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2 – Support Australia’s efforts to eliminate cervical cancer as a public health problem by 2035
TWO
SUPPORT AUSTRALIA’S EFFORTS TO ELIMINATE CERVICAL CANCER AS A PUBLIC HEALTH PROBLEM BY 2035
It is estimated that cervical cancer is likely to be eliminated as a public health problem (incidence <4 per 100,0000) in Australia by 2035, as the achievements of our previous cytology-based screening program, impacts of HPV vaccination and effect of the current HPV-based cervical screening program are realised.
Challenges remain however, in ensuring elimination is achieved equitably and that its achievement and maintenance are not undermined by falls in participation in vaccination or screening. As described in the 2021 C4 CRE Monitoring Report (section 6), lower participation rates in cervical screening occur in rural and remote Australia, in areas of socio-economic disadvantage, amongst culturally and linguistically diverse groups of women, and also in Indigenous women. Aboriginal and Torres Strait Islander women continue to carry an inequitable burden of cervical cancer with incidence and mortality rates two and nearly four times higher than other Australians, respectively. HPV vaccination completion rates are also lower amongst Aboriginal and Torres Strait Islander students and those living in remote areas. Whether there is equity in access to and timeliness of treatment for cervical pre cancer and cancer is also currently unknown. SUPPORTING EQUITY IN ELIMINATION
VCS Foundation is committed to practically supporting equity across cervical cancer prevention initiatives and we do this is in the way we work, through our partnerships and advocacy, and providing policy relevant research and evaluation to support best practice. For example, we know that many people face challenges to screening because they may feel unsafe or unsupported to request a cervical screening test from their health care practitioner, may be people living with a disability who experience difficulty accessing suitable screening services, or have experienced trauma and are fearful of or distressed by cervical screening. VCS Foundation led program initiatives such as selfcollection and telehealth consultations will be an alternative pathway in Australia that can help to overcome such barriers to having a clinician-collected cervical screening test. These initiatives, as well as membership of government working parties and successful delivery of contracted tenders and research to support implementation, mean that VCS Foundation is providing our expertise and advocacy to support the likely policy transition to universally available self-collection.
We also passionately believe that no person, and no groups of people, should be left behind as Australia pursues elimination. Our partnerships with leading Indigenous researchers and communities are about ensuring we play our part in closing the gap in cervical cancer burden for Aboriginal and Torres Strait Islander people. Two examples of our work in this important area are:
This project is part of the TACTICS NHMRC Centre for Research Excellence, in which Professor Julia Brotherton co-leads the vaccination and screening stream with A/Prof Lisa Whop from the National Centre for Epidemiology and Population Health, Australian National University. The study is seeking to identify the factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in Australia.
The project is a critical step in addressing the burden of cervical cancer among Aboriginal and Torres Strait Islander women. Equitable access to primary prevention through HPV vaccination has the potential to reduce disparities in cervical cancer outcomes for Aboriginal and Torres Strait Islander women in Australia.
Refer to the publication – Whop LJ, Butler TL, Brotherton JML, et al Study protocol: Yarning about HPV Vaccination: a qualitative study of factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in AustraliaBMJ Open 2021;11:e047890. doi: 10.1136/ bmjopen-2020-047890
PREVENT Study
VCS Foundation is collaborating in the Australian Department of Health Indigenous Australians’ Health Programme Emerging Priorities funded PREVENT Project. This research project is investigating the acceptability and implementation of point of care HPV self-collection in rural and remote communities.
Led by Aime Powell, University of Notre Dame, this grant-funded project will introduce point-of-care HPV testing which utilises self-collection and same day follow-up testing in the Kimberly Region of Western Australia. VCS Foundation is assisting with the study design, analysis and project evaluation. We are also supporting HPV testing including provision of the point-of-care device, training, education and evaluation. Progress research, evaluation and policy initiatives supporting elimination through the C4 CRE and other research partnerships
VCS Foundation is a key partner of Australia’s National Health and Medical Research Council (NHMRC) funded Centre of Research Excellence (CRE) in Cervical Cancer Control.
The Centre for Research Excellence in Cervical Cancer Control, known as C4, was established in late 2017 following its awarding by the NHMRC, to bring together cervical cancer prevention experts to undertake research and evaluation of HPV vaccination and screening programs. The work of C4 will ensure the future of cervical cancer prevention is underpinned by world-class research that can reduce the global impact of the disease. The core group consists of researchers from the Cancer Council NSW, VCS Foundation, the University of Melbourne and the Kirby Institute with combined expertise in epidemiology, public health, laboratory testing, clinical trial implementation, predictive modelling and economic evaluation. Our associate investigators bring additional expertise and perspectives from a range of organisations. For details of our full team, please visit the C4 website at www.cervicalcancercontrol.org.au C4 focuses on:
+ Evaluating the effectiveness of next generation primary HPV screening and HPV vaccination approach + Developing better tools for monitoring HPV and for predicting abnormalities + Assessing the impact of the HPV vaccination program in Australia, and + Global aspects of cervical cancer control.
VCS FOUNDATION IS A KEY PARTNER OF AUSTRALIA’S NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC) FUNDED CENTRE OF RESEARCH EXCELLENCE (CRE) IN CERVICAL CANCER CONTROL (C4). THE WORK OF C4 WILL ENSURE THE FUTURE OF CERVICAL CANCER PREVENTION IS UNDERPINNED BY WORLD-CLASS RESEARCH THAT CAN REDUCE THE GLOBAL IMPACT OF THE DISEASE.
Within C4, we run Australia’s largest clinical trial, Compass, which is providing world-first evidence on the interaction between HPV vaccination and screening. C4 is supporting the WHO strategy for cervical cancer elimination as a public health problem, with contribution of our expertise to multiple areas of research and implementation activity to ensure that this strategy becomes a reality in Australia, our region and beyond. Our key contributions include: + Modelling work to inform the elimination strategy + Membership of WHO expert advisory groups + Working locally with government and key stakeholders to inform strategies for monitoring progress and achieving elimination in Australia + Working regionally with governments and key stakeholders to inform strategies for scale up to meet the
WHO strategy targets, and + Developing partnerships and grant applications for the undertaking of implementation research to inform scale up for elimination in our region. Within the CRE, VCS Foundation is actively engaged in Australian policy relevant research including the following projects: + STORIES interview study documenting the perceptions of key stakeholders around the implementation of Renewal. + Piloting of a cervical cancer HPV typing system for Australia + VCA funded trial of a universal access to self-collection policy in Victorian practices + VCA funded study on Improving the benefits of the renewal of the
National Cervical Screening Program for Victorian Aboriginal women + Comparison of HPV surveillance approaches using routine screening
HPV assay data compared with genotyping using Linear Array. Establish a pathology advisory service as part of being the Australian HPV Reference Laboratory, supporting validation of novel and affordable HPV tests, particularly point of care tests
VCS Foundation is poised to launch its expertise as the Australian HPV Reference Laboratory. Our capacity includes:
+ Expertise and laboratory services for the evaluation of HPV detection in biological specimens including activities that build capacity + Provision of standardised up-to-date technical information, technical advice, guidance and training on
HPV laboratory practices and quality assurance, and + Provision of testing services linked to the development and use of international standard reagents and operating procedures in laboratory
HPV testing. Announcements on this new business will be included in the 2021/22 Annual Report.
