More than 200 people from around the globe heard from internationally renowned experts at the one-day stream on cervical screening, held at the Melbourne Exhibition Centre in April 2004. The Cancer Council Australia hosted the stream, which was part of the 18th World Conference on Health Promotion and Health Education.
Dr Gael Jennings, board member of The Cancer Council Australia, opened the program on behalf of the Cancer Council, by challenging the audience to reconsider cervical screening practices in Australia. Is the screening interval appropriate? What can we do better to meet the needs of Australia’s Indigenous population? Should existing funds allocated to cervical screening be re-directed within the program and used more effectively?
The challenging issues raised by Dr Jennings were continued throughout the day. Many Australian delegates may have been surprised to hear from Professor Valerie Beral’s (University of Oxford, England) presentation that cervical cancer is the second most common cancer death in women worldwide, with 80 per cent of cases and deaths occurring in less developed countries. Cervical screening in Australia has been highly successful, with the mortality rate from cervical cancer halved during the last two decades. While Australia enjoys this success, the picture cannot be replicated all over the world.
Dr Heather Mitchell (Director, Victorian Cytology Service, Australia) highlighted in her presentation that even though Australia’s national cervical screening program could be considered a public health success story, there are still challenging issues facing the program. Firstly, as new developments contest the appropriateness of the conventional Pap test, there is a need to undertake local research to help determine which of the new developments will help Australia’s program. Secondly, the difficulty of reviewing existing policies needs to be addressed, and finally, there is the ongoing challenge of how to engage underscreened women, including Indigenous women, migrant groups, and older women.
A forum on cervical screening couldn’t be held without some focus on the human papilloma virus (HPV), and the exciting possibilities that lie ahead with HPV testing and HPV vaccines. Professor Ian Frazer (Centre for Immunology & Cancer Research, University of Queensland, Australia) and Associate Professor Suzanne Garland (Microbiology and Infectious Diseases Unit, Royal Women’s Hospital, Australia) provided an update on the HPV vaccine, and discussed potential clinical applications of HPV testing. Early phase trials of the therapeutic vaccine are encouraging – good news for the 5 million or so women already infected with HPV. Furthermore, with strong evidence that prophylactic vaccines prevent HPV infection, research is currently underway to determine how long protection lasts once vaccinated.
With these exciting possibilities ahead and the enormous advances in understanding cervical cancer, women are increasingly being told about HPV. Dr Kirsten McCaffery (University of Sydney, Australia) presented on the psychosocial implications of HPV, and anticipates that HPV information is likely to change women’s perceptions of cervical cancer and screening. She highlighted the need to educate the whole community about HPV, and in order to minimise any negative psychosocial impact, key messages should normalise the infection.
Strategies on how to empower and engage women were also highlighted in the conference stream. Ms Anne Allan-Moetaua and Ms Ngamata Skipper (National Screening Unit, Ministry of Health, New Zealand), and Ms Sandy Angus (Queensland Cervical Screening Program, Queensland Health, Australia) presented their work targeting Indigenous women from New Zealand, the South Pacific and Australia. With Australian Indigenous women dying of cervical cancer at a higher rate than other women, these presentations provided inspiration and direction – and importantly, strategies that could be adopted by other screening programs.
In order to showcase existing good practice at the local level, the stream also included two oral presentation sessions and a poster presentation session. These sessions allowed for local activities and research to be presented, and for delegates to be further inspired by the terrific work that is happening at the “grass roots” level. The one-day program was summarised in the final session, with an exciting debate-provoking hypothetical facilitated by Dr Nick Carr from the ABC’s George Negus Tonight program.
Some people may have thought that with reduced mortality rates from cervical cancer, cervical screening in Australia was no longer a priority health issue. However, the diversity of issues raised on the day has ensured that the program in Australia will remain vibrant and important for some time to come.
The Cancer Council Australia would like to acknowledge the assistance of the Australian Government for their funding support towards the stream, and to the Cervical Screening Conference Stream Organising Committee for their organisation of the stream.