Update on cervical screening in Australia

摘要

The National Cervical Screening Program in Australia has been stable and successful for more than two decades. Nevertheless, the environment in which the program operates has been profoundly disrupted by the introduction of the equally successful National Human Papilloma Virus (HPV) Vaccination Program. The ‘Renewal’ (or review) of cervical screening is designed to ensure that the success of the screening program continues and that all Australian women, HPV vaccinated and unvaccinated, have access to a cervical screening program that is based on current evidence and best practice. Renewal has involved an assessment of the evidence for the benefits and harms of various screening pathways and a modelled assessment to inform the likely efficacy of the various proposed screening pathways in vaccinated populations. The findings indicated that the effectiveness of the program could be increased, while the expenditure could be decreased, if HPV tests were used in place of cytology. In April 2014, the Medical Services Advisory Committee recommended that Australia move to a five yearly screening program using an HPV test with partial genotyping for HPV16/18 as the primary screening test, commencing at age 25 and with an exit test between the age of 70 and 74. At a research level, a major trial, Compass, designed to evaluate primary HPV screening in a partially vaccinated population, will generate empirical evidence against which to test the modelled predictions of the Renewal. Together, the evidence review, modelling and ongoing research provide a framework for continuous improvement of the cervical screening program and the potential for further declines in cervical cancer in Australian women.