Association between a national quality improvement program and excisional treatment of cervical dysplasia in Australia

Abstract

Aim: In Australia, the National Cervical Screening and HPV Vaccination Programs aim to reduce the incidence of cervical cancer. Identification and treatment of preinvasive disease is important, but excisional treatment has been associated with adverse pregnancy outcomes. A national quality improvement program (Cervical Quality Improvement Program [c-QuIP]) aimed to reduce the rate of excisional treatment in young human papilloma virus (HPV)-vaccinated women. This study examined national trends in the rate of excisional treatment in young women. Methods: Comprehensive national data were obtained from Medicare Australia regarding incidence rates of excisional treatment for the 10-year period 2007 to 2016 inclusive. These data were used to calculate age-stratified incidence rates of excisional treatment in young (20–24 years), intermediate (25–34 years) and older (35–60 years) women. Results: The rate of excisional treatment (procedures per 10 000 women) fell in young women (from 25 to 6/7, P < 0.005) and women of intermediate age (from 23 to 13, P < 0.005), but there was no significant change in the rate in women aged 35 to 60 years (from 7 to 6.5). Conclusion: In the decade since introduction of the National HPV Vaccination Program the rate of excisional treatment of the cervix in Australia has fallen in women aged less than 35 years but has not changed for older women. The introduction of a national program aiming to reduce the rate appeared to have little impact.