Dr Sarah Burns is a graduate from the University of Dundee Medical School in Scotland. She has a long-standing interest in public health and addressing the many health inequities seen in rural communities.
5 minute read
Cervical cancer is the fourth most common cancer in women. It is treatable, if diagnosed early.
What’s in this article
Screening for cervical cancer is now much easier for those living in rural and remote communities with self testing now available. Dr Sarah Burns explores the causes, symptoms, screening process and treatment options.
Cervical cancer is the fourth most common cancer in women globally, with an estimated 666,000 new cases diagnosed in 2022.
Despite this, the World Health Organisation (WHO) aims to eliminate cervical cancer by the end of the 21st Century.
The WHO have identified three key targets to achieve this:
- vaccination: 90% of girls fully vaccinated with the Human papillomavirus (HPV) vaccine by age of 15
- screening: 70% of women screened by the age of 35, and again by the age of 45
- treatment: 90% of women with pre-cancer treated, and 90% of women with invasive cancer managed
Australia has been at the forefront working towards the elimination of cervical cancer with a highly successful vaccination and screening program. The Department of Health and Aged care have committed to eliminating cervical cancer in Australia as early as 2035. Undoubtedly, there is still more work to be done to increase the uptake of vaccination and screening programs in rural and remote areas to achieve this goal.
This year, the Australian Cervical Cancer Foundation (ACCF) theme for “Cervical Cancer Awareness Week” is the “Power of Choice”. They are aiming to increase awareness of the options available
Almost all cases of cervical cancer can be attributed to the Human papillomavirus (HPV).
HPV is the most common sexually transmitted infection and almost all sexually active people will be infected at some point in their lives.
Causes of cervical cancer
There are several different strains of HPV, some classified as “low-risk” and others as “high-risk”. In most cases, the immune system clears HPV from the body. Persistent infection of the cervix with “high-risk” HPV strains causes 95% of cervical cancer. HPV has also been linked with anal cancer as well as oropharyngeal cancer.
It takes on average 15-20 years for abnormal cells to become cancer, but other risk factors may accelerate this process in an individual. Risk factors related to cervical cancer include being immunosuppressed, the use of hormonal contraception, smoking, the number of births and the presence of other sexually transmitted infections.
Vaccination against HPV
Not unexpectedly, vaccination against cervical cancer has focused on vaccinating against HPV. The HPV vaccine was developed here in Australia by Professor Ian Frazer and Dr. Jian Zhou at the University of Queensland. Australia was the first country to roll out a national program of vaccination in 2007. This was expanded in 2013 to include teenage boys.
The HPV vaccine used in Australia covers nine different strains, or types, of HPV which cause around 90% of cervical cancers. This includes HPV type 16 and 18, the two “high-risk” strains of which 70% of cervical cancers are attributed to. The vaccine also protects against strains of HPV that cause 90% of genital warts, 70% of vaginal cancers and 50% of vulva cancer.
A single dose of the HPV vaccine is funded in Australia under the National Immunisation Program for adolescents aged 12 to 13. Adolescents who miss this vaccination can catch up for free until the age of 26.
Cervical screening
In Australia, the cervical screening test is available to people who are aged between 25 and 74, people who have ever had any sexual contact, and people who have a cervix. Women are invited to take part in cervical screening every five years.
Around 800 people are diagnosed in Australia every year with cervical cancer. Of these, about 70% of cases occur in women who have never screened or were not up-to-date with screening.
Cervical screening involves sending a swab to check for HPV. If the swab is negative for HPV, then the cervical screening test is repeated in five years. If found to be positive for “low-risk” strains (all except strain 16 and 18), the individual will be invited to repeat there swab in one year to ensure the HPV has cleared. If positive for “high-risk” strains (16 and 18), further testing will be required which will be arranged by the healthcare provider.
The Cancer Institute NSW estimate that only 67% of women living in rural and remote areas in Australia participated in cervical screening. Lack of public transport, long journeys and limited access to healthcare providers were listed as some of the many barriers that women in remote areas face to accessing cervical screening.
Since July 2022, women aged between 25 and 74 have been able to complete their cervical screening via a self-collection of a vaginal sample using a simple swab. Research published in March 2024 by the Department of Health and Aged care showed that 27% of all cervical screening are now done this way.
Encouragingly, in the Northern Territory, self-collection is more than double the national average at 47% (5). This hopefully represents a trend of increasing uptake of cervical screening in rural and remote areas now that an alternative, more accessible option exists.
Symptoms of cervical cancer
The earlier a diagnosis of cervical cancer is made, the better the outcomes. Pre-cancerous or early cancerous changes may cause no symptoms, therefore regular cervical screening is vital.
Symptoms of cervical cancer may include:
- pelvic pain
- persistent pain during intercourse
- bleeding after intercourse
- vaginal bleeding after menopause
- vaginal bleeding between periods, and
- persistent unexplained unusual vaginal discharge
Whilst the presence of these symptoms does not necessarily mean cervical cancer, it is important to discuss them with your GP or healthcare provider.
Treatment
Treatment of cervical cancer will depend on several factors. Treatment options will vary depending on the extent of disease, age and general health. Potential treatment options include:
- surgery
- radiotherapy
- chemotherapy (such as cisplatin)
- immunotherapy, or
- a combination of the above
Decisions regarding a treatment plan will be made in collaboration with your treating doctor.
Taking steps to eliminate cervical cancer
In March 2024, The Department of Health and Aged Care outlined its goal for Australia to be the first country to eliminate cervical cancer by 2035, committing $48.2 million to achieve this. It is essential that an equitable portion of this funding is invested into the rural and remote areas in Australia. Increasing access to the HPV vaccines, regular cervical screening leading to early detection and prompt treatment in rural communities will be vital if this goal is to be achieved.
If you are not up to date in your cervical screening, we encourage you to take the steps to protect yourself from cervical cancer today. It is no longer the challenge it was for those living in rural and remote communities, and it could save your life.
https://www.health.gov.au/our-work/national-cervical-screening-program/getting-a-cervical-screening-test
Dr Sarah Burns is a graduate from the University of Dundee Medical School in Scotland. She has a long-standing interest in public health and addressing the many health inequities seen in rural communities.