Elimination is projected to be more than a decade later for First Nations women, but one intervention has been shown to bring this almost to the national target.
On the current trajectory, cervical cancer will be eliminated in Aboriginal and Torres Strait Islander women 12 years later than the national 2035 target.
But researchers from the University of Sydney said this wasn’t an inevitability – the gap could be closed by increased screening alone.
Using existing data, the researchers projected when elimination would be achieved. They then modelled whether increasing HPV vaccination, routine screening, timely screening, follow-up attendance and ensuring women were screened at least once could bring this forward.
“It was the last of those that was the most impactful,” Associate Professor Megan Smith, epidemiologist, simulation modeller and lead author of the study, told The Medical Republic.
She explained that all screening interventions had some impact on reducing time to elimination but ensuring every Aboriginal and Torres Strait Islander woman was screened at least once could nearly close the gap, bringing elimination forward to 2036.
“Essentially, screening is the way you do it and, in particular, bringing people in so that they have had at least one screen really will make a big difference,” she said.
“And of course, once people have had one screen, if they have a good experience and they feel supported, then they probably will come back. It’s often just getting over that very first hurdle.”
She added that many women reported their last screening occurred opportunistically during another healthcare visit.
“A lot of Aboriginal and Torres Strait Islander women reported the reason they had their last screening test was because they were seeing a provider for another reason, and that provider reminded them.
“So, something concrete that people can do is check when you’re seeing someone, are they up to date with screening? Because that can really make a difference if the provider checks and recommends.”
In their modelling, increasing HPV vaccine uptake didn’t affect the timing of elimination, but Professor Smith said it’s still vital for the future.
“That’s really just about the lag time of vaccination. You know, you vaccinate in early adolescence, [and] they probably wouldn’t have got cancer anyway for 10, 20, 30 years,” she said.
“It’s so important and it’s a real long-term investment. And we’ve seen that vaccination rates are dropping across the board, but particularly in Aboriginal and Torres Strait Islander adolescents.
“So again, that sort of opportunistic check by a provider, you know, is this person up to date with their vaccination? Can we do it today? That kind of thing. Encourage them to get it done.
“The HPV vaccine is now available up to the age of 25 so it gives more time. It’s much, much better if you get it done early, particularly before 15 it is possible up to age 25 to get the vaccine.”
According to the Department of Health, Disability and Ageing, the national HPV vaccination rate in 2025 among adolescent girls was 80.65% and 73.14% for First Nations girls. For boys, it was 77.66% and 67.64%, respectively.
In the surveys USYD have conducted, there was a lot of interest in testing flexibility and positive feedback about self-collection, she explained.
“The option to undertake self-collection for cervical screening has improved participation in locations around Australia with large First Nations populations,” a Department of Health, Disability and Ageing spokesperson told TMR.
They did not comment on the research findings, only stating that “The government is continuing to monitor progress toward the goal of eliminating cervical cancer by 2035, particularly for priority populations”.
Related
“There are some really positive signs coming out of Aboriginal community-controlled health organisations, showing that since self-collection has become an option for everyone, that that’s really been taken up by Aboriginal and Torres Strait Islander women,” said Professor Smith.
“Those really inclusive health services could be a huge part of the solution.
“There is a fair bit of flexibility in the guidelines as they stand. The healthcare provider who’s ordering the test has flexibility to offer screening in whatever way would suit their community and that they think could increase participation.
“One thing that we’ve been working on more generally is getting input from women about how they might like to access screening in the future. And there’s a lot of interest in flexibility, which I think makes sense in the context of these cost-of-living pressures and difficulty accessing the GP.”
She discussed the option of a mail-out cervical screening test, similar to the national bowel cancer screening program
“Historically, the cervical screening participation has been better than the bowel cancer screening, so I think we don’t want to, I guess, give up that strong connection to primary care, which is beneficial in many cases,” she said.
“I think it’s probably just about providing different options for different people, and particularly once people are late, maybe that might be a time you might look at offering something in the mail.”
She said large data gaps remain in areas such as screening, but that the higher incidence in Aboriginal and Torres Strait Islander women – nearly double that of non-Indigenous women – is largely due to historically lower access to screening.
“There’s a lot of lost time to make up for,” she said.
She listed some potential causes for the disparities, including lack of access to a regular provider who they trust, not necessarily being aware of screening, not attending a doctor for prevention and rather only going if you’re sick, cost issues – which are becoming increasingly important – as well as hesitance to get a speculum exam.
“That exam was potentially embarrassing [and] confronting, particularly if you haven’t had it done before,” she said.
While these issues are not specific to Aboriginal and Torres Strait Islander women, she said they are compounded for these communities.
“There’s a traditional distrust of health services because of racist policies in the past, and the way that governments have been involved in taking children away,” she said.
“There’s a legacy of distrust which is very understandable, or perhaps personal experiences with health services that might not have been positive.
“And of course, for people living in remote areas, there is an extra level.”
Professor Smith highlighted a toolkit that could help providers who are interested in doing outreach activities, to boost screening and help close the longstanding gap in cervical cancer outcomes.
