What the new cervical cancer screening program in Australia means for Aboriginal and Torres Strait Islander women
A new screening test designed to safeguard Australian women from the risk of developing cervical cancer will be rolled out this year on 1 December 2017. Delays to the registry set-up by Telstra Health postponed the rollout, initially set for 1 May. Fortunately, the delays will allow for meaningful public engagement and communication to take place for these significant changes to an aspect of women’s health to take place – if the time were to be used for this purpose.
One of the most important public health steps to execute when implementing any new medical intervention program is diffusion, to allow smoother transition for the community to absorb, process and accept the major change that will affect their lives.
An on-line petition by Change.org opposing the new changes to the screening program has since been pulled following an alert by the Australian Medical Association that the information was inaccurate. What this signifies is a critical lack of adequate communication between Australian health policy decision-makers and the public. It is an issue that intensifies the health prevention information needs for Aboriginal and Torres Strait Islander and other vulnerable women.
Australia’s national cervical cancer screening program, which commenced in 1991, has halved the cervical cancer incidence and mortality rates based on the Pap test and Australia’s world-first HPV vaccination program, introduced in 2007. The new HPV-based test is predicted on evaluation models to drop that rate by a further 15%. Two major key changes in the new cervical screening program are the raising of the screening age from 18 years to 25 years and replacing Pap smear tests from once every two years with a HPV-based test (swab instead of smear) which can be taken up to every five years.
There are two important factors for Indigenous women to take on board in regards to the above: unless you actually screen at all for cervical cancer risk, and whether you have had your complete HPV vaccination course, are two of the most important predictors of whether you will also reap the important prevention benefits from the cervical screening program (inclusive of the HPV vaccination program).
Eighty per cent of women who develop cervical cancer have never been screened. Aboriginal and Torres Strait Islander women are one of Australia’s most marginalised health populations in regards to accessing the national cervical screening program. Some remote Aboriginal communities have less than 20% cervical screening rates. Poor access to primary healthcare and poverty are just a couple of reasons for this poor screening rate.
Also, there is evidence that although the National HPV Vaccination Program had high coverage rates of about 73% in 12-13 year olds, Aboriginal and Torres Strait Islander youth had an average of 10% less coverage in both Queensland and Northern Territory (the only two jurisdictions with published data on pre- and post- HPV vaccination HPV prevalence rates).
Despite statistics indicating that Aboriginal and Torres Strait Islander women have much higher rates of cervical cancer incidence and mortality rates than non-Indigenous women – incidence is about three times higher and mortality six times higher respectively – the HPV vaccination program was only freely accessible for women under the age of 26 years. Older women wanting access to the HPV vaccine had to pay for it at a cost of around $100 per vaccine for a three dose course. Had it been also offered free to Aboriginal women of all ages when introduced in 2007, many more cervical cancer morbidity and mortality may have been prevented, not to mention cost savings in healthcare and lives. Other marginalised women with poorer health outcomes for cervical pathology are those in lower socio-economic groups – ‘postcode disadvantage’ – and from non-English speaking backgrounds.
Behaviour change to make cervical screening a habit for such women is a key to the success of this program. It is also vital that other upper stream changes occur including representation by these groups at the decision making levels that determine such programs, such as the Standing Committee on Screening or Medical Services Advisory Committee.
The conflation of epidemiology and statistics is too often used to mask real health disparities that continue to exist in smaller disempowered groups. Health economics is thought to be a cost saving measure for governments, however, we continue to see lack of political will to decide what is best for the most disadvantaged groups in our society. Unfortunately, short-sightedness ends up costing our health system a lot more not just in terms of money but economic stability, too, when lives are affected. Tackling gender and ethnic inequality including Aboriginal and Torres Strait Islander disadvantage are vital mechanisms to persist in changing systems to allow full benefit of such screening programs to all Australians.