Pap tests (cytology), reduced cervical cancer cases and deaths by approximately 50 percent by identifying and treating early cell changes.

In 2007, Australia became the first country globally to implement a national Human Papillomavirus (HPV) vaccination program. This initiative led to a significant decrease in HPV infection rates and the incidence of cervical pre-cancers. Further bolstering prevention efforts, the screening program transitioned to HPV testing in 2017, specifically targeting HPV types 16 and 18, responsible for the majority of cervical cancers. This shift is projected to reduce cervical cancer rates by an additional 20–30 percent.

The introduction of a nine-valent HPV vaccine in 2018, protecting against nine cancer-causing HPV types (including 16 and 18), further expanded protection. These advancements culminated in the launch of a national elimination strategy in 2023, setting ambitious five-year goals: achieving a 90 percent HPV vaccination rate for both girls and boys, screening 70 percent of women aged 25–75 every five years, and treating 95 percent of detected pre-cancers, and cancers.

Early indicators suggest Australia is making strides toward these goals. Cervical cancer rates have shown a slight decline, falling from 6.6 cases per 100,000 women in 2020 to 6.3 cases in 2021. Notably, no cases of cervical cancer were diagnosed in women under the age of 25 in 2021, a result researchers attribute to the widespread impact of HPV vaccination prior to sexual activity.

HPV infection rates are also decreasing, particularly among younger women. In 2021, only 1 percent of women aged 25–29 tested positive for HPV types 16 or 18. Approximately 85 percent of women aged 35–39 have undergone HPV testing at least once, a factor significantly reducing individual cervical cancer risk.

But, the report reveals a concerning trend: declining vaccination and screening rates since the onset of the COVID-19 pandemic. HPV vaccination rates among young people decreased from 85.7 percent in 2020 to 79.5 percent in 2024. Simultaneously, more than one in four women are now overdue for cervical cancer screening.

Julia Brotherton, Professor of Cancer Prevention Policy at the University of Melbourne and a co-author of the report, emphasized the safety and effectiveness of the HPV vaccine. “Parents should think of this as a gift they can give their child to protect them for their lifetime. And I urge all young people who missed out at school, for whatever reason, to talk to their GP, nurse or pharmacist about accessing their free catchup dose,” she stated.

Megan Smith, co-author and Associate Professor at the University of Sydney’s Cancer Elimination Collaboration, highlighted the need for tailored screening strategies. “We are seeing some improvements, including in the 35- to 39-year-old age group, even in very remote areas. But with 15 percent of that age group having never had a screening test in their lifetime, and only 50 percent of 25- to 29-year-olds being up to date with screening, we need to promote tailored strategies such as HPV self-collection.”

The report also underscores existing health inequities. Indigenous Australians experience nearly double the cervical cancer rate of the national average, with significantly higher mortality rates. Dorothy Machalek, an epidemiologist at the Kirby Institute and a report co-author, noted, “Our national elimination strategy is centered on achieving cervical cancer elimination for all. But our report continues to reveal that some groups are at high risk of being left behind unless we act now. We need to focus our efforts on collecting better and more timely data so we can better develop effective solutions.”

The report recommends revitalizing school vaccination programs, improving access to vaccination for Aboriginal and Torres Strait Islander adolescents, piloting innovative screening methods, and strengthening national health data systems. The Centre for Research Excellence in Cervical Cancer Control (C4) brings together researchers from multiple Australian universities to address these challenges.