Cancer risk for First Nations women

Although Australia is on track to become one of the first countries to eliminate cervical cancer, Aboriginal and Torres Strait Islander women are being left behind.

In a study published in Preventative Medicine, researchers from the Australian National University (ANU) and the Cancer Council New South Wales (CCNSW) say we must act urgently to address these inequalities.

“Elimination is not on track for Indigenous women across the globe,” says lead researcher Lisa Whop, an ANU epidemiologist and a Torres Strait Islander. “Australia, Canada, New Zealand and the US must urgently address their systemic failure to care and provide health for Indigenous women.”

Cervical cancer: the facts

• Cervical cancer and pre-cancerous lesions are largely caused by certain types of HPV (human papillomavirus), a sexually transmitted disease.
• The World Health Organization (WHO) estimates that globally there were 570,000 new cases of cervical cancer in 2018.
• In Australia, there were 933 new cases diagnosed in 2020 and 238 deaths in the same year.

Late last year, the WHO launched a strategy to eliminate cervical cancer across the world, outlining three key steps: vaccination, screening and treatment.

The strategy called for three targets to be met globally by 2030: for 90% of girls to be vaccinated against HPV by the age of 15, 70% of women to be screened at least twice in their lives, and 90% of women to have access to treatment.

The WHO estimates that implementing all three measures could reduce over 40% of new cases and 5 million deaths by 2050.

But this new research reviewed data from four high-income colonised countries (Australia, Canada, New Zealand and the US) and found that elimination is not on track for Indigenous women in these countries. Vaccination, screening and treatment are not being adequately carried out in Indigenous populations.

“There are enormous equity issues in Australia,” says co-author Megan Smith, from CCNSW. “Aboriginal and Torres Islander women experience cervical cancer at the same rates as developing regions of the world, despite having access to the vaccination programs and screening programs.”

Only a third of Aboriginal and Torres Islander women in Australia are participating in cervical screening. The report outlines several barriers, including speaking honestly about screening, forming trusting relationships with health professionals, and navigating logistical challenges and privacy concerns.

Smith suggests that self-collection – a quick, simple, effective screening test – may help overcome these barriers, allowing women to retain an element of empowerment and control.

Improving HPV vaccination and timely treatment is also crucial, as well as improved data collection to keep the system that is intended to care for women accountable.

“To achieve equitable health outcomes for Indigenous peoples, strategies need to centre on Indigenous leadership, knowledge, and solutions with ongoing community engagement,” says Whop.

“We need a culture shift of not accepting the status quo of inequity. We need to urgently remove these inequities and eliminate cervical cancer in Indigenous women.”

In their paper the researchers conclude: “We urge the international community to hold individual countries to account for not only meeting their elimination targets, but meeting them for all women.”

The VCS Foundation’s Preventing Cervical Cancer in Australia conference will convene on Friday, 26 March. The PCC conference will mark the Australian launch of both the WHO’s elimination strategy and the Conquering Cancer Campaign.