The Compass Trial: Recognised as One of the Most Important Clinical Trials in 2023
Nature Medicine recently published an article featuring the “11 Clinical trials that will shape medicine in 2023”, which listed the top clinical trials to watch over the course of the year according to leading experts. The Compass Trial, a large-scale randomised controlled trial of Primary HPV DNA testing for cervical cancer in Australia, was included in this list.
Compass is the first major trial investigating cervical screening methods in a population with high rates of HPV vaccination, having recruited 81,000 women since 2013. This trial is co-led by C4 Chief Investigators Prof Karen Canfell at the Daffodil Centre and Prof Marion Saville at the Australian Centre for the Prevention of Cervical Cancer (ACPCC). Together, the trial has been conducted by the ACPCC and the Daffodil Centre, with close affiliations with the C4.
While cervical screening has traditionally used the Pap smear (cervical cytology) method, a more sensitive method which performs molecular testing to detect the presence of HPV is becoming more widely used, with Australia updating its cervical screening guidelines to HPV testing in 2017. In 2021, and with the support of modelling conducted by the Daffodil Centre, the World Health Organisation recommended HPV testing as the primary method for cervical screening. However, primary HPV screening has not yet been directly assessed in a highly vaccinated population.
The results from the Compass Trial are informing the national screening guidelines for the Australian program and safety monitoring of the primary HPV-based cervical screening program. Initial results from the Compass Pilot have already demonstrated increased detection of cervical precancerous lesions in a partially vaccinated population (1). Later this year, we expect to release results on the five-year follow-up from the pilot experience and on first round of HPV screening within the main trial. It is expected that these findings will provide key evidence to many countries around the world who are considering transitioning from cytology-based screening to primary HPV screening.
- Canfell K et al., PLoSMED 2018.
Release of the 2022 Cervical Cancer Elimination Progress Report
In this second data audit of Australia’s progress towards the elimination of cervical cancer as a public health problem, we have brought together the most recent data available across 12 indicators to paint a snapshot of our current status, including reporting for the first time on precancer treatment. We have come far in cervical cancer prevention and control in Australia, but there remains work to do, both in terms of public health action and necessary improvements in the way we gather and synthesise data to inform these actions.
We are optimistic that Australia can address the challenges identified in this report and hope that this report can help inform a national strategy to ensure Australia’s progress towards the elimination of cervical cancer as a public health problem is on-track for all women.
Change to the National Cervical Screening Program Policy to support Self-Collection
C4 celebrates the commencement, as of July 1, 2022, of the new National Cervical Screening Program Policy that makes vaginal self-collection a choice for all people eligible for cervical screening in Australia. C4 investigators are proud to have provided research, modelling, clinical, policy and implementation science expertise and input which has helped informed this policy change and clinical guidelines to support it. We hope to see this option support more people to participate in the program and, in so doing, accelerate Australia’s progress towards the elimination of cervical cancer as a public health problem. For details about the new policy see:
Self-Collection Pamphlet – Department of Health and Aged Care
National Cervical Screening Program – Quick reference guide – Self-collected cervical screening tests
National Cervical Screening Program Guideline Changes
Free Live IPVS Webinar "Everything you need to know about HPV and Pregnancy"
16th March 2022: WHO Policy Brief on Human papillomavirus (HPV) nucleic acid amplification tests (NAATs) to screen for cervical pre-cancer lesions and prevent cervical cancer.
WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition: use of mRNA tests for human papillomavirus (HPV), December 2021
WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, July 2021
C4 CRE Associate Investigator Professor Helen Marshall has been named as the 2022 SA Australian of the Year and awarded a Member of the Order of Australia (AM)
Helen received the honour for her contribution to vaccinology, public health and infectious diseases and her research work that has global impacts. You can read more about Helen’s award here.
C4 CRE Researchers Receive Funding from the Australian Government for three World-leading Projects
C4 CRE researchers have received more than $4.4 million in funding from the Australian Government for three world-leading projects that will help eliminate cervical cancer and support the career development of emerging cancer researchers.
As announced by Minister Greg Hunt this week, the funding will identify new and innovative approaches to increase participation in the National Cervical Screening Program (NCSP).
This research will accelerate Australia’s progress towards the elimination of cervical cancer as a public health problem. The three studies will support cervical screening participation in general practice, for Aboriginal and Torres Strait Islander people, and for people living with an intellectual disability. These projects will help increase participation in cervical screening in these groups to ensure Australia reaches elimination in a more equitable way.
Dr Claire Nightingale (University of Melbourne) and Associate Professor Megan Smith (the Daffodil Centre) are co-leading a project to improve the implementation of self-collection through general practice. This work will develop tools to support decision-making and explore alternative service delivery models to further improve access to cervical screening. They are looking forward to working with policymakers and providers to make the most of the opportunity that the universal option of self-collection will provide.
Torres Strait Islander researcher, Associate Professor Lisa Whop (Australian National University), is partnering with researchers and Aboriginal and Torres Strait Islander health organisations and communities to co-design and implement community driven strategies to increase cervical screening. Embedding the option of cervical screening by self-collection into community health will be a key element of this work. The grant will enable Associate Professor Whop and her team to engage more Aboriginal and Torres Strait Islander people in cervical screening in a culturally safe environment led by and for Aboriginal and Torres Strait Islander communities.
Professor Deborah Bateson (Family Planning NSW) will lead a project in partnership with researchers and peak disability organisations that will identify ways to increase engagement in the NCSP for people with intellectual disability. The team will co-design and trial information and training resources for people with an intellectual disability, their carers, GPs, and disability support workers. This will assist people with an intellectual disability to participate in cervical screening. People with intellectual disability are less likely to participate in cervical screening, and experience multiple barriers to access. Specialised training for GPs will help ensure people with intellectual disability understand the procedure, feel safe, and can provide informed consent to screening.
Congratulations to C4 Researchers on Grant Success
C4 Chief Investigators Rebecca Guy and Andrew Vallely from the Kirby Institute, and Associate Investigator Lisa Whop from ANU have all been awarded NHMRC Investigator grants. These awards are a testament to their excellence as researchers and all three grants will further the control of cervical cancer through their innovative and important programs of work.
Prof Rebecca Guy’s grant ‘Public health interventions to control sexually transmitted infections’ will involve developing and trialing more effective interventions which will move Australia and the Asia-Pacific Region substantially closer to the goal of controlling STIs (including HPV) in high-risk populations
Prof Andrew Vallely’s grant ‘Innovative technologies to improve sexual and reproductive health among women in high-burden, low-resource settings’ will further his world leading work preventing premature deaths due to cervical cancer by establishing and scaling-up robust clinical screening algorithms in high burden, low resource settings.
Assoc Prof Lisa Whop’s grant ‘Addressing racialised health inequities in cancer’ will focus on overcoming racial inequities via strategic culturally safe interventions focused on the three pillars of cervical cancer elimination.
Congratulation Rebecca, Andrew and Lisa!
C4 Researchers Successful in Securing Funding for Screening in Vulnerable Populations
Last week, Federal Health Minister Greg Hunt announced $5.9m in cancer prevention funding for women in vulnerable communities across the world through the Global Alliance for Chronic Disease (GACD). C4 partners are leading two of the projects that will be funded under this commitment.
- VCS Foundation is leading a project to implement HPV-based cervical cancer screening in rural India
- The Kirby Institute (at University of NSW) is leading a project to implement HPV-based testing and treatment in Papua New Guinea
VCS Foundation’s Medical Director, Associate Professor Julia Brotherton will lead implementation research with partners in two states of India, Tamil Nadu in Southern India and Mizoram in North Eastern India, and experts on cancer and disease prevention from the International Agency for Research on Cancer, and the Baker Heart and Diabetes Institute.
India has a high burden of cervical cancer, with one-fifth of the total global burden, and a death rate of around 60,000 people every year. The project aligns to the World Health Organisation strategy to eliminate cervical cancer as a public health problem worldwide, and the $1.33 million grant will enable the project group to work closely with those already engaged with vulnerable communities in India to trial new approaches through co-designing care pathways using self-collection and human papillomavirus (HPV) based testing, which is more accurate and less invasive for women.
Professor Andrew Vallely from the Kirby Institute at UNSW Sydney will lead a project on HPV testing and treatment for the elimination of cervical cancer in rural and remote Papua New Guinea. This $1.59 million project builds on an initiative announced earlier in the year by the Kirby Institute to co-lead a new cervical cancer elimination program in the Western Pacific.
The project will utilise the novel ‘test and treat’ screening model developed by our collaborative research team, comprising HPV testing of self-collected vaginal specimens followed by same-day treatment using a new battery operated, portable thermal ablation device. This approach proved highly effective, acceptable and cost-effective in previous field trials.”
The team will now establish how best to reach women in rural and remote communities, where cervical pre-cancer and cancer rates are highest, access to health services most constrained, and the most at risk women in PNG and other high-burden, low-resource countries live.
The Minister’s announcement can be found here.
Preventing Cervical Cancer Conference
C4 and VCS Foundation are hosting two free online events for the Preventing Cervical Cancer Conference – PCC2021 – on Friday 26 March 2021. The major theme across the PCC2021 events is addressing the inequities in cervical cancer outcomes within and across countries to ensure all women and girls can have a cervical cancer-free future.
The first virtual event focuses on Australia’s leading role in cervical cancer prevention globally and what we need to do to achieve cervical cancer elimination as a public health problem in our country by 2030. The event commences at 7.15am and will conclude at 8.50am AEDT. For program information and to register, click here.
The second event focuses on what is required for countries across the Indo-Pacific region to scale up vaccination and screening to achieve the World Health Organization global targets for cervical cancer elimination. The event commences at 4.15pm to and will conclude at 7.15pm AEDT. For program information and to register, click here.
If you cannot attend and would like to receive a recording of these events, please email a request to email@example.com
World Health Organization launches cervical cancer elimination strategy – C4 features
The World Health Organization launched the Cervical Cancer Elimination Initiative on Tuesday 17th November 2020. C4 featured in the event and you can watch the video here (the C4 contribution to the event starts at 33:25).
Cervical cancer is one cancer the world can actually eliminate: it’s time to do it. Following a Call to Action in May 2018 from the World Health Organization (WHO) Director-General, Dr. Tedros, 194 countries collectively resolved to end needless suffering from a cancer that is both preventable and curable. The world already has the necessary tools; they just need to be made accessible.
In August 2020, the World Health Assembly passed a resolution calling for elimination of cervical cancer and adopting a strategy to make it happen. It is a testament to the enthusiasm for this important goal that, even in the context of the COVID-19 pandemic, countries around the world have affirmed their support for this important priority.
The moment has arrived for an ambitious, inclusive strategy to accelerate eliminating cervical cancer as a public health problem. Elimination is within the reach of all countries. We can all leave behind a great legacy if we seize the opportunities that are within our reach now, so that girls who are born today will live to see a world free of this disease.
C4CRE Chief Investigator Professor Karen Canfell discusses the launch and Australia’s involvement in working towards cervical cancer elimination for all in this blog post.
C4 is a Proud Sponsor of the Conquering Cancer Campaign
The C4 CRE is a proud sponsor of the Conquering Cancer Campaign, a social impact communications initiative that celebrates the efforts made to eliminate cervical cancer around the world. Eliminating cervical cancer will be one of the greatest achievements in the history of global health, “rivalling the end of polio in terms of shear impact on humankind,” according to Professor Ian Frazer.
To achieve the dream of conquering cervical cancer, we must first share this remarkable story through a compelling global narrative that engages, educates and inspires decision-makers worldwide to prioritise elimination and empower them to take action now.
While great strides are being made towards global elimination, there are still 600,000 cases of cervical cancer recorded annually and more than 300,000 women continue to die from the disease every year. The vast majority of women diagnosed with cervical cancer live in low – middle income countries.
To eliminate cervical cancer, leaders need to recognise that it is feasible in all countries. Our collective voices must join the call-to-action by the World Health Organization and urge for widespread introduction and up-scaling of HPV vaccination for young girls everywhere; access to cervical screening for every adult woman; and proper treatment and care for all women diagnosed with cervical cancer.
The Conquering Cancer Campaign will amplify the achievements of countries where elimination is imminent and encourage decision-makers in other nations to advocate for change and urgent action. This wave of awareness will strengthen the existing movement to eliminate cervical cancer. The campaign is supported by strategically-aligned organisations and their members, who will engage decision-makers worldwide, and promote action by introducing vaccination, screening and treatment programs.
The Conquering Cancer Campaign also speaks to women across the globe, especially those aged between 30-65, by helping to raise awareness about cervical cancer and reducing barriers to preventative measures, including cervical cancer screening and HPV vaccination of children.
Over 18 months – starting from September 2020 to April 2022 – Moonshine Agency will create, release, promote and publicise a series of original films, photographs, stories and visual communications in 10 languages. These will be well-told, feel-good success stories, balancing human-interest and cutting-edge health innovations.
Success looks like a global groundswell around the vision of conquering cervical cancer, which will put every country on the pathway to elimination. Because a woman’s chance of being diagnosed with cervical cancer shouldn’t depend on where she resides.
You can support the campaign by:
- Liking, following and sharing the Conquering Cancer Facebook page
- Following and sharing the Conquering Cancer Twitter profile
- Following the Conquering Cancer Instagram feed
- Connecting with the Conquering Cancer LinkedIn page
- Subscribing to the YouTube Channel
- Subscribing to the Email Newsletter on the website
C4 Continues work on HPV Screening in Malaysia with colleagues from the University of Malaya
In November 2019, Adam Keane from Cancer Council NSW visited Malaysian colleagues at the University of Malaya. They discussed plans for a modelled evaluation on the impact of a national HPV-based screening program in Malaysia, based on the success of the Project ROSE (Removing Obstacles to cervical ScrEening) trial. He also gave a talk on previous modelling work by Cancer Council NSW. Pictured are Prof. Chiu Wan Ng from the University of Malaya on the left and Adam Keane on the right.
Increased HPV vaccination, screening and treatment access in the world’s poorest countries could save over 62M lives in the next 100 years
Australia has led by example and played an integral role in informing this focus on elimination of cervical cancer around the world
The World Health Organisation (WHO) is developing a plan to eliminate cervical cancer globally, and two new studies published today in Lancet estimate the potential benefits. The studies, led by Cancer Council NSW, Université Laval and Harvard University working with the World Health Organisation, have found that over 74 million cervical cancer cases and 62 million deaths could be averted over the next 100 years if 78 of the poorest countries in the world are able to rapidly scale up HPV vaccination, cervical screening and access to cancer treatment services. This follows last year’s Cancer Council NSW paper, which found that global elimination of cervical cancer is possible by the end of the century.
The two studies focus on 78 low and lower-middle income countries (LMIC) which bear the largest cervical cancer burden, located in East Asia & Pacific, Europe & Central Asia, Latin American & Caribbean, Middle East & North Africa, South Asia, and Sub-Saharan Africa. In these countries, combining vaccination of girls with twice-lifetime cervical screening and improved access to invasive cervical cancer treatment was predicted to reduce cervical cancer incidence by 97% and mortality by almost 99%, and avert over 74 million cervical cancer cases and over 62 million deaths in the next 100 years.
These figures rely on three targets being met in these countries by 2030: 90% of girls being vaccinated against HPV, 70% coverage for twice-lifetime cervical screening with HPV testing, and 90% coverage for treatment of preinvasive lesions and invasive cancer.
Adjunct Professor Karen Canfell, Director of Research at Cancer Council NSW and Adjunct Professor at the University of Sydney, who co-led both studies, said, “These results will inform the global strategy to achieve cervical cancer elimination, which is being reviewed by WHO’s Executive Board next week and which will be considered by countries at the World Health Assembly in May 2020.”
“Cervical cancer causes over 300,000 deaths worldwide each year, yet the evidence shows it could be eliminated as a public health issue.”
“Australia has been at the forefront – through being the first country in the world to establish an HPV vaccination program and the shift two years ago to a new National Cervical Screening Program based on HPV testing. It is a great example of the government and nongovernment sectors working together and has positioned Australia to take a leading role globally.
“Our goal is a cancer-free future and this study shows that it can be done, for a cancer that causes hundreds of thousands of deaths each year throughout the world.”
Previously, Cancer Council NSW researchers have found that Australia is set to be the first country to eliminate cervical cancer, by as early as 2035, through successful implementation of a combined approach to vaccination and screening. However, this is not the case elsewhere around the globe. Cervical cancer is still the fourth most common cancer in women worldwide and the leading cause of cancer death in 42 countries, including some of the world’s poorest countries, for example those in sub-Saharan Africa. In 2018, the large majority of the 570,000 new cervical cancer cases worldwide occurred in women living in LMICs.
“While Australia has one of the world’s lowest cervical cancer rates, we still have a long way to go to achieve our elimination goal – globally and in Australia,” Professor Canfell said.
“Given that over 90% of cervical cancer deaths occur in less-developed regions, these countries must be our first priority for implementation of HPV vaccination programs, high coverage cervical screening, and establishing cancer treatment services. This will help alleviate the enormous global inequities with the burden of this devastating disease.
“In Australia, we can build on our successes and further reduce cervical cancer deaths by at least 20%, by supporting the renewed screening program and reaching priority populations – particularly Aboriginal and Torres Strait Islander women and others who screen at low rates and face cultural and economic barriers to services.
“Everyone can get behind our push for a cervical cancer free future, from individuals who can engage in the screening and immunisation programs and health professionals checking their patients are up to date with screening and vaccination, to policy makers and collaborators who can drive this agenda globally.”
You Can access the studies by clicking on the titles below:
Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries
Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries
Call to Action - Towards the Elimination of Cervical Cancer in the Pacific Islands
C4 CRE team members Marion Saville, Julia Brotherton, Andrew Vallely, and Deborah Bateson met with key organisations in Suva, Fiji on 5-6 December 2019 and agreed to a Call to Action on the global target to achieve elimination of cervical cancer as a public health problem, (below), noting the current high burden of cervical cancer in the Pacific and the current lack of adequate vaccination, screening and treatment there.
L-R: Andrew Vallely, Julia Brotherton, Marion Saville, and Deborah Bateson
Meeting Delegates in Suva, Fiji on 5-6 December 2019
Call to Action – Towards the Elimination of Cervical Cancer in the Pacific Islands
Delegates from the following countries and organisations met in Suva, Fiji on 5-6 December 2019 and agreed the Call to Action below:
Delegates from Papua New Guinea, Vanuatu, Solomon Islands, Kiribati, Federated States of Micronesia, Fiji and Samoa together with representatives of the Pacific Society for Reproductive Health, Papua New Guinea Obstetrics and Gynaecology Society, Fiji Obstetrics and Gynaecology Society, Papua New Guinea Institute of Medical Research, Cervical Cancer Prevention in the Pacific, The Pacific Community (SPC), VCS Foundation, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Kirby Institute at the University of New South Wales, Family Planning Australia, Australian Cervical Cancer Foundation, Fiji Cancer Society, Fiji National University, University of Otago, National University of Samoa and Victoria University. Also present were representatives of the United Nations Population Fund and the United Nations Children’s Fund.
We agreed to the following principles:
- We support the global target to achieve elimination of cervical cancer as a public health problem, noting the current high burden of cervical cancer in the Pacific and the current lack of adequate vaccination, screening and treatment.
- In line with the World Health Organization (WHO) draft targets for 2030, in the Pacific our targets are:
- 90% of girls are fully vaccinated against human papillomavirus (HPV) by 15 years of age.
- 70% of women have had an HPV screening test between 30 – 39 years of age and a second HPV test between 40 – 49 years of age.
- 90% of women identified with cervical pre-cancer and cancer have received appropriate treatment and care
- We support the principles of equity in striving for the elimination of cervical cancer in the Pacific so that no woman or community is left behind.
- We support the principle of meaningful collaboration between Pacific Island nations in planning, procurement and knowledge sharing.
We are committed to the following actions:
- Raising awareness of cervical cancer in the Pacific and its impact on families and communities and strengthening advocacy for elimination.
- Exploring funding options including public-private partnerships for ongoing HPV vaccination in the Pacific.
- Urging Pacific Island governments to include HPV vaccination against HPV onto existing immunization schedules.
- Urging Pacific Island governments to transition to the delivery of effective cervical cancer screening with HPV testing and pre-cancer treatment services.Consideration should be given to self-collection of vaginal samples in order to facilitate scale up and acceptability.
- Urging cooperation between Pacific Island Governments to establish a treatment centre for cervical cancer, including radiotherapy, to act as a referral hub within the Pacific.
- Assisting Pacific Island governments and training agencies to develop an essential workforce for the delivery of HPV vaccination, cervical cancer screening and the management of cervical cancer.
- Assisting in establishing an adequate registry to record information about vaccination, screening and treatment for the prevention of cervical cancer; and with potential linkage to a cancer registry. This will facilitate follow-up of the young with incomplete vaccination and women through the screening pathway. It will also enable robust monitoring and evaluation of vaccination and screening program performance.
For more information, please email/call any of the following:
Professor Alec Ekeroma, HOD, Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand. E: firstname.lastname@example.org
Professor Marion Saville, Executive Director, VCS Foundation, Melbourne, Australia. E: email@example.com
Professor Andrew Vallely, Papua New Guinea Institute of Medical Research, Goroka; and The Kirby Institute, UNSW Sydney, Australia. E: firstname.lastname@example.org
Dr Steven Badman, Public Health Interventions Research Group, The Kirby Institute, UNSW Sydney, Australia. E: email@example.com
Clinical Associate Professor Deborah Bateson, Medical Director Family Planning NSW, Australia. E: firstname.lastname@example.org
Professor Diana Sarfati, Head of Department, Public Health, University of Otago, Wellington, New Zealand. E: email@example.com
 These two tests should be 10 years apart. Clinically validated PCR based tests should be used.
Papillomavirus Research Special Edition
This special collection consists of a series of reviews summarizing some of the key insights presented and discussed at the 32nd International Papillomavirus Conference (IPVC) and Asia-Oceania Research Organization in Genital Infection and Neoplasia (AOGIN) 2018, which was held in October 2018, in Sydney Australia. The conference was held at a pivotal moment for the International Papillomavirus Society, AOGIN and for HPV research: it came hard on the heels of the announcement by the Director-General of the World Health Organization (WHO) that cervical cancer elimination was within reach and that WHO would focus on the development of a draft strategic plan for elimination.
You can find the special edition here.