New evidence about the role of human papilloma virus (HPV) in the development of cervical cancer and new technologies to detect the virus have led to a new National Cervical Screening Program.
Australia is well advanced in cervical cancer prevention, thanks to the combined effects of the HPV Vaccination Program and cervical screening through the pap test.
“The number of deaths in Australia caused by cervical cancer have more than halved over the past ten years” said Associate Professor Brand, Chair of ANZGOG.
The pap test, often referred to as the pap smear, looks for abnormal changes in the cells of the cervix. The cells are collected via a physical swab of the cervix, usually performed by a GP and recommended every two years for women aged 18 – 69 years old.
The Australian and New Zealand governments have approved a new schedule, which has already been implemented in New Zealand, expected to improve cervical cancer detection and prevention. Associate Professor Alison Brand contributed to these new guidelines.
“New evidence about the role of human papilloma virus (HPV) in the development of cervical cancer and new technologies to detect the virus has emerged recently” said Associate Professor Brand.
The current vaccination and screening programs have made no difference to the rate of adenocarcinoma, a type of cervical cancer, but the new HPV test has the potential to reduce the rates of adenocarcinoma.
A better and more accurate test, the HPV test, is now available. The HPV test looks for HPV, the virus that can cause pre-cancerous abnormalities, in the cervix. The procedure for collecting the sample of cervical cells is the same as for the pap test.
It usually takes 10 or more years for HPV to develop into cervical cancer, and cervical cancer is a rare outcome of a HPV infection. If a woman becomes infected with HPV the day after her test, it is not likely the infection will cause problems within the following five years before her next HPV test.
“Women will now only need to have the screening test every 5 years starting at age 25 and continuing to age 70 to 74” said Associate Professor Brand. The benefits for women will be less frequent and more effective testing.
“It is estimated that 22% less women will die of cervical cancer, thanks to this new screening test” said Associate Professor Brand.
The current vaccination and screening programs have been very effective against the most common type of cervical cancer, but they have made no difference to the rate of adenocarcinoma, which accounts for 15% of cervical cancers. The new HPV test has the potential to reduce the rates of adenocarcinoma.
Better treatments for advanced cervical cancer
“There are women who have rarely or never had a pap test for a variety of reasons” said Professor Linda Mileshkin, Principal Investigator and ANZGOG member.
These women can present with locally advanced cervical cancer, where the treatment outcomes are not always as good.
Professor Mileshkin is leading OUTBACK, an international clinical trial aimed at improving survival rates from locally advanced cervical cancer.
The OUTBACK trial involves 900 women, half of whom receive the standard treatment of radiation to the pelvis plus low dose weekly chemotherapy, which isn’t 100% effective for every woman; and the other half receive the same standard treatment plus an additional course of chemotherapy treatment designed to stop cells that may have escaped from the primary cancer and could spread to other parts of the body.
“This approach is routine in breast and many other cancers, we want to see if it’s the same for locally advanced cervical cancer” said Professor Mileshkin.
“There are many parts of the world where pap smears and vaccinations are not available” said Professor Mileshkin.
Cervical cancer is a huge killer of women in the developing world, causing more than a quarter of a million deaths globally each year.
“We need to continue to develop better treatments as well as access to preventive measures, so more women in Australia and around the world can live a long and happy life” said Professor Mileshkin.
The OUTBACK trial led by ANZGOG has recently closed to recruitment, find out more about the EXCISE study in cervical cancer, which has just received funding from ANZGOG.