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Australia has made significant advances in the prevention of cervical cancer, but progress on other gynaecological cancers is falling behind.
Gynaecological cancers arise from the reproductive tract and represent the third most common cancer type affecting individuals who were assigned female at birth (hereafter respectfully referred to as women). Of note, while traditionally cancers are recognised by the organ in which they arise (uterine (including endometrial), ovarian, cervical, vulvar, vaginal and placental cancers) there are more than 230 distinct morphological types of gynaecological cancers. These types differ in terms of their risk factors, site of origin, biologic and clinical behaviour, and, as a result of these variations, they differ in response to treatment. This diversity presents challenges for diagnosis, management, and research, particularly for rare or less common types. Today, an estimated 26 400 women are living with a gynaecological cancer which was diagnosed within in the past five years. Over the next decade, a 21% increase in gynaecological cancer incidence is projected. The current five-year survival rate remains at the low figure comparable to the average five-year-survival rate for all cancers back in 1975 (49%), underscoring the lack of progress over the past 50 years for gynaecological cancers. Despite the impact and complexity of these diseases, awareness of gynaecological cancers remains low. While symptoms may be present, they are often overlooked or misattributed — by women themselves and/or their healthcare providers.
Australia’s successes
Cervical cancer is one of Australia’s public health victories, with prevention achieved through both HPV vaccination and the National Cervical Screening Program (NCSP). Launched in 1991 using cytology to detect pre-cancerous changes before progression to invasive disease, the program transitioned in 2017 to the more sensitive HPV screening test. incorporating partial HPV genotyping with reflex cytology triage. This shift to HPV testing reflects its causal role in 95% or more of cervical cancers and has contributed to significant declines in incidence and mortality. The national HPV vaccination program was introduced in 2007 and now achieves coverage of more than 80% of adolescents. Vaccination is a powerful primary prevention strategy, blocking HPV infection before it can initiate cancer. It also reduces the risk of other HPV-related cancers, including vulvar and vaginal cancers. Cervical cancer prevention has stood apart as an Australian success story for the past several decades, with high vaccine coverage and participation in screening, significant progress is being made towards the national goal of eliminating cervical cancer.
Unquestionably, investment in cancer research has consistently translated into significant improvements in survival outcomes. Australian researchers have led studies, and collaborated internationally, generating significant discoveries and personalised care pathways which have enabled improvements not only in cancer-related survival but also in overall survival. These include systemic therapy trials that have prompted a change to standard treatments for women with advanced disease in ovarian (here and here), endometrial (here and here) and cervical cancers, defining who best will benefit from additional radiation or systemic therapies in locally advanced or early disease, and refining techniques to reduce the long-term impacts of surgery (here and here).
In addition, Australian-based evidence paved the way for a change to international guidelines for genetic testing for women with ovarian and endometrial cancer, which enables the use of targeted therapies and, importantly, facilitates the prevention of other cancers in both the index woman and her family members (here and here).
Challenges remain
While these improvements are significant, there remain disparities among Australian women, particularly for those living in rural and remote areas, those of Aboriginal and Torres Straight Island ethnicity, and women from lower socioeconomic backgrounds. Women in these groups have lower HPV vaccination and screening rates, higher rates of gynaecological cancers with a greater proportion diagnosed at later stages, and higher mortality rates from advanced disease. These inequities may relate to systemic barriers to healthcare access, lower health literacy, and reduced engagement with preventive services (here and here).
While cervical cancer is Australia’s success story, for all other gynaecological cancers with no screening opportunity for early or precancer detection, improvement in outcomes has been much slower. Despite their complexity and poor outcomes, gynaecological cancers have historically received significantly less funding than other cancer types. Between 2003 and 2020, breast cancer research received $442 million, bowel cancer $191 million, prostate cancer $185 million, and in comparison, all gynaecological cancers combined received just $137 million. While gynaecological cancers are less common or rare, this shouldn’t mean that funding should be low enough to prevent improvement in outcomes.
Translated into simple terms, gynaecological cancer is the poorest research-funded cancer group in aggregate, of all major cancer groups. Today, more than 90% of women diagnosed with a gynaecological cancer in Australia do not know or request comprehensive molecular profiling at first diagnosis, outside the research setting, despite the majority of lethal gynaecological cancers being rare, without a proven second-line therapy. Such profiling includes technologies that have been shown to significantly improve survival and treatment outcomes.
While progress has been made, there are still barriers to the adoption of comprehensive molecular profiling in routine clinical practice include a lack of established guidelines, gaps in clinician knowledge required for the interpretation of test results and complex genomic data, lack of molecular test and drug reimbursement and a lack of resources and systems, particularly in resource-constrained and regional hospitals.
Looking ahead
While the cumulative effect of systemic barriers and gender bias has contributed to delayed diagnosis and treatment for many women, there is substantial opportunity for change (here and here). In alignment with the Australian Federal Government’s Australian Cancer Plan, the strategic vision of the Australia New Zealand Gynaecology Oncology Group (ANZGOG), the leading national gynaecological cancer research organisation in Australia and New Zealand is to accelerate discovery, ensure equity of access, and transform outcomes for all women affected by these cancers. With targeted investment and collaborative action, we can catalyse innovative, practice-changing research and expand its reach and impact— ensuring that advances in science translate into tangible improvements in care.
The future we seek is one where no woman dies prematurely from a gynaecological cancer, and where every woman, regardless of where she lives or her circumstances, has access to the latest, most effective treatments. Through commitment, collaboration, and innovation, this future is within reach.
Associate Professor Yoland Antill is a Medical Oncologist and Cancer Genetics specialist based at Cabrini Health, Frankston Hospital and Royal Melbourne Hospital in Victoria. She holds an adjunct clinical position in the Faculty of Medicine, Dentistry, and Health Sciences at Monash University.
Clare Scott AM is a Medical Oncologist at the Peter MacCallum Cancer Centre and the Royal Melbourne and Royal Women’s Hospitals and is Joint Head, Clinical Discovery and Translation and Laboratory Head at the Walter and Eliza Hall Institute of Medical Research and Professor of Gynaecological Cancer at University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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