Decision Maker Response

Greg Hunt’s response

Feb 23, 2017 — Dear Isabella and petitioners,

Thanks for the opportunity to respond to the petition.
 
Women’s health and cancer testing is extremely important. That’s why it is so vital that people have accurate information.
 
I'm happy to clarify some of the information here - I think some confusion around what these changes mean has left women concerned, when medical professionals can assure you there's absolutely no need to be.

What’s actually happening is that an old test is being replaced with a newer and far more effective test.
 
This was recommended by Australia’s leading medical experts. They’ve told us the new test is so much more effective that it could reduce the incidence of cervical cancer by up to 30%.
 
It also means that women only need to have a pap smear every five years instead of every two.
 
But don’t just take my word for it – here’s what the Australian Medical Association, the Chief Medical Officer and Professor Ian Frazer (the person who created the HPV vaccine against cervical cancer) had to say about the switch to the new test.
 
PROFESSOR IAN FRASER – Former Australian of the Year, developer of HPV vaccine against cervical cancer
 
The current cervical cancer screening program has served Australia well over many years, and has prevented many deaths from cervical cancer.  The new program builds on the success of the current program, but uses a newer and more rational approach to screening, by testing for persisting infection with the viruses that cause cervical cancer.
 
This program is better for the general public because it allows the same near 100% protection against cervical cancer for women who fully participate in the program, but with less frequent testing, as has been shown in clinical trials both internationally and in Australia.  
 
The new program also has the advantage that it will be easier to run, as the old screening test was manual, and required considerable professional expertise and training, and the new screening test is automated, with reliable testing systems. 
 
Also, the number of abnormal tests will fall in the future, as young women who have been protected from HPV and cervical cancer with the HPV vaccines enter the cervical cancer screening program. 
 
Quality assurance is essential for screening tests and it will be easier to provide quality assurance for the new cervical cancer testing program that the old one in future, as quality assurance for the old program depended on finding an  expected number of abnormal screening tests, and this expected number will be so much lower in the future that the old quality assurance system will no longer be reliable..  
 
Overall, the new program will be more convenient for women, and just as effective at preventing cervical cancer, on the available research evidence.
 
DR MICHAEL GANNON – President of the Australian Medical Association
 
It is time to sink some of the myths around changes to National Cervical Screening Program (NCSP). The well-intentioned change.org petition, which is hurtling past 50,000 signatures, is nonetheless woefully misinformed and misguided. The new guidelines are evidence-based, and a fabulous good news story for girls and women across Australia.
 
The new guidelines have been developed over many years by an eminent panel of Gynaecologists, Pathologists, Clinicians, and Scientists. They have been meticulously reviewed through the Medical Services Advisory Council (MSAC) process, and represent a further improvement to the Cervix Cancer screening program, which was already the world’s best.
 
The new NCSP reflects an increased understanding of the biology of Cervix Cancer. It reflects the changes in epidemiology that will accrue from having a population of young adults (boys and girls) who should nearly all be vaccinated against cancer producing HPV (wart virus) infection.
 
These changes will mean that millions of women can perfectly safely reduce the number of times they face the nuisance, expense, and discomfort of having Pap smears. Perhaps the only down side of the change is the health promotion opportunities that have accrued from women visiting their GP on a two-yearly basis.
 
Nonetheless, it will lead to thousands of women avoiding the anxiety of an abnormal Pap smear and an appointment for follow-up testing. In time, this will result in thousands of women avoiding the need for referral to a Gynaecologist for examination and Colposcopy.
 
Most importantly, it will mean that thousands of women will avoid surgery historically performed (in good faith) to reduce the risk of progression to severe pre-cancerous changes or Cervix Cancer.
 
The natural history of HPV infection is that, in many cases, especially in healthy, young non-smokers, the immune system will eliminate the virus without treatment. These women need not have surgery.
 
The old system was never particularly good in detecting Cervix Cancer in women under the age of 25. The progression from pre-cancerous change to invasive Cancer typically takes many years. The change from cytology (examining the cells under a microscope) to HPV testing is appropriate, with more than 99 per cent of cases of Cervix Cancer being caused by HPV infection.
 
The most important reason to reduce the number of women having this kind of surgery is to reduce short and medium term risks such as infection, haemorrhage, and cervical stenosis.
 
Most importantly, at a population level it will reduce the incidence of Cervical Incompetence and preterm birth.
 
Prematurity is the number one cause of death and disability in children less than five years old in the developed world.
 
In many women, preterm birth occurs secondary to a deficiency in the defence mechanism that a length of closed cervix provides. A reduction in the number of women having surgery on the uterine cervix will be expected to reduce the incidence of prematurity.
 
Prematurity is associated with increased risks of Cerebral Palsy, chronic lung disease, intellectual impairment, hearing impairment, blindness, learning difficulties, and behavioural problems.
 
The NCSP changes will thus save taxpayers millions of dollars, but they are not merely a cost-saving measure. This is a well thought out, evidence-based change to Gynaecological practice, which will be a bonanza for improvements in child health.
 
The existing Cervix Cancer screening program was never perfect in detecting non-HPV-related cancers. It is absolutely essential that, with the new NCSP guidelines, we remind women of the importance of presenting for asymptomatic screening.
 
It is also absolutely essential that all women are encouraged to report abnormal bleeding to their GP. Whether this bleeding occurs throughout the cycle or after intercourse, it must (as always) be interrogated. It will remain the case that women under the age of 25 with abnormal bleeding will merit Gynaecological investigation and care.
 
This is a good news story for not only the health of Australian women and girls, but that of their future children. The fact that it is likely to be cost-effective is an added bonus for the taxpayers who fund the success story that is Australia’s NCSP.
 
PROFESSOR BRENDAN MURPHY – Australia’s Chief Medical Officer
 
Cervical cancer is a largely preventable cancer and Australia has one of the lowest rates in the world

The Pap smear currently recommended for 18 to 69 year old women every 2 years is going to be replaced by a test for the Human Papilloma Virus (HPV). Because this test is much more sensitive and detects the presence of the virus before it has causes any damage (which happens slowly over many years) it only needs to be done every five years for women from 25 to 74 years of age.

The Australian Government is making this change based on the latest international evidence on the prevention and early detection of cervical cancer. The evidence was reviewed by an independent, expert committee and the government accepted their recommendations without amendment. 

Until these changes come into effect women are advised to continue screening in accordance with their current schedule. Women of any age who have symptoms (including pain or bleeding) should see their doctor. There are other very rare forms of cervical cancer but unfortunately neither the current test or new test detect these. 

It is estimated that this new test will reduce the incidence of cervical cancer by up to 30%.