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Cancer screening in the spotlight of Public Health Research & Practice

Australia’s screening programs for cervical and colorectal cancers are cost-effective, with benefits substantially outweighing harms, according to major new research published in Public Health Research & Practice (PHRP), a journal of the Sax Institute.

The research article – whose senior author is Professor Karen Canfell, Chair of the Cancer Screening and Immunisation Committee, Cancer Council Australia – is the first comprehensive review of the benefits, harms and cost-effectiveness of cancer screening in Australia, using quantitative evidence and the most recent estimates.

It finds that the bowel and cervical cancer screening programs are cost effective, with bowel cancer screening having an exceptionally favourable benefit-to-harm balance. It suggests that further work is needed on the benefits and harms (such as overdiagnosis and overtreatment) of Australia’s BreastScreen program, as well as other emerging screening approaches.

Cancer screening in Australia is the focus of the latest issue of PHRP, which was supported by and developed in partnership with Cancer Council Australia and Cancer Institute NSW. Articles explore a range of topics on this theme, while a perspective series looks at the state of play and potential for screening for skin, lung, liver and prostate cancers, as well as for the genetic condition Lynch syndrome, which predisposes carriers to colorectal and other cancers.

In an editorial, Professor Sanchia Aranda, CEO of Cancer Council Australia and Professor David Currow, CEO of the Cancer Institute NSW, state that while emerging knowledge of risk factors for different cancers opens the door to new risk-stratified approaches to screening, this will make both the system and the messaging to the public more complicated.

Other articles find that:

  • Simulation modelling could play a key role in identifying the harms and benefits of population screening policies.
  • GP endorsement may be one of the most effective ways to boost low levels of participation in the National Bowel Screening Program
  • We need to address screening inequities if we are to eliminate cervical cancer as a public health threat by 2040

Professor Neville Hacker, Founder and Director of the AGCF, says that: “Australia has a proud record in relation to cervical cancer screening and prevention. A vaccine against the human papilloma virus (HPV) – a sexually transmitted virus which is responsible for virtually all cases of cervical cancer – was developed at the University of Queensland in the 1990s. In 2007, Australia was the first country in the world to introduce HPV vaccination into the childhood immunisation program. The vaccine, called Gardasil, protects against HPV types 16 and 18, which together cause 70% of cervical cancers. The program was initially for girls only, but it was extended to include boys in 2013.

In 2018, a vaccine called Gardacil-9 was introduced, which protects against another 5 high-risk HPV viruses, together with two low-risk viruses which cause genital warts. This vaccine will protect against viruses that cause 90% of cervical cancers. Nevertheless, women are still at some risk of developing cervical cancer, so regular screening is important.

The good news is that a new screening test for cervical cancer was also introduced in 2018, called the Cervical Screening Test (CST). This test replaces the traditional Pap smear and is more accurate. This means that screening is now recommended every five years from the age of 25 years, instead of every 2 years. With regular screening and vaccination of 12-13 year old boys and girls, cervical cancer should be a rare disease in the future.”

PHRP is Australia’s first online-only open access peer-reviewed public health journal, with a strong focus on connecting research, policy and practice. You can follow them on Twitter @phrpjournal