Analysis of cervical cancer and abnormality outcomes in an era of cervical screening and HPV vaccination in Australia

Australian Institute of Health and Welfare, Release Date: 

This is the third report from an Australian-first project, combining screening, cancer, death, and HPV vaccination data to demonstrate the effects of screening and HPV vaccination on cervical cancer, precancerous abnormalities and cervical screening behaviour.

Screen-detected cervical cancers were less likely to cause death than those diagnosed in never-screened women, and HPV-vaccinated women were more likely to participate in cervical screening, and less likely to have a high-grade abnormality.

 

A community perspective: On Human Papillomavirus (HPV)-related cancer among women and, trans and gender diverse people

Positive Life NSW & Femfatales, April 2019

Authors: Liz Sutherland, Lance Feeney, Katya Samodurov

Human papillomavirus (HPV) is a common virus which can be passed through skin to skin contact during sexual activity. Evidence to date shows that women living with HIV are 3 to 6 times more likely to develop cervical cancer than the general female population. They are also at greater risk of developing anal, vaginal, oropharyngeal and vulvar cancers.

There are other groups who may have a higher but preventable risk because they are often left out of the conversation about HPV and related cancers. Trans men are less likely to be up-todate with Pap tests to screen for cervical cancer. Furthermore, several studies have highlighted that trans and gender diverse people, and lesbian and bisexual cis-gendered women are often disregarded as not being at risk.

Positive Life and Femfatales developed a cross-sectional study to:

• Assess awareness and knowledge of HPV infection and risk for 4 HPV-related cancers (cervical, vaginal, vulvar, and anal) among women and, trans and gender diverse people in Australia;

• Assess the knowledge gaps to inform the development and implementation of population-specific educational resources to increase community and healthcare professional awareness of HPV and related cancers;

• Assist with the prevention of morbidity and mortality by increasing screening, early detection and treatment of HPV-related cancers, and;

• Assess rates of HPV vaccination in women and, trans and gender diverse people

KEY FINDINGS:

1. The results from this survey highlighted a lack of awareness of risk, prevention,
symptoms, and early detection of HPV-related vaginal, vulvar, and anal cancers.

2. Approximately 28% of HIV-positive respondents were unaware that a vaccination
against HPV exists and 71% of HIV-positive respondents had not been vaccinated
against HPV.

3. Over half (60%) of HIV-positive respondents believe their risk of anal cancer was either‘about the same’, ‘lower’, or ‘much lower’ than the general female population’s risk.

4. While all HIV-positive respondents had screened for cervical cancer at some point in
their lives, 91.7% had never had an anal examination for anal cancer.

5. Among HIV-positive and HIV-negative but immunocompromised respondents who had undergone staging or treatment for either cervical, vaginal, or vulvar cancer, none had ever screened for anal cancer.

6. Of the HIV-positive respondents who do not receive screening reminder notifications, none were aware of the new 3 yearly National Cervical Screening Guidelines and changes.

7. Qualitative responses indicated that respondents generally preferred having clinician-initiated conversations with female doctors or nurses who were non-judgemental, non-dismissive, clear, and made them feel comfortable.

8. In an open-ended short-answer question, more than 25% of qualitative respondents felt that more awareness and normalising talking about HPV in the public realm would help increase their chance of detecting HPV-related cancer early.

Women and Sexual and Reproductive Health Position Paper: Second Edition, 2019

Australian Women’s Health Network Inc., 2019

The Australian Women’s Health Network first published its Women and Sexual and Reproductive Health Position Paper in 2012. Since then significant work has been undertaken across Australia in this area and a number of its recommendations have been implemented. This has resulted in a robust on going public conversation and a greater understanding of women’s sexual and reproductive ill health, its impact, what drives it and how best to prevent it. These gains have only been possible through continuing evidence-informed advocacy, research and practice development.

In light of the new knowledge and experience available, and changes to the political, organisational and social landscape in 2019, the Australian Women’s Health Network has updated its Women and Sexual and Reproductive Health paper to produce
this Second Edition.

This paper advocates for a rights-based approach to ensuring all women can access comprehensive sexual and reproductive health care appropriate to their needs,
regardless of their location, age, sexuality, financial status and religious and cultural background. It explores seven key areas through which good sexual and reproductive
health for Australian women can be achieved.

These are:

1. promoting positive and respectful attitudes to sex and sexuality

2. developing women’s health literacy

3. increasing reproductive choice

4. facilitating women’s health throughout pregnancy and birth

5. expanding prevention and treatment of reproductive cancers and menstrual issues

6. improving prevention and treatment of sexually transmitted infections (STIs)

7. equipping the health workforce to better respond to women’s health needs.

Liver cancer death rate rising: study

SBS News, 9/4/19

The rate of liver cancer deaths and diagnoses has increased substantially in the past three decades, yet researchers say little has been done to help Australians most at risk.

While it is considered a relatively rare type of cancer – nearly 2000 people were diagnosed in 2014 – the high mortality rate and increasing incidence of diagnosis has been concerning, researcher Barbara de Graaff says.

Rates were highest in the Northern Territory, mostly due to a higher prevalence of hepatitis B and C.

Cervical cancer self-tests helping to break down barriers and increase screening rates

ABC Health & Wellbeing, Posted Friday 8th March 2019 at 14:54

In Australia, 80 per cent of cervical cancers are found in women who are overdue for screening or have never been screened.

“We know there’s an equity issue in our cervical screening program,” said Dr Saville, executive director of the VCS Foundation, a cervical screening not-for-profit.

“Women from lower socio-economic settings, Aboriginal and Torres Strait Islander women, and women from culturally and linguistically diverse backgrounds do not screen as often … and are more likely to get cancer.”

In a bid to overcome these barriers, a self-testing process was introduced to Australia’s National Cervical Screening Program in 2017.

Cervical cancer could be all but eliminated in 80 years: Lancet study

RACGP News, 20 Feb 2019

The Lancet Oncology modelling study found 149 of 181 countries could cut rates of the preventable cancer to four per 100,000 women by the end of the century – the threshold for considering it eliminated as a public health problem.

The study finds that combining high uptake of the vaccine with high screening could prevent up to 13.4 million cases of cervical cancer within 50 years, with the most benefit in low and middle income countries.