Bridging Gaps in Cervical Cancer Screening Access
A global forerunner in the race to achieve the Sustainable Development Goal of eliminating cervical cancer, one of the most preventable and treatable forms of cancer, and the fourth most common cancer among women globally, Australia has reached the scale-up target of 70% cervical screening coverage more than five years ahead of schedule.
Unfortunately, these gains have not benefited all women equally, and some communities experience considerably poorer cervical cancer outcomes than others. Over 2017-2021, 3.5 times more Indigenous women died from cervical cancer than non-Indigenous women. Mortality was also much higher for women in the most remote areas (3.3 deaths per 100,000) than in major cities (1.9 deaths per 100,000).
The Royal Women’s Hospital in Melbourne, Australia's first and leading specialist hospital for the health and wellbeing of women and newborns, in partnership with the Victorian Government, is taking the lead on improving access to screening by piloting a programme that will train nurses to perform colposcopy. This is a critical procedure for the identification of cancerous or pre-cancerous cells in or near the cervix, for which there is significant under-serviced demand, as indicated by long waitlists across the country. While nurses in other countries have performed colposcopy for decades, in Australia, colposcopists are almost exclusively doctors, and in short supply in the public health system. Once qualified, Victoria’s nurse colposcopists will be able to work in areas of great need and provide care that is not just more accessible, but also of comparable or even higher quality, given the volume of colposcopies trained nurses would routinely do. This task-shifting approach would be more cost-effective for our strained public health systems, and would also enable a potentially more relaxed service for women if the procedure is integrated into the sexual health service offering that nurses usually provide.
The Nossal Institute is working closely with the Royal Women’s Hospital to evaluate the pilot training programme, and now at the mid-point, the outlook is very positive. The first nurse in Victoria has risen to the challenge of a technically-rigorous and robust curriculum, and qualified as a colposcopist, with the overall program being strengthened through the learnings of this experience. In the months to come, the Nossal Institute’s evaluation will examine patient experiences and further opportunities for strengthening the nurse colposcopy training programme, including its expansion across more rural and remote parts of Victoria.
The ultimate aim is improving colposcopy access and quality not just in Victoria, but also Australia-wide – so we can bring all women with us on our cervical cancer elimination pathway.
Authors
Minhui Law is a Technical Advisor at the Nossal Institute for Global Health. She is passionate about addressing systemic disadvantage and promoting inclusion, and has a keen interest in improving the inclusiveness of health and governance systems for vulnerable groups and communities
Clare Strachan is a Principal Advisor at the Nossal Institute for Global Health. Clare is a public health and health security specialist with more than twenty years of experience. She has a broad range of expertise including communicable disease control, pandemic preparedness and response, health security, health systems strengthening, community health and development, health financing and governance, and implementation science across a range of settings in Africa and the Asia Pacific.