National Screening Programs

• Population Screening

  • Cost effective
  • Organised
  • Target group
  • Simple tests required to look for changes or early signs of diseases before it gets a chance to develop
  • DOES NOT INCLUDE SYMPTOMATIC PATIENTS 
• Current Australian Screening Programs

  • 1991 National Cervical Screening Program
  • 1991 Breast Screen Australia
  • 2006 National Bowel Cancer Screening Program

   
• National Cervical Screening Program (NCSP)

  Originally introduced to reduce incidence and death from cervical cancer

  • Target group - 18-70yrs - Or commence 1-2 years after first sexual activity
  • 2 year screening interval
  • Decreased cervical cancer by 50%

  Success of NCSP

  Cervical cancer 13th most common cancer in women

  2019 - 7.2 per 100,000 new cases/year

  1.9 per 100,000 deaths/yr
• Effect of HPV Vaccine on NCSP

  Australia is one of the first to introduce the National HPV vaccine Program in April 2007

  Girls 12-13yrs and catch up of 13-18 years done in schools

  3 doses by 15 years gives 70.8% coverage

  18-26 year olds done by GPs

  Males vaccinated from 2013 herd immunity

  Introduction of Gardasil 9 in Dec 2014 to cover >95% of precancerous HPV types
• NCSP Renewal


  Strategy for reviewing the policy to ensure HPV vaccinated and unvaccinated women have access to a screening program which is acceptable, effective, efficient and based on current evidence
• Changes in science since the program started

  • New evidence about:
  • Optimal screening age range
  • Intervals
  • HPV vaccine introduction
  • Developments in new technologies for early detection
• Reason for the need for renewal is despite the program's success there is now a greater depth of knowledge about the natural progression of cervical cancer
• Evidence regarding screening age

  In 2014 WHO and IARC recommended the screening age be 25-65 years and every 3 years up to 49 and then 5 yearly until 65 years
• How?


  1. Evidence for screening test and pathways

  2. Screening interval

  3. Age range and commencement

  4. Consideration HPV vaccinated & HPV non-vaccinated pathways

  5. Cost effective screening pathway & program mode

  6. Collection system components
• Medical Services Advisory Council (MSAC)


  Advises the Minister for Health on evidence of new medical technologies
• MSAC Responsibilities


  • Safety
  • Effectiveness
  • Cost effectiveness
• MSAC Recommendations 2014


  • A new cervical screening test
  • Should replace the current pap smear
  • For vaccinated and unvaccinated women
  • A HPV test with partial HPV genotyping be done every 5 years with reflex LBC triage
• Screening age


  • 25-69 years
  • Exit testing 70-74 years of age
• Women with symptoms can have a cervical test at any age (bleeding, pain)
• NCSP Renewal


  HPV Vaccinations should decrease abnormalities and cancer of cervix, initially in youngest women of screening age group
• Cervical cancer peaks in 45-50 so the full effect of the vaccine will take years
• HPV Vaccine


  • Protects against most high risk HPV types (incl. 16 and 18 which are 70-80% of cervical cancer)
  • Other high risk types not vaccinated against so cervical screening is needed
• Vaccinated and non-vaccinated women still require screening