Cervical cancer in Indigenous women: The case of Australia

Globally, health inequities between Indigenous and non-Indigenous populations exist. The disparity in health outcomes between Indigenous and non-Indigenous Australians is exemplified by cervical cancer. Current evidence suggests that Indigenous women have higher age standardised incidence and mortality than non-Indigenous women when adjusted for stage at diagnosis and co-morbidities; however, there is little information pertaining to national estimates of cervical cancer in Indigenous women. In this paper we review available evidence on the difference in occurrence and case fatality of cervical cancer among Indigenous and non-Indigenous Australian women. The Australian Bureau of Statistics, Australian Institute of Health and Welfare, and State- or Territory-based Cancer Registries were utilised to collect surveillance data. To corroborate existing data, further available journal literature was identified through Medline and Embase. All papers selected for review were cross-referenced to identify further relevant studies. The most recent national estimate of age-standardised cervical cancer incidence rate was 16.9 and 7.1 per 100,000 women-years in Indigenous and non-Indigenous women respectively (incidence ratio 2.4). The Indigenous age-standardised mortality rate was 9.9 per 100,000 women years (95% CI 7.1-13.3), over 5 times the non-Indigenous rate. Cervical cancer incidence, in both Indigenous and non-Indigenous women, has decreased since 1991. Despite the decline, age-standardised incidence among Indigenous women is still higher than non-Indigenous women. The pattern of cervical cancer incidence and survival corroborates the health inequities that exist in Australia. Indigenous women are more likely than non-Indigenous women to develop cervical cancer and are less likely to survive it. Similar patterns exist in Indigenous populations worldwide, such as New Zealander Maoris and Canadian Aboriginals, suggesting that high rates of cervical cancer incidence and mortality may be a symptom of social and economic inequity.