Accelerating cervical cancer elimination in Aboriginal and Torres Strait Islander women: a modelling study
1Citations
Australia aims to achieve cervical cancer elimination (incidence <4 cases per 100 000 women) nationally by 2035. Incidence in Aboriginal and Torres Strait Islander women is around twice the national rate, driven by long-standing inequity in screening. We aimed to predict when elimination would be achieved among Aboriginal and Torres Strait Islander women, and if increased vaccination or screening coverage could expedite elimination, using a cervical cancer simulation model. In this modelling study, we adapted Policy1-Cervix-an existing dynamic model of human papillomavirus (HPV) transmission and vaccination, and linked model of HPV natural history, cervical screening, and cancer-to reflect data on Aboriginal and Torres Strait Islander women. We compared the timing of cervical cancer elimination for a scenario where current coverage continues to seven hypothetical scenarios involving improved vaccination and screening coverage in Aboriginal and Torres Strait Islander women: increased HPV vaccination coverage (from 80·9% to 90·0% in 12-year-old females); increased uptake (reducing the proportion of individuals who are never-screened); timeliness (reducing under-screening); and increased follow-up attendance. Cervical cancer elimination timing was defined as the first year from which cervical cancer incidence was consistently lower than 4 per 100 000 women. Under current vaccination and screening rates in Australia, cervical cancer elimination among Aboriginal and Torres Strait Islander women was projected to occur in 2047, 21 years later than projected for Australian women overall (2026). Improving vaccination coverage (from 80·9% to 90·0%) improved longer-term outcomes but did not accelerate elimination in Aboriginal and Torres Strait Islander women. Increasing screening uptake, on-time attendance, and attendance for follow-up tests to match national rates expedited elimination in Aboriginal and Torres Strait Islander women by 4 years (2043). A one-off large-scale screening initiative that reached every unscreened Aboriginal and Torres Strait Islander women, and sustained efforts thereafter, could achieve elimination by 2036, aligning with national targets and setting a precedent for global efforts. Urgent effective action to improve culturally safe access to screening and follow-up could markedly accelerate cervical cancer elimination among Indigenous women in Australia. National Health and Medical Research Council (Australia) and Cancer Institute NSW.
Journal
The Lancet Public HealthTL;DR
Authors
Funding
Australian National University FundingNational Health and Medical Research Council Grant 1194679National Health and Medical Research Council Grant APP1120215National Health and Medical Research Council Grant 2009380National Health and Medical Research Council Grant 2034453National Health and Medical Research Council Grant APP1159491Cancer Institute NSW Grant ECF181561