Cancer Council supports strategies to optimise uptake of prophylactic HPV vaccination by the target population, improve participation in the cervical screening program of eligible women, and further research to contribute to improvements in both programs.
Promote participation in the National HPV Vaccination Program among adolescents
The impact of the HPV vaccination on future cervical cancer incidence and mortality will be influenced by uptake of the vaccine by the population. National HPV vaccination data for girls turning 15 in 2016 shows 78.6% of girls had completed the full course of the HPV vaccine. Evidence shows higher coverage is possible through similar school-based vaccination programs in the UK, demonstrating room for improved coverage rates. For example, offering missed vaccine doses through schools the following year has been shown to improve course completion. Reminders via mail and SMS have also been shown to increase coverage.
The uptake of the HPV vaccines is influenced by the target population’s perceptions of benefits and risks and knowledge of the HPV vaccine as well as health professionals’ attitudes and advice. Therefore communication strategies targeting health professionals, parents, and adolescents – that are sensitive to culture, religion and age – are required to support uptake. Specific and targeted strategies are necessary to optimise uptake of HPV vaccination in population groups that are at higher risk of cervical cancer and/or have lower participation in cervical cancer screening, particularly Indigenous women and women of culturally and linguistically-diverse backgrounds.
Over the longer term, HPV vaccination has the greatest potential to reduce cervical cancer incidence and associated mortality in under-screened populations with a higher incidence of cervical cancer. There is a strong association between socioeconomic status, cervical screening, and cervical cancer incidence, with the lowest screening rates and highest incidence rates evident in the most disadvantaged areas. Conversely, national data has shown that HPV vaccination coverage has a much less pronounced socioeconomic gradient, with coverage rates only slightly lower in girls from the most disadvantaged areas, and early impact data suggests that the impact of HPV vaccination has been similar across different levels of disadvantage. In Australia, Indigenous women are twice as likely to be diagnosed with and over four times more likely to die of cervical cancer than non-Indigenous women. This higher risk is, in part, due to lower participation in the National Cervical Screening Program. National HPV vaccine uptake data are not available by Indigenous status, however, data from Queensland and the Northern Territory showed lower uptake in Indigenous girls aged 12-17 than in non-Indigenous girls in 2007. In Indigenous women, the prevalence of vaccine-targeted HPV types has decreased by 94% (from 24% to 1.4%). These results are consistent with surveillance data of non-Indigenous women, suggesting impact has been similar. Effective prevention will require a good understanding of barriers to participation in the National HPV Vaccination Program for this population and strategies to overcome these barriers.
Promote participation in cervical cancer screening
For women beyond the target age for vaccination, screening is still the most important strategy to prevent cervical cancer. The renewed NCSP provides an opportunity to increase participation among women in under-screened populations with the option for self-collection.
There is strong evidence that self-collection increases participation rates of women who do not attend regular screening. Addressing practical and perceived barriers of self-collection may increase usage among women who are never- or under-screened. Common barriers include fear of the procedure and results as well as access to healthcare services. Offering the option for self-collection to eligible women opportunistically may increase participation rates for this group.
Strategies to increase participation in under-screened populations should focus on making the renewed NCSP accessible and culturally appropriate to population groups including Indigenous and culturally and linguistically-diverse communities. Block blocking has been suggested as a strategy to improve participation rates among Indigenous women as it provides social support. Screening reminders and face-to-face consultations with healthcare professionals have been shown to increase the participation rates of under-screened women. The renewed NCSP will be supported by a new National Cancer Screening Register that will send invitations and reminder letters to women. Culturally appropriate support and information tailored to specific communities is needed. Engaging with the community and developing trust through Aboriginal Health Workers or bilingual health promotion officers is important for encouraging women to participate in cervical screening.
Support a national HPV surveillance program
A national surveillance program should be supported to monitor HPV genotypes causing cervical cancers and genital warts. While the IMPACT study has been funded, there are areas that require development in order to comprehensively monitor the impact of vaccination on cervical cancer. Reporting of HPV status to the cancer registry will further assist with the understanding of the contribution of vaccine- and non-vaccine targeted HPV types to cancer burden over time. The recording of Indigenous status and country of birth on vaccine consent forms and pathology collection forms for cervical screening tests should be strongly encouraged and will enable evaluation of effectiveness of programs and other targeted efforts.
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