Renewal of the National Cervical Screening Program

1. Renewal of the National Cervical Screening Program

2. History of the National Cervical Screening Program Alison Lang Assistant Director Screening Section

3. Background • In 1988, the Australian Health Ministers' Advisory Council established the Cervical Cancer Screening Evaluation Steering Committee to examine cervical screening. • In light of their findings, the Committee recommended health authorities establish an organised approach to screening which would provide better protection against cervical cancer. • In 1991, the Organised Approach to Preventing Cancer of the Cervix was established as a joint initiative of the Australian and state and territory governments. • In 1995 it was renamed the National Cervical Screening Program (NCSP). • The NCSP aims to reduce morbidity and mortality from cervical cancer in a cost effective manner through an organised approach to screening. • Jointly funded by the Australian, state and territory governments.

4. Background • Since 1991 the national policy has stated: • Routine screening with Pap smears should be carried out every two years for women who have no symptoms or history suggestive of cervical pathology. • All women who have ever been sexually active should start having Pap smears between the ages of 18 to 20 years. • Pap smears may cease at the age of 70 years for women who have had two normal Pap smears within the last five years. Women over 70 years who have never had a Pap smear, or who request a Pap smear, should be screened.

5. Outcomes Trends since the introduction of the NCSP in 1991: • Incidence of cervical cancer decreased by 47% • 17.1 per 100000 women in 1991 to 9.0 in 2007. • Mortality decreased by 53% • 4.0 per 100000 women in 1991 to 1.9 in 2007. • Participation > 60% and 70% within 2 and 3 year intervals respectively. • Up to 85% of the target age group had a Pap smear within 5 years.

6. The Renewalof the NCSPIntroduction Professor Ian Hammond Chair Renewal Steering Committee

7. Changing environment • 2005 - NHMRC recommended a review of the screening interval. • 2007 - National HPV Vaccination Program. • New scientific knowledge on the development of cervical cancer. • New technologies • liquid-based technology • computer assisted image analysis • HPV DNA tests • Workforce roles and constraints.

8. Aim The Renewal aims toensure the success of the program continues and all Australian women, human papillomavirus (HPV) vaccinated and unvaccinated, have access to a cervical screening program that is based on current evidence and best practice.

9. Objectives Assess the evidence for the effectiveness of screening tests and pathways, the screening interval, age range and commencement for both vaccinated and non-vaccinated women. Determine a cost-effective screening pathway and program model. Investigate options for improved national data collection systems and registry functions to enable policy, planning, service delivery and quality management. Assess the feasibility and acceptability of the renewed program for women.

10. Feedback Session 1

11. Questions What are your experiences and views of the current program? What are the major changes that might be required of the National Cervical Screening Program as a result of the science? What are the key challenges to changing the current program? How will potential changes impact on the program and specific groups? What areas for improvement are there within the current program?

12. cont…The Renewal of the NCSP Professor Ian Hammond Chair Renewal Steering Committee

13. Governance Australian Health Ministers’ Advisory Council Australian Population Health Development Principal Committee Screening Subcommittee Renewal Steering Committee

14. Stages • Phase 1: Expected Completion August 2013 • Stage 1a - Decision Analytic Protocol development • Stage 1b - Evidence to prevent cervical cancer • Stage 2 - Economic evaluation • Phase 2: Expected Completion June 2014 • Stage 3 - Data systems and quality management • Stage 4 - Program acceptability

15. Medical Services Advisory Committee • Principal role of MSAC is to advise the Australian Minister for Health and Ageing on evidence relating to the safety, effectiveness and cost-effectiveness of new medical technologies and procedures. • Information on MSAC - www.msac.gov.au • To ensure the screening policy making process is aligned with the Medicare Benefits Schedule (MBS) listing process, a consultant from the MSAC Panel has been appointed to undertake Phase 1 of the Renewal.

16. MSAC Process (Phase 1 of the Renewal)

17. ExpectedOutcomes • A cervical screening pathway which incorporates emerging science and technologies into the National Cervical Screening Program, is safe and is based on best available evidence. • Consideration of the impact of the HPV vaccine on cervical screening now and in the future. • An improved cervical screening register system. • A quality management plan. • Advice on a renewed program’s acceptability to the community and health professionals.

18. Conclusion • Australian women, HPV vaccinated or unvaccinated, will have equitable access to a safe, efficient, cost-effective screening program which maximises benefits and minimises harms and is based on the best available evidence. PARTNER CONSULTATION IS VITAL

19. Feedback Session 2

20. Questions What are your expectations of the Renewal? Are there any topics that you consider have been overlooked by the Renewal process? How do you feel you can assist with the Renewal process? What level of communication would you like about the Renewal Project? (direct or via website) Email: CervicalRenewal@health.gov.au Website: www.cancerscreening.gov.au