Australia is within striking distance of eliminating cervical cancer as a public health problem, a landmark achievement driven by decades of investment in human papillomavirus (HPV) vaccination and robust screening programs. However, a new report from the NHMRC Centre of Research Excellence in Cervical Cancer Control reveals a concerning trend: declining vaccination and screening rates threaten to derail this progress. The success story unfolding in Australia offers valuable lessons for global health initiatives, but maintaining momentum requires renewed focus and targeted interventions to ensure equitable access and sustained participation.
Cervical cancer, largely caused by persistent infection with high-risk types of HPV, remains a significant health burden worldwide. But unlike many cancers, it is largely preventable. Australia’s journey towards elimination began with the introduction of the National Cervical Cancer Screening Program in 1991, utilizing Pap tests – also known as cytology – to detect precancerous cell changes. This program demonstrably reduced the incidence and mortality rates of cervical cancer by approximately 50%. The subsequent rollout of HPV vaccination in 2007, a world first, marked a turning point, dramatically reducing HPV infection rates and the prevalence of cervical pre-cancers.
The screening program underwent a significant update in 2017, transitioning from Pap tests to HPV testing, which directly identifies the presence of high-risk HPV types, particularly types 16 and 18 responsible for approximately 70% of cervical cancers. Cancer Australia details the benefits of this shift, noting increased accuracy in identifying those at risk. Further bolstering prevention efforts, a nine-valent HPV vaccine, offering protection against nine HPV types, was introduced in 2018, expanding the scope of protection beyond the earlier quadrivalent vaccine.
A National Elimination Strategy
Building on these successes, Australia launched a national cervical cancer elimination strategy in 2023, setting ambitious five-year goals. These include achieving a 90% HPV vaccination rate for both girls and boys, screening 70% of women aged 25-75 every five years, and ensuring treatment for 95% of detected pre-cancerous lesions and cancers. The 2025 Cervical Cancer Elimination Progress Report, authored by researchers at the University of Sydney, the University of Melbourne, the Kirby Institute at UNSW, The Australian National University and the Australian Centre for the Prevention of Cervical Cancer (ACPCC), assesses the nation’s progress towards these targets.
The report highlights encouraging findings. Notably, in 2021, no cases of cervical cancer were diagnosed in women under the age of 25 – a remarkable achievement attributed to the high uptake of the HPV vaccine before the onset of sexual activity. This data underscores the effectiveness of the vaccination program in preventing HPV infection and subsequent cervical cancer development. HPV infection rates have significantly declined, with only 1% of women aged 25-29 testing positive for HPV types 16 or 18. Approximately 85% of women aged 35-39 have undergone at least one HPV test, a crucial step in reducing individual risk.
Declining Rates Raise Concerns
Despite these positive trends, the report reveals a worrying decline in both HPV vaccination and cervical screening rates since the onset of the COVID-19 pandemic. HPV vaccination coverage among young people decreased from 85.7% in 2020 to 79.5% in 2024. This drop is particularly concerning as it threatens to undermine the long-term benefits of the vaccination program. Julia Brotherton, Professor of Cancer Prevention Policy at the University of Melbourne and a co-author of the report, emphasized the safety and efficacy of the vaccine, stating, “Parents should feel 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.”
Screening rates have also experienced a downturn, with more than one in four women now overdue for cervical cancer screening. Associate Professor Megan Smith from the University of Sydney’s Cancer Elimination Collaboration noted improvements in screening uptake among women aged 35-39, even in remote areas, but highlighted that 15% of this age group have never been screened, and only 50% of women aged 25-29 are up-to-date with screening. She advocates for “tailored strategies such as HPV self-collection” to improve accessibility and participation. The University of Sydney reports that these declines are prompting calls for enhanced national data systems to better monitor and address these trends.
Addressing Health Inequities
The report also underscores the persistent health inequities in cervical cancer prevention and outcomes. Indigenous Australians experience nearly double the cervical cancer rate compared to the national average, and their mortality rate from the disease is significantly higher. This disparity highlights the require for targeted interventions to improve access to vaccination and screening services for Indigenous communities, as well as culturally appropriate health education and support. Dorothy Machalek, an epidemiologist at the Kirby Institute, emphasized the importance of collecting better and more timely data to develop effective solutions for these vulnerable populations, stating, “Our national elimination strategy is centered on achieving cervical cancer elimination for all. But our report continues to show that some groups are at high risk of being left behind unless we act now.”
Recommendations for Continued Progress
The report outlines several key recommendations to revitalize Australia’s cervical cancer elimination efforts. These include reinvigorating school-based vaccination programs, improving access to vaccination and screening for Aboriginal and Torres Strait Islander adolescents, piloting innovative screening methods like self-collection, and enhancing national health data systems to facilitate more effective monitoring and evaluation. The C4 Centre of Research Excellence in Cervical Cancer Control, funded by the National Health and Medical Research Council (NHMRC), plays a crucial role in driving these initiatives and translating research into policy and practice. The ACPCC website provides further information on the C4’s ongoing projects and publications.
Cervical cancer is a preventable disease, and Australia’s experience demonstrates the power of sustained investment, comprehensive screening programs, and widespread vaccination. While elimination is within reach, the recent declines in vaccination and screening rates serve as a stark reminder that ongoing vigilance and proactive measures are essential. The challenges faced in Australia mirror those observed in other countries, including the United States, emphasizing the need for a global commitment to cervical cancer prevention and elimination.
The next key checkpoint in Australia’s cervical cancer elimination strategy will be the release of the 2026 progress report, providing an updated assessment of vaccination and screening rates, as well as an evaluation of the impact of the implemented interventions. Continued monitoring and adaptation of strategies will be crucial to ensure that Australia remains on track to achieve its ambitious goal of eliminating cervical cancer as a public health problem. What are your thoughts on the challenges and opportunities in cervical cancer prevention? Share your comments below, and help spread awareness about this important public health issue.
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