📋 Key Information Summary
- Persistent infection with high-risk HPV (especially types 16 and 18) is the necessary cause of virtually all cervical cancers; HPV 16/18 account for approximately 70% of cases in Australia.
- Since December 2017, the Pap smear has been replaced by the HPV-based Cervical Screening Test (CST) as the primary screening modality in Australia.
- Screening is recommended for all people with a cervix aged 25–74 years, every 5 years with a negative HPV result (changed from 2-yearly Pap smears).
- The Cervical Screening Test detects HPV DNA/RNA first; if HPV-positive, reflex liquid-based cytology (LBC) is performed on the same specimen.
- HPV 16/18-positive results require direct referral to colposcopy regardless of cytology findings.
- HPV-positive for other high-risk types with abnormal cytology (≥ASC-US) also requires colposcopy; if cytology is normal, repeat CST at 12 months.
- Self-collected vaginal samples are now a validated and funded option for under-screened and never-screened individuals aged 30–74, significantly improving equity of access.
- The National HPV Vaccination Program (Gardasil® 9) funds vaccination for ages 12–13 via school-based programmes; catch-up is available for those who missed vaccination, with the single-dose schedule adopted from 2023 for ages <25.
- CIN 1 (LSIL) usually regresses spontaneously; CIN 2 has intermediate behaviour; CIN 3 (HSIL) is the definitive precancerous lesion requiring treatment (excision or ablation).
- Women who are immunocompromised, HIV-positive, DES-exposed, or have a history of treatment for high-grade disease require more intensive surveillance per ASCCP-equivalent Australian guidelines.
- Aboriginal and Torres Strait Islander women experience cervical cancer incidence and mortality rates 2–3 times higher than non-Indigenous women; culturally safe screening programmes and self-collection pathways are critical to closing this gap.
- Exit from the National Cervical Screening Program is recommended at age 74 with two consecutive negative HPV results in the previous 10 years.
Introduction & Australian Epidemiology
Cervical cancer is one of the most preventable malignancies thanks to effective screening programmes and vaccination against human papillomavirus (HPV). Australia introduced its National Cervical Screening Program (NCSP) in 1991 with two-yearly Pap smears, and transitioned in December 2017 to a five-yearly HPV-based Cervical Screening Test (CST). This transition was based on robust evidence that primary HPV testing is more sensitive than cytology alone for detecting high-grade cervical intraepithelial neoplasia (CIN 2/3) and adenocarcinoma in situ (AIS), the precursors to invasive cervical cancer.
Australian Burden of Disease
- Approximately 900–950 new cases of cervical cancer are diagnosed in Australia each year, and around 250–300 women die annually from the disease (AIHW, 2023).
- The age-standardised incidence rate has fallen dramatically since the introduction of organised screening—from 14 per 100,000 in the early 1990s to approximately 6–7 per 100,000 currently.
- The most common histological types are squamous cell carcinoma (~70%) and adenocarcinoma (~25%); adenocarcinoma is harder to detect by cytology but equally well detected by HPV testing.
- Australia's HPV vaccination programme (commenced 2007 for girls, 2013 for boys) has led to measurable reductions in HPV prevalence, genital warts, and high-grade cervical abnormalities in vaccinated cohorts, with modelling predicting near-elimination of cervical cancer by 2035.
Key Differences from the Old Programme
| Feature | Old Programme (Pap smear) | Current Programme (CST) |
|---|---|---|
| Primary test | Cytology (Pap smear) | HPV nucleic acid test |
| Screening interval | Every 2 years | Every 5 years |
| Age to start | 18 years (or within 2 years of first sexual activity) | 25 years |
| Age to cease | 70 years | 74 years |
| Self-collection | Not available | Available for ages 30–74 (expanded 2022) |
| Test of cure | Annual cytology | HPV test at 12 months post-treatment |
HPV & Natural History of Cervical Neoplasia
Human Papillomavirus (HPV)
HPV is a small, non-enveloped, double-stranded DNA virus that infects basal keratinocytes of squamous epithelium. Over 200 types have been identified; approximately 14 are classified as high-risk (oncogenic) types. HPV is the most common sexually transmitted infection worldwide — approximately 80% of sexually active individuals will acquire at least one HPV infection in their lifetime.
High-Risk HPV Types
| Category | HPV Types | Attributable Cervical Cancer (%) |
|---|---|---|
| Highest risk | 16, 18 | ~70% |
| Other high-risk | 31, 33, 45, 52, 58 | ~20% |
| Lower oncogenic potential | 35, 39, 51, 56, 59, 66, 68 | ~10% |
Natural History: From HPV Infection to Cervical Cancer
The natural history of cervical neoplasia follows a well-characterised, multi-step process:
1
HPV Acquisition
Transmission via skin-to-skin contact, usually during sexual activity. Most infections occur within years of sexual debut. Incubation period is 1–6 months for visible warts (types 6, 11); high-risk types may be latent for years.
2
Transient Infection (~90%)
The majority of HPV infections are cleared by cell-mediated immunity within 12–24 months. No treatment is required. Persistence is the key risk factor for progression.
3
Persistent Infection (~10%)
Persistence of high-risk HPV (especially types 16, 18, 31, 33) beyond 12–24 months significantly increases the risk of developing CIN. HPV 16 has the highest rate of persistence and progression.
4
CIN 1 (LSIL)
Low-grade dysplasia — represents productive HPV infection. Approximately 60–80% regress spontaneously within 1–2 years, particularly in younger women. Approximately 10–15% persist and ~5–10% progress to CIN 2+.
5
CIN 2 / CIN 3 (HSIL)
CIN 2 is a borderline lesion (some regress, some progress). CIN 3 (carcinoma in situ) is the direct precursor to invasive cancer. Without treatment, the median time from CIN 3 to invasive cancer is estimated at 10–15 years, though this can be shorter in immunocompromised individuals.
6
Invasive Cervical Cancer
Approximately 0.5–1% of untreated CIN 3 will progress to invasive cancer. The risk varies by HPV type (HPV 16 progresses most rapidly). Once invasion occurs, the cancer follows standard staging (FIGO) and requires multimodal treatment.
Key concept: HPV infection is necessary but not sufficient for cervical cancer development. Co-factors that increase progression risk include immunosuppression (HIV, transplant), smoking, high parity, long-term oral contraceptive use (>5 years), and co-infection with other STIs (Chlamydia trachomatis, HSV-2).
HPV Vaccination in Australia
The National Immunisation Program (NIP) funds Gardasil® 9 (nonavalent vaccine covering types 6, 11, 16, 18, 31, 33, 45, 52, 58) for:
- Routine schedule: All adolescents aged 12–13 years, delivered as a single dose in school-based programmes (adopted from February 2023, replacing the previous 2-dose schedule for this age group).
- Catch-up: A single dose for individuals aged <25 years who have not yet been vaccinated (catch-up funded through the NIP).
- Older individuals / those ≥25 years: A 3-dose schedule is required if vaccination is pursued, but is not NIP-funded; approximately 0–600 for the course (private prescription).
Gardasil® 9 (Nonavalent HPV Vaccine)
MSD · Recombinant 9-valent HPV vaccine
Composition
VLPs for types 6, 11, 16, 18, 31, 33, 45, 52, 58
Routine dose
0.5 mL IM, single dose (ages 12–13, from Feb 2023)
Catch-up dose
Single dose for those <25 years who missed vaccination
Immunocompromised ≥25 yrs
3 doses at 0, 2, and 6 months (standard 3-dose schedule)
PBS / NIP status
✔ NIP Funded (ages 12–13 school; catch-up <25)
Australian success story: Since the introduction of the HPV vaccination programme in 2007, HPV 16/18 prevalence in young Australian women has fallen by over 75%, genital wart presentations have declined by >90% in those aged <21, and high-grade cervical abnormalities have decreased significantly in vaccinated cohorts. Modelling by Hall et al. (2019) predicts cervical cancer elimination (<4 cases per 100,000 women-years) in Australia by approximately 2035.
CIN Grading & The Bethesda System
Cervical cytology in Australia is reported using a modified Bethesda System, which classifies specimens based on the presence and type of epithelial cell abnormalities. Understanding this system is essential for interpreting Cervical Screening Test results and determining appropriate clinical management.
Bethesda Reporting Categories
| Category | Description | Approximate CIN Equivalent | Clinical Significance |
|---|---|---|---|
| Negative for intraepithelial lesion or malignancy (NILM) | Normal squamous and glandular cells; no evidence of dysplasia | Normal | Routine 5-yearly screening if HPV-negative |
| Atypical squamous cells of undetermined significance (ASC-US) | Mild squamous cell changes of uncertain significance | Atypical | Requires HPV triage or repeat in 12 months depending on HPV result |
| Atypical squamous cells — cannot exclude HSIL (ASC-H) | Atypical squamous cells suspicious for high-grade lesion | Atypical / possible HSIL | Referral to colposcopy recommended |
| Low-grade squamous intraepithelial lesion (LSIL) | Koilocytic changes consistent with HPV effect | CIN 1 | Usually regresses; colposcopy if HPV 16/18 or persistent at 12 months |
| High-grade squamous intraepithelial lesion (HSIL) | Moderate to severe dysplasia | CIN 2 / CIN 3 | Colposcopy required; treatment usually indicated |
| Squamous cell carcinoma | Invasive squamous carcinoma | Invasive cancer | Urgent referral to gynaecological oncology |
| Atypical glandular cells (AGC) | Atypical endocervical, endometrial, or glandular cells NOS | Variable (may indicate AIS or endometrial pathology) | Colposcopy + endometrial sampling (if ≥45 years or abnormal bleeding) |
| Adenocarcinoma in situ (AIS) | High-grade glandular precursor lesion | AIS | Colposcopy + excisional biopsy; higher risk of occult invasion |
Correlation: Cytology (Bethesda) vs Histology (CIN)
Cytology and histology use parallel but distinct classification systems. The correlation is:
| Cytology (Bethesda) | Histology (CIN) | Regress (%) | Persist (%) | Progress (%) |
|---|---|---|---|---|
| LSIL | CIN 1 | 60–80% | 10–20% | ~5–10% |
| HSIL | CIN 2 | 30–50% | 30% | ~20–30% |
| HSIL | CIN 3 | Low (<10%) | ~20% | ~12–30% (to invasion if untreated) |
CIN 2 — the equivocal lesion: CIN 2 has variable biological behaviour; in women aged <25, observation (conservative management with repeat colposcopy and cytology at 12 months) is often appropriate because regression rates are higher. In women ≥25, treatment is more commonly recommended, especially for confirmed CIN 2 on biopsy.
Cervical Screening Test — Who, When, and How
Who Should Be Screened?
- All people with a cervix aged 25–74 years who have ever been sexually active (regardless of gender identity, sexual orientation, or vaccination status).
- Screening should commence at age 25 (not 18), as HPV infections acquired before this age overwhelmingly resolve spontaneously, and screening younger women leads to unnecessary investigation without cancer prevention benefit.
- Vaccinated individuals must still screen — the vaccine does not cover all oncogenic HPV types.
Screening Intervals and Pathways
Routine
HPV Negative
No HPV detected by the CST. Return to routine 5-yearly screening.
Repeat CST in 5 years
Requires Assessment
HPV Positive (not 16/18) + Normal Cytology
Other high-risk HPV detected but reflex cytology is NILM. Most will clear the infection.
Repeat CST in 12 months
Urgent Referral
HPV 16/18 Positive (any cytology)
Highest-risk HPV types detected. Direct to colposcopy regardless of cytology result, as the risk of CIN 2+ is significantly elevated.
Colposcopy referral
Complete Management Pathway Based on CST Results
| HPV Result | Reflex LBC (Cytology) | Management |
|---|---|---|
| HPV not detected | Not performed | Routine screening in 5 years |
| HPV 16/18 detected | Any (including NILM) | Colposcopy referral |
| Other HR-HPV detected | NILM | Repeat CST in 12 months |
| Other HR-HPV detected | ASC-US or LSIL | Colposcopy referral |
| Other HR-HPV detected | ASC-H, HSIL, AGC, AIS, or SCC | Colposcopy referral (urgent if SCC) |
| Other HR-HPV detected at 12 months | Any | Colposcopy referral |
| HPV not detected at 12 months | — | Return to 5-yearly screening |
Collection Method
- Clinician-collected sample: Traditional Cervex-Brush® or similar device, with sampling of the transformation zone. Specimen placed in liquid-based cytology (LBC) medium. This remains the gold-standard collection method.
- Self-collected vaginal sample: Since July 2022, all individuals aged 30–74 who are under-screened (never screened or ≥2 years overdue) or never-screened may self-collect a vaginal swab for HPV testing. This uses a dry flocked swab inserted 4–5 cm into the vagina. Self-collection detects HPV with high sensitivity (~75–85% for CIN 2+, versus ~90% for clinician-collected) and is significantly more acceptable to many underscreened women.
Important limitation: Self-collected samples test for HPV only — they do not provide reflex cytology. If the self-collected sample is HPV-positive, the patient must attend for a clinician-collected sample (with LBC) or be referred directly for colposcopy (if HPV 16/18 detected). Self-collection is not appropriate for symptomatic patients (e.g., abnormal bleeding) who should undergo clinician assessment.
Medicare Benefits Schedule (MBS) Items
| MBS Item | Description |
|---|---|
| 69316 | Cervical Screening Test — clinician-collected (routine screening) |
| 69317 | Cervical Screening Test — self-collected (eligible patients) |
| 69320 | Follow-up CST for HPV-positive patients (12-month repeat) |
| 35524 | Colposcopy with directed biopsy |
| 35530 | Excisional treatment of the cervix (LLETZ / LEEP) |
Test of Cure After Treatment
Following treatment (excision or ablation) for CIN 2/3 or AIS:
- First follow-up CST (HPV test) at 12 months post-treatment.
- If HPV-negative at 12 months: repeat at 24 months post-treatment (second test of cure).
- If both negative: return to 5-yearly routine screening.
- If HPV-positive at any test of cure: colposcopy referral.
- If margins of excision specimen are involved by CIN 2+ or AIS: closer surveillance recommended (CST at 6 months + colposcopy).
Exit from the National Cervical Screening Program
- At age 74 years, with documented two consecutive negative HPV tests within the preceding 10 years (i.e., two negative CSTs at routine 5-yearly intervals).
- Women who have had a total hysterectomy (with removal of the cervix) for benign indications, with no history of CIN 2+, do not require further screening.
- Women who have had a total hysterectomy with a prior history of CIN 2+ should have annual vaginal cuff cytology for 25 years following treatment (or until age 74).
Screening in Special & Underscreened Populations
Underscreened and Never-Screened Women
Approximately 30% of eligible Australian women are not up to date with cervical screening. Key barriers include lack of awareness, cultural and language barriers, previous negative healthcare experiences (including sexual assault), geographic remoteness, and cost (particularly for those without Medicare access). The NCSP Register sends reminder letters, but many women do not respond.
Self-collection is the game-changer: Since the July 2022 expansion, all eligible women aged 30–74 who are never-screened or overdue (≥2 years since last CST, or ≥4 years since last Pap) can self-collect a vaginal HPV sample in the clinic (or at home via approved programmes). Practice nurses and GPs should proactively offer self-collection to all overdue patients. Data from the Victorian Cytology Service show that self-collection uptake has significantly increased screening rates among previously underscreened women.
Immunocompromised Women
Includes: HIV-positive, organ transplant recipients, those on immunosuppressive therapy (e.g., biologics, high-dose corticosteroids, chemotherapy).
Key difference: HPV infections are more likely to persist and progress more rapidly. CIN may develop at any age, including <25 years.
Recommendations:
- HIV-positive women: commence screening within 1 year of sexual debut or at age 18 (whichever is earlier) — not at 25 as per general population.
- Screen annually (not 5-yearly).
- Organ transplant recipients: commence screening at 1 year post-transplant or per transplant-unit protocol; annual CST.
- If abnormalities are detected, treat at lower thresholds (CIN 1 may warrant treatment in severely immunocompromised patients).
Young Women (<25 Years)
Key principle: Do not screen before age 25 in the general population. HPV infections in young women are overwhelmingly transient, and screening leads to unnecessary colposcopy and excisional treatments that may increase future obstetric risks (preterm birth, cervical incompetence).
Exception: If clinically symptomatic (persistent abnormal bleeding, post-coital bleeding), investigate regardless of age with appropriate examination and consider HPV testing / colposcopy.
Pregnant Women
Screening: CST can safely be performed during pregnancy (preferably in the first trimester). Colposcopy for HPV 16/18-positive results can be performed during pregnancy by an experienced colposcopist.
Treatment: Excisional and ablative treatments are contraindicated during pregnancy. If CIN 2/3 is diagnosed, defer treatment until ≥6 weeks postpartum. Repeat colposcopy at 36 weeks if CIN 3 is present.
Postpartum: Perform CST at 6 weeks postpartum; regression of CIN 1 is common during pregnancy.
Older Women (>65 Years)
Key point: Women over 65 who have been adequately screened (two negative HPV tests in previous 10 years) may safely exit the programme. However, women who have never been screened or are under-screened should be encouraged to have a CST at any age until two consecutive negative results are obtained.
Risk: Cervical cancer in older women is often diagnosed at a later stage because screening has ceased. Maintain vigilance for symptoms (postmenopausal bleeding, vaginal discharge).
Women Who Have Had a Hysterectomy
- Total hysterectomy for benign disease, no history of CIN 2+: No further screening required.
- Total hysterectomy with history of CIN 2+: Vaginal cuff cytology annually for 25 years after treatment of the most recent CIN 2+ lesion, or until age 74.
- Subtotal (supracervical) hysterectomy: Continue routine CST as per guidelines (cervix remains in situ).
Women with Symptoms
Red flag symptoms: Post-coital bleeding, intermenstrual bleeding, postmenopausal bleeding, persistent vaginal discharge, pelvic pain, or dyspareunia are NOT indications for routine screening — these require clinical assessment, examination, and appropriate investigation (which may include a CST but should not be limited to it). Refer for urgent gynaecological assessment if cancer is suspected.
Investigations
Primary Screening Test
Essential
Cervical Screening Test (HPV + reflex LBC)
Liquid-based cytology medium specimen. Processed by accredited pathology laboratories (e.g., Douglass Hanly Moir, Sullivan Nicolaides, PathWest). Results typically available within 7–14 business days. Self-collected samples tested at same laboratories using validated PCR-based HPV assays (Cobas® HPV, Aptima® HPV, or BD Onclarity™).
Available
Colposcopy
Optical magnification (6–40×) of the cervix with acetic acid (3–5%) and Lugol's iodine (Schiller test). Available in specialist gynaecology clinics, family planning clinics, and some hospital outpatient departments. Waiting times vary: 2–6 weeks in metropolitan areas, potentially longer in regional/remote areas. MBS item 35524.
Available
Cervical Biopsy (Punch / Cone)
Directed biopsy at colposcopy for histological confirmation. Punch biopsies taken from the most abnormal area. Cone biopsy (cold-knife cone or LLETZ/LEEP) for diagnostic and therapeutic purposes. Processed by specialist gynaecological pathologists.
Specialist
LLETZ / LEEP (Large Loop Excision of the Transformation Zone)
Electrosurgical excision for treatment of CIN 2/3. Performed under local anaesthesia in colposcopy clinic. Provides tissue for histological assessment including margin status. MBS item 35530.
Referral
Gynaecological Oncology Referral
Required for confirmed or suspected invasive cervical cancer, AIS with positive margins, or microinvasive squamous cell carcinoma. Tumour staging (FIGO 2018), MRI pelvis, CT chest/abdomen/pelvis, and PET-CT for staging. Available at all state-based gynaecological oncology centres (e.g., RPA Women's Health, RBWH, Royal Women's Melbourne, QEH Adelaide).
Management of Abnormal Results
At Colposcopy — Biopsy and Treatment Thresholds
| Colposcopy / Histology Finding | Recommended Action |
|---|---|
| Normal colposcopy, HPV positive (non-16/18) | Endocervical curettage; repeat CST in 12 months |
| CIN 1 (LSIL) on biopsy | Observation — repeat colposcopy and CST in 12 months (conservative management preferred in women <30) |
| CIN 2 on biopsy (confirmed by specialist pathologist) | If age <25: observation with 12-monthly review. If ≥25: excision (LLETZ) recommended; observation may be considered in select cases. |
| CIN 3 (HSIL) on biopsy | Excisional treatment (LLETZ / LEEP). Ablation (cryotherapy/cold coagulation) only if transformation zone fully visible and no glandular abnormality. |
| AIS on biopsy | Excisional cone biopsy (diagnostic). If margins negative and patient completed family, consider hysterectomy. Fertility-sparing: excision with negative margins + close follow-up. |
| Microinvasive squamous cell carcinoma (<3 mm depth, Stage IA1) | Referral to gynaecological oncology. Cone biopsy may be sufficient if margins clear; lymphovascular invasion assessment essential. |
| Invasive cancer (≥Stage IA2) | Urgent referral to gynaecological oncology for staging and treatment planning. |
Excisional Treatment Details
LLETZ / LEEP Excision
Large Loop Excision of the Transformation Zone
Setting
Outpatient colposcopy clinic, local anaesthesia (1–2% lignocaine with adrenaline)
Procedure
Excision of transformation zone using thin wire loop with electrosurgical current (cut/coag blend)
Success rate
~90–95% clearance of CIN 2/3 in a single procedure
Complications
Intraoperative/postoperative haemorrhage (3–5%), cervical stenosis (rare), preterm birth in future pregnancies (relative risk ~1.5–2× with excision depth >10 mm)
MBS item
35530
Obstetric implications: Excisional treatment of the cervix (especially excision depth >15 mm or repeat excision) is associated with an increased risk of preterm birth (before 37 weeks) and preterm premature rupture of membranes (PPROM) in future pregnancies. In women who have not yet completed their family, minimise excision depth and consider conservative management for CIN 2 where appropriate. Always document excision dimensions in the operative report.
Aboriginal and Torres Strait Islander Health Considerations
Aboriginal and Torres Strait Islander Health
Aboriginal and Torres Strait Islander women experience disproportionately high rates of cervical cancer and cervical cancer mortality compared with non-Indigenous Australian women. This inequity reflects a complex interplay of historical, systemic, and cultural barriers to screening, follow-up, and treatment. Closing the gap in cervical cancer outcomes requires a multipronged, culturally safe approach.
Action for every GP practice: Audit your patient register to identify Aboriginal and Torres Strait Islander women aged 25–74 who are overdue for cervical screening. Contact them proactively and offer self-collection as the first option. Partner with local ACCHOs and Aboriginal Health Workers to deliver culturally safe screening programmes.
📚 References
- 1. Australian Government Department of Health and Aged Care. National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding. Canberra: Department of Health; 2023.
- 2. Cancer Council Australia Cervical Cancer Screening Guidelines Working Party. National Cervical Screening Program: Recommendations for Clinical Practice. Sydney: Cancer Council Australia; 2023. Available at: wiki.cancer.org.au.
- 3. Australian Institute of Health and Welfare (AIHW). Cervical Screening in Australia 2023. Cat. no. CAN 139. Canberra: AIHW; 2023.
- 4. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Cervical Cancer. Canberra: AIHW; 2023.
- 5. Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019;4(1):e19–e27.
- 6. Machalek DA, Garland SM, Brotherton JML, et al. Very low prevalence of vaccine human papillomavirus types among 18- to 35-year old Australian women 9 years following implementation of vaccination. J Infect Dis. 2018;217(9):1398–1407.
- 7. Brotherton JML, Budd AC, Drennan K, et al. Elimination of cervical cancer in Australia: progress and projections. Aust N Z J Obstet Gynaecol. 2023;63(3):305–311.
- 8. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–e203.
- 9. National Health and Medical Research Council (NHMRC). National Cervical Screening Program: Self-Collection Policy. Canberra: NHMRC; 2022.
- 10. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement: Cervical Screening in Pregnancy. C-Obs 33. Melbourne: RANZCOG; 2021.
- 11. Mbatani N, Adams T, Michelow P, et al. Self-collected human papillomavirus testing for cervical cancer screening in underscreened populations: a systematic review and meta-analysis. Int J Gynaecol Obstet. 2023;160(1):40–51.
- 12. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Updated HPV chapter (single-dose schedule).
- 13. Australian Institute of Health and Welfare (AIHW). Cancer in Aboriginal and Torres Strait Islander People of Australia. Cat. no. CAN 108. Canberra: AIHW; 2023.
- 14. Currow DC, You H, Aranda S, et al. Cervical screening outcomes in Indigenous women in the Northern Territory: a population-based study. Aust N Z J Public Health. 2022;46(3):318–324.
- 15. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102–131.