Background: Australia has one of the world’s lowest cervical cancer death rates, due to a Pap-test based screening programme introduced in 1991. Through the research of Australian immunologist Prof. Ian Frazer, Australia led in the development of a vaccine for human papillomavirus, the cause of most cervical cancers. Following the vaccine’s introduction, and HPV protection for a new generation of women, the Australian Government commissioned a systematic review to scope a major change in screening practice. The review concluded that a shift from two-yearly Pap testing of women aged 18-69 to five-yearly HPV testing of women aged 25-74 would reduce cervical cancer incidence in Australia by 25-36%. Following the Government’s agreement to renew the programme, the Department of Health commissioned Cancer Council Australia to develop guidelines to support associated clinical practice.
Objectives: To ensure that Australia has a comprehensive, accessible, evidence-based clinical guideline, endorsed by key stakeholders, to support an unprecedented change in organised cervical screening.
Methods: An expert Working Party was formed to develop the guidelines. Given the rigour applied to the systematic review that recommended the change in screening age and test, the Working Party engaged research leaders who guided the programme’s renewal, with a shift in focus to practice points and clinical pathways across the screening and healthcare spectrum.
Literature reviews (systematic and general) and modelling of natural disease history were applied to the clinical questions. This focused on a range of scenarios, given the fundamental change in screening practice.
Results & Conclusion: After a lengthy development process and consultation, the National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding were launched in March 2017. They guide the most significant organised change in cancer management at a national level in Australia’s history and will be disseminated over the next 6-8 months to prepare clinicians for the new programme in December.