There’s one area of women’s health that’s progressed a little differently to others. That area is cervical cancer, which in 2018 became the first and still only cancer that the World Health Organisation urged the globe to eliminate.
The campaign around cervical cancer has shown us that if the impetus and leadership exists, then eradication of a disease is more than possible.
Indeed, recent research from the UK shows that the human papillomavirus (HPV) vaccination, has cut cases of cervical cancer by 90 per cent. And, thanks to innovation and improvements in screening programs, those who typically have a pelvic examination to test for the virus that causes the cancer, will now be able to access a simple, less invasive swab test. The test will be available to eligible Australians from midway through next year.
When I spoke to Professor Marion Saville for the Women’s Health Project podcast, within hours of that announcement regarding the swab test being made, she was clearly excited and optimistic about what lay ahead.
We can’t underestimate the significance and possibility of this swab screening in dismantling some of the barriers that come with a more traditional pelvic examination.
She spoke about how this new swab process would help reach those falling through the cracks of the more traditional pelvic examination process, particularly in reached under-screened populations.
This self-collection method involves a simple swab accessed through a health provider, and similar to a COVID swab — which could be done in a bathroom or behind a curtain. It’s far less invasive than the more traditional screening process and is expected to improve participation rates across currently under-screen populations, including linguistically diverse women and Aboriginal and Torres Strait Islander women.
Professor Saville has been with the VCS Foundation for decades, which changed its name just over a week ago to The Australian Centre for the Prevention of Cervical Cancer to better speak to its key goal of eliminating cervical cancer as a public health problem in the country.
She said Australia may well become the first country to reach the WHO elimination target.
So what’s helped make this happen?
“It’s not an overnight success. There has been decades of support for an organised approach and has become the national cervical screening program,” she said.
Professor Saville noted a significant drop in cervical cancer numbers that occurred in the 1990s when pap test registers were established and a number of underperforming labs were regulated out.
When those falling numbers plateaued in the early 2000s, there were a couple of new developments: the arrival of the HPV vaccine alongside a comprehensive rollout program, as well as further improvements to screening and the screening reminder process.
But it hasn’t been an equitable result.
“Without doubt equity in our program is the biggest challenge,” says Saville.
“We will be the first country to get there but we don’t want to leave communities behind. Importantly Aboriginal women are two and a half to 3 times more likely to develop this cancer than other Australian women and almost four times as likely to die from it.”
As well as greater attention needed on Indigenous communities, Saville says there is work to do in others like CALD and LGBTQI communities that are often under-screened.
For decades, Professor Saville has been involved in various campaigns to reach under-screened women and seen incremental gains in participation.
But she says around 15% of the eligible screening population are not going to participate in a pelvic examination. That’s why the less invasive swab test will be such a gamechanger.
“In our surveys of acceptability, I would characterise the rates we are seeing as a breakthrough in participation, not an incremental gain.
“It’s not 100%, but in our studies among women refusing a pap smear, we got around 85% to return a swab they collected. Which is far greater than anything we did with reminders and support.
Clearly for some people there is the physical discomfort. There are cultural barriers. There are people who’ve experienced sexual abuse. There are a whole range of reasons why lying down and having a pelvic exam is just not something some people are willing to do.
The announcement is not saying you can’t have a sample collected in the same way, of course, you can. But it’s putting the participant in charge of that decision.”
Then there’s the scalability of the swab test, which just wouldn’t be possible with pelvic examinations.
Professor Saville speaks to the possibilities in places like Papua New Guinea, where the rate of cervical cancer is around 30 in 100,000 (compared with Australia’s six) due to low rates of screening and detection.
“It’s a terrible tragedy in those communities because it strikes women in their 40s and 50s when they are critical to their families. Many of them die without a diagnosis and without adequate treatment,” she says.
“There’s a lot of work to do in those regions. But there’s no way we’re going to do it with our pap program.
“Self-collection gives us the scalability in lower and middle-income countries to have any hope of meeting those targets.”
Internationally, we have the tools to make the WHO’s elimination strategy a possibility.
But as Professor Saville says, we now need to figure out a way to get such tools to as many communities internationally as possible.
“That is about political will, scaling up and implementation. That’s where we’re working now. It’s an exciting time to be involved.”
The Women’s Health Project is produced by Agenda Media, publisher of Women’s Agenda.
This project is editorially independent, but made possible thanks to the support of Organon, the recently launched pharmaceutical company dedicated to a better and healthier every day for every woman.