Virology and Microbiology

The Australian National Cervical Cancer Screening Program commenced in 1982 and reduced the incidence of cervical cancer from 20 to 9 per 100,000 women by 2010. Since then the rate of reduction of cancers leveled off and remained relatively unchanged. In 2007, a National HPV (human papillomaviruses) Vaccine program for girls and young women using quadri-valent vaccine commenced and in 2009 became school-based and expanded to include boys. The nonavalent vaccine will be launched in 2018. Up-take of vaccination is above 80% and the incidence of HPV-related high-grade lesions has fallen in the vaccinated population. A smaller reduction in high-grade lesions in older women suggests a herd-immunity effect. With the reduced incidence of cervical lesions in the population, the low sensitivity of Papanicolaou smears will likely decline. In the HPV vaccine era, the need for a more sensitive and specific test with a high negative predictive value predicated on a change to HPV DNA testing. Numerous international studies show that HPV DNA testing with partial genotyping confers the most costeffective and effective means of population-based cervical screening. The Renewed HPV DNA Screening Program commenced in December 2017. A new National Cancer Screening Register will change the way women are invited to screening and are recalled for follow-up, aiming to reduce under-screening. Further, a new self-sample HPV DNA test to screen women who, for cultural or other reasons have not been screened, will enhance the efficacy of the program. A further reduction of the incidence of cervical cancer in Australia is anticipated.