Population sub-groups
Women's health - cervical cancer
| Topics: |
- What is cervical cancer?
- Summary of cervical cancer among Indigenous women
- Policies and strategies
- Published resources
- Organisations
- Other web-based materials
What is cervical cancer?
Cervical cancer affects cells in the lining of the cervix which is the lower part of the uterus (womb) and situated at the connection to the vagina [1]. There are several forms of cervical cancer, the greatest proportion are squamous cell carcinomas and adenocarcinomas or combinations of both. The disease can spread to other parts of the body. Cervical cancer can take 10 years or more to develop, but cells may show pre-cancerous changes before this time. Symptoms are not obvious in the early stages of cervical cancer, those that may occur are unusual bleeding from the vagina and sometimes an unusual vaginal discharge, but these symptoms may not always be due to cancer. There is an increasing risk of the disease with age, it is very rare before the age of 25 years.
Risk factors
Cervical cancer is preventable in most cases - internationally it has been demonstrated that 90% of squamous cervical cancer can be prevented through early screening and treatment [2]. Risk factors for cervical cancer include human papilloma virus (HPV) infection, sexual behaviour and cigarette smoking [3]. In Australia HPV infections are among the most common types of sexually transmitted infections (STIs), but it is difficult to monitor the incidence as they are not notifiable diseases [4]. HPV often does not cause symptoms as the immune system suppresses the infection. It is only some strains of HPV that lead to abnormal cell changes.
Screening for cervical cancer
The Papanicolaou (Pap) smear test is the usual means of screening and can detect changes in the cells before they develop into cancer. Pre-cancerous lesions are treatable. Currently the Australian recommendation is for all women who have been sexually active at any stage in their lives to have a Pap smear every 2 years until the age of 70 years [1]. Pap smears may cease at age 70 years for women who have had two normal Pap smears within the previous five years. Women aged 70 years or older who have never had a Pap smear, or who request a Pap smear, should be screened. Women who have had a hysterectomy should seek advice on their individual needs regarding screening.
Cervical cancer screening for Australian women began in the 1960s
[2]. The National Cervical Screening Program
(NCSP) was introduced in response to the report Cervical Screening
in Australia in 1990. The program has been widely accepted
by women, service providers and other stakeholders and there has
been increasing participation in the program.
References
1. Australian Institute of
Health and Welfare and Commonwealth Department of Health and Aged
Care National Cervical Screening Program (2000). Cervical screening
in Australia 1997-1998. Canberra: Australian Institute of Health
and Welfare and the Commonwealth Department of Health and Aged Care
National Cervical Screening Program
2.Commonwealth Department of Health and Aged Care
(2001). The National Cervical Screening Program. Canberra:
Commonwealth Department of Health and Aged Care
3. O'Brien E, Bailie R, Jelfs
P (2000). Cervical cancer mortality in Australia: contrasting risk
by Aboriginality, age and rurality. International Journal of
Epidemiology;29(5): 813-816
4. Australian Institute of
Health and Welfare (2002). Australia's health 2002. The
eighth biennial report of the Australian Institute of Health and
Welfare. Canberra: Australian Institute of Health and Welfare
Summary of cervical cancer among Indigenous women
Data about cervical cancer among Indigenous women are incomplete,
with only Western Australia, South Australia and the Northern Territory
considered to have adequate coverage prior to 1998 and with Queensland
data since then reaching an acceptable level.
Over the five-year period 1993-1997 in Western Australia, there
were 20 cases of cervical cancer notified among Indigenous women,
an incidence rate of 22 cases per 100,000 population [1].
This rate is three times higher than the incidence among non-Indigenous
women.
In 1995-1997 there were 19 deaths from cervical cancer reported among Indigenous women living in Western Australia, South Australia and the Northern Territory (an age-standardised death rate of 27.6 per 100,000 women, which is over nine times more than in non-Indigenous women - 3.0 per 100,000 women) [2].
In 1997-2000 in Queensland, Western Australia, South Australia and the Northern Territory there were 22 deaths from cervical cancer recorded for Indigenous women in the 20-69 year age group [3]. The age-standardised rate for Indigenous women (11.3 per 100,000) was five times that for non-Indigenous women (2.1 per 100, 000 women). Mortality rates increased with increasing age and rates for Indigenous women were higher than for non-Indigenous women in every age group.
Analysis of data from 1986-1997 demonstrates a geographical disparity in the risk of death from cervical cancer for Indigenous women compared with non-Indigenous women [4]. The risk ranges from 4.3 times higher for Indigenous women in metropolitan areas, 9.7 times higher for those in rural areas and 18.3 times higher for those in remote areas.
Screening for cervical cancer among Indigenous women
The 2001 National Health Survey reported that 50% of Indigenous women aged 18 years and over had regular Pap smears [5]. However, they are far less likely to attend regularly for Pap smears than non-Indigenous women, with those in rural regions and communities the least likely to have Pap smears and to be the least educated about cervical cancer issues [4]. The lack of facilities, support networks and the likelihood of delayed diagnosis appear to be the main contributors to the excess mortality of Indigenous women from cervical cancer in these areas. State and Territory cervical screening plans identify Indigenous women as a priority target group and aim to encourage communities to take ownership of the cervical screening initiatives [6].
Generally, most women go to their general practitioners (GPs) for Pap smears, with other options including family planning services, government-funded community health services, and government hospital outpatient departments. For Indigenous women, Aboriginal community-controlled health services are major providers of screening services, supplemented by the Royal Flying Doctor Service in rural and remote areas [7].
In the general population, the women who are less likely to participate in screening are: over 50 years of age; single; less well educated and from lower socioeconomic groups [4]. Barriers to accessing cervical screening are often exacerbated for Indigenous women and include: physical access to general practitioners (GPs), poor transport, lack of child care, difficulty getting time off work, financial problems, lack of understanding or confusion about Pap smear procedures, and fear or embarrassment about the procedure (particularly if there is prior history of sexual abuse).
A Queensland project found that Indigenous women generally preferred a female practitioner and access to one increased the number of women attending women's health programs [7]. There are growing numbers of female practitioners in urban and regional centres, but a limited number in rural and remote areas. Trust, security, confidentiality and respect between patient and practitioner were essential for Indigenous women accessing cervical cancer screening services. A recommendation from this project was for women's health programs to be developed in partnership with local women and be based on an Indigenous community development model.
In an anthropological assessment of a successful cervical screening
program in remote northern Australia it was found that understandings
about culture and gender were found to be crucial factors in the
design and application of Pap smear programs [8].
Key elements for better service delivery included committed health
practitioners, cross cultural education, and improved socio-economic
conditions for Indigenous populations.
References
1. Thomson N and Irvine J (2001).
A review of cancer among Aboriginal people in Western Australia.
Perth: Cancer Foundation of Western Australia
2. Australian Institute of Health and
Welfare and Commonwealth Department of Health and Aged Care National
Cervical Screening Program (2000). Cervical screening in Australia
1997-1998. Canberra: Australian Institute of Health and Welfare
and the Commonwealth Department of Health and Aged Care National
Cervical Screening Program
3. Australian Institute of Health
and Welfare (2003) Cervical screening in Australia 1999-2000. Canberra:
Australian Institute of Health and Welfare
4. O'Brien E, Bailie R, Jelfs P (2000)
Cervical cancer mortality in Australia: contrasting risk by Aboriginality,
age and rurality. International Journal of Epidemiology;29(5):
813-816
5.Australian Bureau of Statistics
(2002) National Health Survey: Aboriginal and Torres Strait
Islander Results, Australia. Main features. Canberra: Australian
Bureau of Statistics
6. Commonwealth Department of Health
and Aged Care (2001). The National Cervical Screening Program.
Canberra: Commonwealth Department of Health and Aged Care
7. Kirk M, Hoban E, Dunne A, Manderson
L (1999). Barriers to and appropriate delivery systems for cervical
cancer screening in Indigenous communities in Queensland. Herston:
Australian Centre for International & Tropical Health & Nutrition
8. Toussaint S, Mak D, Straton
J (1998). Marnin business: anthropological interpretations of cervical
screening among Australian Aboriginal women. Australian Journal
of Primary Health - Interchange 4(2): 43-52
Policies and strategies
Commonwealth Department of Health and Aged Care
The National Cervical Screening Program
View
details
Lessons learned/Case studies
Department of Health and Ageing (2004)
Principles of practice, standards and guidelines for providers
of cervical screening services for Indigenous women.
Canberra: Department of Health and Ageing
View
report: Department of Health and Ageing (PDF - 888KB - large file warning!)
The National Cervical Screening Program's Pap Smear website includes
women's stories about Pap smears.
View
stories
Published resources
Journal articles
2006
Binns PL, Condon JR (2006)
Participation in cervical screening by Indigenous women in the Northern Territory: a longitudinal study.
Medical Journal of Australia;185(9):490-494
View article: Medical Journal of Australia (HTML)
View article: Medical Journal of Australia (PDF - 526KB)
View website: Medical Journal of Australia
Breeze C, De Costa CM, Jagusch M (2006)
Do women in rural and remote areas need different guidelines for management of low-grade abnormalities found on cervical screening? [letter]
Medical Journal of Australia;184(6):307-308
View article: Medical Journal of Australia (HTML)
View article: Medical Journal of Australia (PDF - 306KB)
View website: Medical Journal of Australia
Panaretto KS, Dallachy D, Manessis V, Larkins S, Tabrizi S, et
al. (2006)
Cervical smear participation and prevalence of sexually transmitted
infections in women attending a community-controlled Indigenous
health service in North Queensland.
Australian and New Zealand Journal of Public Health;30(2):171-176
View article: Australian and New Zealand Journal of Public Health (PDF - 92KB)
View website: Public Health Association of Australia
2005
Corkrey R, Parkinson L, Bates L, Green S, Htun AT (2005)
Pilot of a novel cervical screening intervention: interactive voice
response.
Australian and New Zealand Journal of Public Health;29(3):261-264
View
abstract: HealthBulletin
View article: Australian and New Zealand Journal of Public Health (PDF - 32KB)
View website: Public Health Association of Australia
2002
Royal Australian College of General Practitioners (2002)
The RACGP Aboriginal and Torres Strait Islander Women's Project
Australian Indigenous HealthBulletin, 2(4), Brief report
2.
View
brief report: HealthBulletin
Coory MD, Fagan PS, Muller JM, Dunn NAM (2002)
Participation in cervical cancer screening by women in rural and
remote Aboriginal and Torres Strait Islander communities in Queensland.
Medical Journal of Australia;177:544-547.
View
article: Medical Journal of Australia (HTML)
View
article: Medical Journal of Australia (PDF - 536KB)
View website: Medical Journal of Australia
Hunt JM, Geia LK (2002)
Can we better meet the healthcare needs of Aboriginal and Torres
Strait Islander women? [editorial].
Medical Journal of Australia;177:533-534.
View article: Medical Journal of Australia (HTML)
View
article: Medical Journal of Australia (PDF - 136KB)
View website: Medical Journal of Australia
2001
Amega B (2001)
Achievements in cervical cancer screening practice in the NT.
The Northern Territory Disease Control Bulletin;8:18-19.
View article: The Northern Territory Disease Control Bulletin (PDF - 356KB)
National Aboriginal Community Controlled Health Organisation (2001)
How can cervical cancer incentives benefit Aboriginal women?
NACCHO issues paper. Retrieved 3/9/2004 from http://www.naccho.org.au/CervicalCancer.html
View
article: National Aboriginal Community Controlled Health Organisation (HTML)
2000
Jackson LW, Ward JE (2000)
An analysis of resources for Indigenous women in NSW about cervical
screening.
Australian and New Zealand Journal of Public Health; 24:327-330.
View
abstract: Australian and New Zealand Journal of Public Health
View website: Public Health Association of Australia
Reports and publications
2005
Australian Institute of Health and Welfare (2005)
Cervical screening in Australia 2002-2003.
Canberra: Australian Institute of Health and Welfare
View
report: Australian Institute of Health and Welfare (PDF - 637KB)
2004
Department of Health and Ageing (2004)
Principles of practice, standards and guidelines for providers
of cervical screening services for Indigenous women.
Canberra: Department of Health and Ageing
View
report: Department of Health and Ageing (PDF - 888KB)
2003
Australian Institute of Health and Welfare (2003)
Cervical screening in Australia 1999-2000.
Canberra: Australian Institute of Health and Welfare
View
report: Australian Institute of Health and Welfare (HTML)
Carey M (2003)
The RACGP Aboriginal and Torres Strait Islander Women's Project:
supporting GPs to improve early detection and management of breast
and cervical cancer in Aboriginal and Torres Strait Islander women.
Melbourne: National Rural Faculty of the Royal Australian College
of General Practitioners
View
abstract: HealthBulletin
View
project report (PDF - 467KB)
View
report (PDF - 1.3 MB - large file warning!)
2002
Saunders V, Elston J, Gennat H (2002)
Early detection and management of breast and cervical cancer
in Aboriginal and Torres Strait Islander women: supporting the role
of the general practitioner.
Townsville, School of Public Health and Tropical Medicine, James
Cook University:1-56.
View
abstract: School of Public Health and Tropical Medicine
Theses
Mak, D. (1997).
Cervical screening in the Fitzroy Valley.
Unpublished
Master of Public Health thesis, University of Western Australia,
Perth.
Trees J (2000)
High grade anxiety: Australian Aboriginal women and Pap test screening.
Unpublished Bachelor of Science (Honours) thesis, School of History & Philosophy of Science, University of New South Wales, Sydney.
View abstract: HealthBulletin
Conference abstracts
2006
RACGP Annual Scientific Convention
6 - 9 October 2006, Brisbane, Queensland
Millard FB. Cervical screening for Indigenous women: the GP role
View abstract (HTML)
View presentation (PDF - 416KB)
2001
From the Ground up: Conference on Aboriginal health in the 63rd
millennium
Fay Acklin and Jill Cockburn
What do Koori women know, feel, believe and perceive about cervical
cancer and pap tests?
View
abstract
Other resources
Pap smear good for umi long life - video
View
abstract: HealthBulletin
Well women equal strong women - pamphlet
View
abstract: HealthBulletin
Pap screen Victoria
Pap screen Victoria is coordinated by the Victorian Department
of Human Services and is a joint Commonwealth–State funded
program . PapScreen Victoria urges all Indigenous women to have
regular two-yearly Pap tests in a bid to reduce deaths caused by
cervical cancer.
Brochures are available free of charge and can be obtained by contacting:
PapScreen Victoria ph:(03) 9635 5316 or ordered online at www.papscreen.org.au
or from your local Aboriginal health service.
View
web page
Programs and projects
The National Cervical Screening Program
View
details
Cervical cancer: when did you last have a Pap smear? A joint Commonwealth/
State Territory Health initiative
View
details
Royal Australian College of General Practitioners (2002)
The RACGP Aboriginal and Torres Strait Islander Women's Project
Australian Indigenous HealthBulletin, 2(4), Brief report
2.
View
brief report: HealthBulletin
Guidelines
Department of Health and Ageing (2004)
Principles of practice, standards and guidelines for providers
of cervical screening services for Indigenous women.
Canberra: Department of Health and Ageing
View
report: Department of Health and Ageing (PDF - 888KB)
National Health and Medical Research Council (2005)
Screening to prevent cervical cancer: guidelines for the management
of asymptomatic women with screen detected abnormalities.
Canberra: National Health and Medical Research Council
View
report: National Health and Medical Research Council (PDF - 651KB)
References
Key references
- Acklin F (2000) What Koori women know, feel, believe and
perceive about cervical cancer and pap test. 12th National
Health Promotion Conference, Inequalities in Health - reflecting
back, stepping forward, Melbourne, Australia, Australian Health
Promotion Association.
View abstract - Angus S (1999) Paper for the Indigenous women's cervical
cancer prevention and control strategy. Public Health Conference,
Darwin.
View paper - Australian Institute of Health and Welfare and Commonwealth Department of Health and Aged Care National Cervical Screening Program (2000). Cervical screening in Australia 1997-1998. Canberra: Australian Institute of Health and Welfare and the Commonwealth Department of Health and Aged Care.
- Couzos S, Wribsjum U, Murray R, Cox H (1998) Augmentation of pap smear screening of high risk Aboriginal women. Use of computerised process tool within the Broome Aboriginal Medical Service. Australian Family Physician;27(4): 269-74.
- Gilles M, Crewe S, Granites I, Coppola A (1995) A community-based cervical screening program in a remote Aboriginal community in the Northern Territory. Australian Journal of Public Health;19(5): 477-481.
- Hancock L, Sanson-Fisher R, Perkins J, Corkrey R, Burton R, Reid S (2001) Effect of a community action intervention on cervical cancer screening rates in rural Australian towns: the CART project. Preventive Medicine;32: 109-117
- Health Department of Western Australia (1998) Western Australian cancer prevention program. Strategic plan for the recruitment of women for cervical cancer screening 1998/99-2000/01. Perth: Women's Cancer Screening Service, Public Health Division.
- Kirk M, Hoban E, Dunne A, Manderson L (1999) Barriers to and appropriate delivery systems for cervical cancer screening in Indigenous communities in Queensland. Herston: Australian Centre for International & Tropical Health & Nutrition.
- O'Brien E, Bailie R, Jelfs P (1999). Cervical
cancer mortality in Australia: contrasting risk by Aboriginality,
age and rurality. Australasian Epidemiological Association
Annual Scientific Meeting, Carlton Hotel, Darwin, Northern Territory,30
September - 1 October 1999.
View abstract - O'Brien E, Bailie R, Jelfs P (2000) Cervical cancer mortality in Australia: contrasting risk by Aboriginality, age and rurality. International Journal of Epidemiology;29(5): 813-816.
- Queensland Health (nd) Queensland Indigenous women's cervical screening strategy 2000-2004. Brisbane: Women's Cancer Screening Services, Queensland Health.
- Reath J (1999) Preventing cervical cancer: strategies for a remote Aboriginal community. Aboriginal and Islander Health Worker Journal;23(3): 7-9.
- Reath J, Usherwood T (1998) Improving cervical screening in a remote Aboriginal community. Australian and New Zealand Journal of Public Health;22(6): 659-663.
- Saunders V, Elston J, Gennat H (2002) Early detection and management of breast and cervical cancer in Aboriginal and Torres Strait Islander women: supporting the role of the general practitioner. Townsville: School of Public Health and Tropical Medicine, James Cook University: 1-56. View full report (PDF)
- Thurecht K (2000). Aboriginal women talk about Pap smear screening for cervical cancer in southeast Queensland. Aboriginal And Islander Health Worker Journal;24(5): 21-23.
- Toussaint S, Mak D, Straton J (1998) Marnin
business: anthropological interpretations of cervical screening
among Australian Aboriginal women. Australian Journal of Primary
Health - Interchange;4(2): 43-52.
Bibliography
You may wish to search through the HealthInfoNet bibliographic database for references to cervical cancer or Pap smears.
Organisations
Currently no information available.
Other web-based materials
NSW Cervical screening program
The purpose of this web page is to provide information and resources
about cervical cancer screening to consumers and health service
providers. A section is dedicated to Aboriginal and Torres Strait
Islander women and has downloadable resources.
View web page
Pap screen Victoria
Pap screen Victoria is coordinated by the Victorian Department
of Human Services and is a joint Commonwealth–State funded
program . The organisation works in collaboration with its partners,
the Victorian Cytology Service and the Victorian Cervical Cytology
Registry. The Cancer Council Victoria is contracted to develop and
implement Victoria’s cervical screening communications and
recruitment strategy. PapScreen Victoria works across a range of
communications, community and research projects to meet its objectives.
It also utilises the skills of a nurse, GP and gynaecologist to
inform the program. PapScreen Victoria urges all Indigenous women
to have regular two-yearly Pap tests in a bid to reduce deaths caused
by cervical cancer.
View
web page (This web page details downloadable brochures)
View website
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