Background/History of NCSP
Australian rates of cervical cancer incidence and mortality are among the lowest in the world. This is largely attributed to the successful introduction of the NCSP. Opportunistic cervical screening began in Australia in the 1960s, with some women having regular Pap smears while others remained unscreened. In 1982 cervical cancer was the sixth most common cancer in Australian women and by 1991 it had fallen to eighth ranking, presumably related to increased opportunistic screening. Following the introduction of the NCSP in 1991 there was a steady fall in the incidence of cervical cancer, and by 2009 it ranked the twelfth most common cancer in Australian women.
On 1 December 2017, Australia established a new cervical screening process based on recommendations by Australia’s independent Medical Services Advisory Committee (MSAC). MSAC recommended that Pap smears be replaced with HPV tests as the primary screening test and that the new test be conducted every five years instead of every two for people aged 25 to 74 years.
This followed a rigorous and independent process.
The Renewal Steering Committee was established in 2011, tasked with reviewing the NCSP, to ensure that Australian women had access to effective cervical screening, taking account of the impact of the National HPV Vaccination Program and emerging new test technologies.
A referral was made to MSAC. MSAC considered a systematic literature review and modelled evaluation and made their recommendations in April 2014.
The Steering Committee for the Renewal Implementation Project (SCRIP) was then established and identified three key priorities for implementation including: 1. the development of clinical management guidelines for positive screening results, 2. development of pathology performance measures and standards for HPV testing and reflex cytology; and 3. register capability. As part of the 2015-16 Commonwealth Budget, the Australian Government committed funds to implement a renewed National Cervical Screening Program and National Cancer Screening Register.
- The Australian Government Department of Health (Health) provides overall policy direction and coordination, national data collection, quality control and monitoring and evaluation. Cervical screening services are largely provided in general practices with funding through the Medicare Benefits Schedule (MBS).
- State and territory governments provide local oversight of the delivery of the program including health promotion activities, monitoring and program management.
- The NCSP Program Management Committee, which comprises Health, state and territory Program Managers, the Australian Institute of Health and Welfare and the National Cancer Screening Register monitors program performance and provides advice to Health on policy and operational matters.
- MSAC is an independent non-statutory committee established by the Australian Government Minister for Health in 1998.
MSAC appraises new medical services proposed for public funding, and provides advice to Government on whether a new medical service should be publicly funded on an assessment of its comparative safety, clinical effectiveness, cost-effectiveness, and total cost, using the best available evidence. Amendments and reviews of existing services funded on the MBS or other programmes (for example, blood products or screening programmes) are also considered by MSAC.
- Cancer Council Australia (as commissioned and funded by the Department of Health) is responsible for the development and maintenance of clinical management guidelines for the NCSP.
- National Pathology Accreditation Advisory Council (NPAAC) is responsible for the development of performance measures and standards for human papillomavirus (HPV) testing and cervical cytology.
- Quality and Safety Monitoring Committee (QSMC) – has been established by the Department of Health and provides advice on the safety and quality aspects of the NCSP to the NCSP Program Management Committee.
The National HPV Vaccination Program commenced for girls in 2007 and for boys in 2013, using a quadrivalent vaccine against HPV types 6, 11, 16 and 18 (Gardasil). This vaccine is effective in preventing infection with the oncogenic HPV types (16 and 18) that cause 70–80% of cervical cancer in Australia. In 2018, Australia commenced using the new 9 valent HPV vaccine, replacing the 4 valent HPV vaccine and protecting against an additional 5 strains of HPV.