Don't get complacent about your Cervical Cancer Screening

Don’t get complacent about your Cervical Cancer Screening

Cervical Cancer

Pathology Awareness Australia has released new findings indicating a lack of knowledge and awareness of the Cervical Screening Test among Australian women. 

The survey of over 600 women found that 13 percent of us did not know we were overdue for the test and 15 percent had never had a Cervical Screening Test, putting ourselves at risk of developing the cancer.

The findings also revealed that vast number of us are not aware that the Cervical Screening Test is required every five years, or that the test only takes five minutes.

The findings are in line with National Cervical Cancer Awareness Week, where organisations including Pathology Awareness Australia and the Australian Cervical Cancer Foundation are calling for Australian women to reengage with their healthcare providers to ensure they are informed about the importance of cervical screening. We are also being encouraged to speak to our family and friends about the test.

Associate Professor Annabelle Farnsworth, said in a statement that “…more work needs to be done to educate women across the country about the importance of Cervical Screening Tests and the risk of delaying.”

Prof Farnsworth is the Medical Director at Douglass Hanly Moir Pathology and believes participation in screenings is vital to a woman’s health and wellbeing. 

“There are women out there between the ages of 25-74 that do not realise they are overdue, so it’s important for women to have that conversation with their healthcare provider and find out if they need a CST,” she said.

“We have the chance to eliminate cervical cancer in Australia if we can ensure that we have strong participation in screening and immunisation against HPV.”

Ambassador for the Australian Cervical Cancer Foundation, Sarah Maree Cameron said this week’s awareness-raising opportunity is critical to early detection.

“Cervical health wasn’t a topic of conversation when I was diagnosed with cervical cancer at the age of 22,” she said in a statement.

“A few of my friends weren’t even up to date with their screenings either. That quickly changed when they heard I was diagnosed with cervical cancer and had to have my cervix removed. National Cervical Cancer Awareness Week is a great opportunity to talk to our family and friends. We all have check-ups that we need to stay on top of and a quick chat could save someone’s life.”

This week also saw the publication of new data released by the Australian Institute of Health and Welfare which showed a 54 per cent decrease in the screening rate between January and June 2020 compared to 2019.

The report, titled Cancer Screening and COVID-19 in Australia, revealed that in the first half of 2020, 38,756 cervical screening tests were completed compared to 85,019 for the same period last year.

Melissa Ledger, the director of Cancer Prevention and Research said the reported emphasises the importance of women talking about cervical cancer screening.

“While this decrease was expected due to the program transitioning from the two-yearly Pap smear to the five-yearly cervical screening test, it is likely the reduction could be a result of the COVID-19 lockdown,” Ledger said.

“We know that less people attended face-to-face appointments with their GP, and therefore it is likely that fewer cervical screening tests were completed. “This is concerning as it means there is a sizeable portion of women who could now be overdue for screening.”

The Australian Institute of Health and Welfare also released another report which indicated 90 per cent of women diagnosed with cervical cancer were those who had never been screened or had not screened for some time.

“We know cancer screening helps find cancer earlier so treatment can start before the cancer reaches a more advantaged stage, giving people a better chance of survival,” Ledger added. She recommends persons between ages 25 to 74 years with a cervix obtain regular Cervical Screening Tests as part of their ongoing health and wellbeing checks.

“If people with a cervix delay their cervical screening, there is a chance a pre-cancerous abnormality may develop into cancer or an early cancer may develop to a stage that is more difficult to treat,” she said.

“It will be sometime before we know the full effect of COVID-19 pandemic on cancer screening, so we are urging people to stay up to date with their screening during cervical cancer awareness week. If it has been sometime since they have had a cervical screening or if they have never had one, it is important to make a time to speak to your GP.”

77 percent of survey respondents who are up to date with their screenings reported that they have told other women to have their cervical screening test done too.

In December 2017, a new test was introduced by the Department of Health for cervical cancer screening and the recommended frequently changed from every two years, to every five years. 

Global Task 

This week, the World Health Organisation launched its Global Strategy to Accelerate the Elimination of Cervical Cancer with the aim of emliminating cervical cancer and implement national cervical cancer control plans.

Globally, over 300,000 women die from cervical cancer each year. Despite cervical cancer being both preventable and treatable, it remains the the leading cause of cancer death in some of the poorest countries in the world, including Swaziland, Malawi, Zambia and Zimbabwe.

The Global Strategy was announced right after the 73rd World Health Assembly took place virtually, and includes the following targets to be met by every country by 2030:

90 percent of girls being vaccinated against HPV. 

70 percent coverage for twice-lifetime cervical screening with a high precision approach such as HPV testing. 

90 percent coverage for treatment of pre-invasive lesions and invasive cancer.

The strategy, “Accelerating the Elimination of Cervical Cancer as a Public Health Problem”, is designed to advance women’s health, strengthen worldwide health systems and address inequities between and within countries.

Dr Meg Doherty, Director of the WHO Global HIV, Hepatitis, and STI Programmes believes meeting these goals could potentially save more than 5 million women from premature deaths. 

“We must now redouble our efforts and work towards achieving the new WHO cervical cancer elimination targets… including access to palliative care by 2030,” she said. “Achieving these targets could reduce more than 40 percent of new cervical cancer cases and 5 million related deaths by 2050.” 

“We have made great progress in expanding HIV treatment for all who need it. We now need to ensure that women living with HIV lives are not cut short by cervical cancer, an entirely preventable condition through vaccination, screening and treatment. On this launch of the Cervical Cancer Elimination Initiative, we recommit to ensuring women, implementing partners and ministries of health have the tools needed to implement our updated guidelines”

Dr Princess Nothemba (Nono) Simelela, the WHO Assistant Director-General said in a statement, “As the world comes together to pledge to eliminate cervical cancer, we must keep our eye on ending this preventable burden on women and girls who are living with HIV. It is our unfinished business” 

Closer to Home 

Australia became the first nation to introduce a national publicly-funded HPV vaccination program in 2007. Ten years later, we became the first to introduce an HPV-based cervical screening program specifically designed to assist the HPV vaccination. 

Despite us having one of the world’s lowest cervical cancer rates, Aboriginal and/or Torres Strait Islander and Culturally and Linguistically Diverse (CALD) female-identifying persons experience different rates of detection and diagnosis. 

Last year, a report from the Australian Institute of Health and Welfare revealed that the incidence of cervical cancer among Aboriginal and Torres Strait Islander women was more than double that of non-Indigenous women. Indigenous women aged between 20-69 were found to have 22.3 new cases per 100,000 compared to 8.7 new cases per 100,000 for non-Indigenous women. 

The report also found that Aboriginal and Torres Strait Islander women were three times more likely to die from the cancer than non-Indigenous women. 

Rachel Tipoti, a clinical nurse consultant based at Queensland Health, told the ABC last week that a lack of testing and several barriers put Indigenous women at higher risk.

“Previous experiences with health services, kinship connections as well, they might feel shame to come in,” Tipoti said. “Also if there’s other things going on in the community — sorry business, they’re caring for other people, they tend to put themselves last. There’s a list that we’re going through and there’s 700 on the list for one community.” 

Tipoti believes more Indigenous women would have the test if their communities had locally based female clinicians who were Indigenous or culturally trained.

Renee Blackman is the Chief Executive Officer of Mount Isa Indigenous health service Gidgee Healing. She wants nurses to be trained in cervical screening, though acknowledges that a dwindling of government funding has been part of a general lack of interest.

“When we did have that resource of health promotion, there was a line up of nurses wanting to become accredited or trained to be able to be a part of cervical screening,” she told the ABC. “We used to have a very keen and passionate women’s health workforce that used to work out of the hospital, that I think has been depleted over the years. [It’s a matter of] getting into people’s minds that this is a really important thing for women to pay attention to and to stop putting ourselves last.” 

A study published earlier this month proved that disparities in both measures of Cervical cancer incidence and mortality between Indigenous and non-Indigenous women remain.

The study, titled “Spatial and temporal variations in cervical cancer screening participation among indigenous and non-indigenous women, Queensland, Australia between 2008-2017” found that the overall screening participation decreased over time for both Indigenous and non-Indigenous women and that Indigenous women had significantly lower participation than the Queensland average.

“Cervical cancer burden in Australia can only be reduced through concentrated efforts on identifying and addressing key drivers of the continuing disparities in screening participation,” the authors concluded. “Achieving equitable screening participation for all women especially Indigenous women requires community engagement and localised interventions.” 

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