Elsevier

Vaccine

Volume 26, Supplement 12, 19 August 2008, Pages M80-M88
Vaccine

ICO Monograph Series on HPV and Cervical Cancer: Asia Pacific Regional Report
Human Papillomavirus and Cervical Cancer in Australasia and Oceania: Risk-factors, Epidemiology and Prevention

https://doi.org/10.1016/j.vaccine.2008.05.041Get rights and content

Abstract

The region encompassing Australasia and Oceania, including Australia, New Zealand, Fiji and Papua New Guinea, is a diverse one with respect to ethnicities, cultures and behaviours. It includes countries with comprehensive cervical cytology screening programmes which can be credited with significant reductions in cervical cancer incidence and mortality, and countries with no prevention programmes and significantly higher incidence and mortality. As elsewhere in the world, human papillomavirus (HPV)-16 and 18 are the commonest high-risk types, with the highest rates in women under 25 years of age. These two high-risk HPV types are found most frequently in cervical cancers and high-grade dysplasias, although there are minimal data for many countries in Oceania. In April 2007, Australia became the first country worldwide to commence a government funded universal HPV vaccine programme. The school-based programme targets 12-year old females in an ongoing schedule, with a catch-up programme up to 26 years of age, to be completed in mid-2009. Vaccine introduction has been comprehensively rolled out, with around 75% uptake of the complete vaccine schedule among school-girls in the first year of this initiative. This represents a successful model for other countries. We present data on cervical cancer, risk factors and prevention strategies, including epidemiology of HPV and HPV vaccine strategies.

Introduction

The region encompassing Australasia (Australia and New Zealand) and Oceania is culturally, ethnically, and economically diverse, which influences the availability of high quality health care systems. Countries in the region vary from those with well-organised cervical cancer screening programmes with high coverage, as well as government funded universal human papillomavirus (HPV) vaccine programmes, to those countries with no cervical cancer screening or planned vaccine initiatives. This review aims to describe the level of morbidity due to cervical cancer within countries in the region. We describe the various initiatives taken by these countries in cervical cancer prevention, their achievements, but also the huge scope for improvement. In describing deployment of the HPV vaccine, we provide considerable detail as to how this is occurring in Australia, as this was the first country to implement a universal female HPV vaccination initiative and may be a model for others.

Section snippets

Cervical cancer incidence and mortality across Australasia and Oceania

In Australia and New Zealand (NZ), the introduction of national cervical screening programmes of high quality, wide coverage, as well as adequate treatment for precancerous lesions, has resulted in significant reductions in cervical cancer incidence, as well as mortality. This is in marked contrast to other countries in the region (e.g., Fiji and Papua New Guinea (PNG)) that have some of the highest rates of cervical cancer in the world, with late presentations and concomitant high morbidity

Co-factors for HPV exposure and carcinogenesis

The most comprehensive source of data on sexual behaviour at the population level is from the Australian Study of Health and Relationships (ASHR) in 2002 of 19,307 Australians aged 16–59 years, which had a response rate of 73% [8], [9]. The mean number of lifetime sexual partners varied by age (Table 1). Of the men surveyed between the ages of 16 and 24, 22% reported more than one sexual partner in the previous year and the equivalent figure for women was 14%. For those aged 25–34 years, 15% of

Australia

In Australia, the National Cervical Screening Programme, using conventional Pap testing starts at age 18 or two years after sexual debut, whichever is later and continues at two-year intervals until age 69. The programme achieves coverage of approximately 61% at the two year screening interval and approximately 80% at three years [1].

Laboratory quality is actively regulated through a system of performance measures and laboratory accreditation, linked to ongoing funding. The implementation of

Australia

New vaccines are initially assessed by the Therapeutic Goods Administration (TGA) for listing on the Australian register of Therapeutic Goods. Advice to the government about the possible role of the vaccine in the Australian population is provided by the Australian Technical Advisory Group on Immunisation (ATAGI). Since 2006, ATAGI also provides advice to the Pharmaceutical Benefits Advisory Committee (PBAC), whose role is to make recommendations to the government regarding public funding of

Conclusion and Research needs

Within this region there is an extreme disparity in preventive service provision by country and this is reflected in the levels of disparity in cervical cancer screening programmes from very effective to nonexistent. There is commensurate variation in cervical cancer incidence and mortality. Unfortunately many countries in the region have the highest mortality due to cervical cancer in the world, while accurate cervical cancer incidence data in many instances is inadequate. There is a need to

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