The number of new cases of cervical cancer is likely to be dramatically reduced as the benefits of human papillomavirus (HPV) vaccination are realised (Hall et al. 2018). It is likely that in the future, cervical cancer will largely (but not exclusively) be confined to women who have not been immunised, or for whom immunisation comes well after exposure to HPV.

Three HPV vaccines are registered for use in Australia – Gardasil, Gardasil 9 and Cervarix. All three vaccines protect against the two high risk HPV types (16 and 18) which are associated with around 70 per cent of cervical cancers in Australian women. Gardasil and Gardasil 9 also protect against two low risk HPV types (6 and 11), which cause 90% of genital warts (Cancer Council Australia, 2017). Gardasil 9 replaced Gardasil on the National Immunisation Program in January 2018, Gardasil 9 commenced use in the NHVP program for 12 and 13-year-old girls and boys. This is protecting against an additional five strains of HPV (31, 33, 45, 52 and 58), and predicted to further reduce the incidence of cervical cancer (Simms K T el al 2016). HPV vaccination is delivered via a school-based program to adolescent females and males in years 7 or 8 (i.e. aged 12 to 13 years) as part of the National Immunisation Program, with a catch up program available to individuals (females and males) up to the age of 19 years.

The National Cervical Screening Program aims to prevent cervical cancer by detecting early changes in the cervix. A five-yearly HPV test for women aged 25–74 years began on 1 December 2017 to replace the previous two-yearly Pap test for women aged 18–69 years. The cervical screening test checks for the presence of HPV, the causal agent for most cervical cancers (Australian Government Department of Health 2017).

Self-sampling is available to women at least 30 years of age and who are considered under- screened (four or more years since last Pap test), or who have never been screened and who decline a practitioner-collected specimen. Self-collection is a vaginal swab for HPV testing.

HPV-vaccinated women still require cervical screening tests because the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.

Primary health practitioners, including general practitioners and nurses, play a crucial role in encouraging women to screen regularly.

For more information refer to the 2016 guidelines: The National Cervical Screening Program: guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.