EVALUATION OF CERVICAL SCREENING TESTS COLLECTED BY NURSES IN VICTORIA DURING 2017

Victorian Cervical Screening Registry

Produced by: Karen Peasley, Senior Health Information Manager, Data & Reporting Victorian Cervical Screening Registry PO Box 178 Carlton South VIC 3053 ISSN 2205-8710 Q-Pulse reference CSR-Pub-1 Telephone: 03 8417 6843 Fax: 03 9349 1818 E-mail: data@vcs.org.au

December 2018

EVALUATION OF CERVICAL SCREENING TESTS COLLECTED BY NURSES IN VICTORIA DURING 2017

Victorian Cervical Screening Registry

The Victorian Cervical Screening Registry acknowledges the support of the Victorian Government

Table of Contents

Foreword ...................................................................................................................................... 1

1. Number of Cervical Screening Tests (CSTs) collected by nurses ........................................... 2

2. Post-hysterectomy tests .......................................................................................................... 3

3. Type of practice/organisation for nurses .................................................................................. 4

4. Practice and woman location at time of CST ........................................................................... 5

5. Proportion of CSTs collected by nurses by Department of Health and Human Services (DHHS)

area ........................................................................................................................................ 6

6. Socio-Economic Index for Areas (SEIFA) ................................................................................ 7

7. Age distribution of CSTs .......................................................................................................... 8

8. Endocervical status ............................................................................................................... 10

9. Profile of CSTs ...................................................................................................................... 11

10. Time since previous screening ............................................................................................ 12

11. Collection of Aboriginal and Torres Strait Islander status, Country of Birth and Language

Spoken at Home ................................................................................................................... 12

12. Conclusion ........................................................................................................................... 15

13. References .......................................................................................................................... 16

Tables and Figures

Table 1.1 Number of Cervical Screening Tests (CSTs) collected by nurses in Victoria by year of collection………………………………………………………………………….……….......

3

Figure 1.1 Proportion of CSTs collected by nurses in Victoria, 1996 to 2017…………….….……… 3

Table 3.1 Number of CSTs collected by nurses in 2017 by practice/organisation type................ 4

Figure 3.1

Comparison of the proportion of CSTs collected by nurses 2015 to 2017 by practice/organisation type.............................................................................................

4

Table 4.1 Nurse practice and CST location in 2017 by Australian Statistical Geography Standard

Remoteness Areas, Victoria…………………................................................................ 5

Table 5.1 CSTs collected by nurses for women with a cervix in 2017 by Department of Health and Human Services (DHHS) area, Victoria…………….…………………………........... 6

Figure 5.1 Proportion of CSTs collected by nurses in 2017 by DHHS area…...…………......……. 7

Table 6.1 Distribution of women screened by nurses in Victoria by SEIFA category in 2017……. 8

Figure 6.1 SEIFA distribution of women screened by nurses in Victoria in 2017…………………... 8

Table 7.1

Figure 7.1

Age distribution at time of CST in 2016 and 2017………………….……………………… Age distribution at time of CST in 2017..........................................................................

9

9

Figure 8.1 Proportion of Victorian cytology tests collected by nurses and other provider types with an endocervical component, 2003 to 2017............................................................ 10

Table 9.1 Profile of cytology test results collected in 2017 for women with a cervix.................... 11

Table 9.2 Profile of HPV (without LBC) test results for women in 2017……………………..……. 11

Table 10.1 Time since previous CST during 2017 for women with a cervix.….…...……………….. 12

Table 11.1

Figure 11.1

Figure 11.2

Number and percentage of CSTs collected by nurses in 2017 by Aboriginal and Torres Strait Islander status ………………….……………..………………………………………. Percentage of CSTs collected by nurses for which Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth were recorded for each month of 2017…………………….………………………………………................... Percentage of CSTs collected by nurses for which Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth were recorded, 2012 to 2017……………………………………………………………………………..………..…

13

13

14

1

Foreword Victorian Nurse Cervical Screening Providers - Certification Program 2017 The world of cervical screening underwent a significant change in 2017 with the commencement of the Renewed National Cervical Screening Program on 1 December. The implementation of the new program also brought about changes to what was previously known as the Credentialling Program for Nurse Cervical Screening Providers and the transition into the new Certification Program for Victoria. Cancer Council Victoria (Cancer Council) has continued to support and value the role of Victorian Certificated Nurse Cervical Screening Providers in 2017, the twenty first year of the program. The successful maintenance of the significant role of nurses in cervical screening through transition in Victoria has been supported by the Department of Health and Human Services (DHHS), VCS Pathology and the Victorian Cervical Screening Registry (VCSR) to ensure that nurses’ role in cervical screening remains identifiable as the transition of data to the National Cancer Screening Register continues. Nurses that complete their endorsed Victorian training course are granted Certification as cervical screening providers and are eligible to access a ‘practice number’ with VCS Pathology. As of December 2017, the program had 504 certified nurses providing cervical screening in Victoria. The quality of nurses’ practice has been reported by VCSR annually since 2000. Victoria remains the only Australian state or territory that has nurse collected cervical screening data reported. The VCSR Nurses Evaluation Report 2017 is the fourth edition in which data from all Victorian nurses providing cervical screening have been reported, regardless of pathology provider used. The outcome of this report continues to demonstrate the close working relationship between VCSR and Cancer Council. We would like to acknowledge their shared commitment to showcasing cervical screening undertaken by Victorian nurse cervical screening providers. Sandy Anderson Nurse Consultant Victorian Nurse Cervical Screening Certification Program Screening, Early Detection & Immunisation Cancer Council Victoria Ashlee Taylor and Kate Walker Certification Team Screening, Early Detection & Immunisation Cancer Council Victoria Phone: 1800 111 255 Fax: (03) 9514 6804 Email: certification@cancervic.org.au

2

1. Number of Cervical Screening Tests (CSTs) collected by nurses This report includes data on Cervical Screening Tests (CSTs) collected by nurses who are certified and funded by the DHHS to be eligible for their own ‘practice number’ at VCS Pathology. Also included in this report are CSTs from nurses using Private Pathology Services. These nurses provide cervical screening data to Cancer Council, which is then provided to VCSR for analysis and inclusion in this report. The report captures all CST reported in Victoria, including those conducted as part of the Compass study. The Compass study is a clinical trial comparing two and a half yearly cytology screening with five yearly Human Papillomavirus (HPV) based screening.1 The Pilot study commenced at the end of 2013 and the Main trial commenced at the start of 2015. Since 2014, data from the study have been included in this report. Data in this report include:

1. All cytology and LBC2 tests (as usually reported) that are not part of Compass 2. All LBC primary screening tests conducted as part of Compass 3. LBC triage tests for Compass 4. Compass HPV primary screening tests for which there is no LBC triage

Due to the introduction of the renewed National Cervical Screening Program (Renewal) on 1 December 2017, all of the data in this 2017 report are for the period 1 January 2017 to 30 November 2017 only. As of 1 December 2017 CST has been used in the renewed cervical screening program to refer to a primary HPV test with reflex cytology where required. The term CST in this report is not used in the same way, with most CSTs in this report being conventional or liquid based cervical cytology specimens. As reported to VCSR, a total of 27,015 CSTs were collected by 419 nurses during January to November 2017 (with 26,801 from women with a cervix). This is from a total of 515,513 Victorian CSTs for the same 2017 period (with 507,960 from women with a cervix). Of the CSTs reported by nurses, 23,836 tests (88.2%) were reported to VCS Pathology. The remaining 3,179 tests (11.8%) were taken by nurses and reported by Private Pathology Services under a doctor's name. The 27,015 tests collected by nurses represent 5.2% of all Victorian CSTs collected between January and November 2017. As shown in Table 1.1 and Figure 1.1, the number and proportion of tests collected by nurses has declined since 2013. However, the number still remains more than seven times higher than the figure recorded in 1996.

1 VCS Foundation Compass Future Directions in Cervical Screening. URL: http://www.compasstrial.org.au Accessed: 27/12/2018 2 Liquid Based Cytology

3

Table 1.1 Number of Cervical Screening Tests (CSTs) collected by nurses in Victoria by year of collection3

Year Number of CSTs

collected by nurses % of all Victorian

CSTs 20174 27,015 5.2% 2016 31,574 5.4% 2015 33,780 5.6% 20145 36,410 6.1% 2013 38,012 6.3% 2012 33,875 5.6% 2011 31,613 5.5% 2010 28,546 5.0% 2009 25,594 4.4% 2008 21,668 3.8% 2007 18,651 3.2% 2006 16,035 2.8% 2005 14,375 2.5% 2004 13,100 2.2% 2003 11,494 2.0% 2002 10,635 1.8% 2001 11,017 1.9% 2000 9,628 1.7% 1999 9,922 1.6% 1998 9,858 1.6% 1997 7,155 1.2% 1996 5,170 0.8%

Figure 1.1 Proportion of CSTs collected by nurses in Victoria, 1996 to 20174

2. Post-hysterectomy tests During 20174, 214 CSTs collected by nurses were taken from women whose records indicated previous hysterectomy. This represents 0.8% of tests collected by nurses in this period. The percentage of post-hysterectomy tests completed by other Victorian provider types in the same period was 0.9%.

3 Data from 1996-2012 excludes tests taken by nurses through Private Pathology under a doctor’s name 4 2017 data is for the period 01/01/2017 to 30/11/2017 only 5 Since 2014, HPV tests (without LBC) and cytology tests completed by nurses as part of the Compass trial have been included in these data

0%

1%

2%

3%

4%

5%

6%

7%

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

PERC

ENTA

GE

YEAR

4

3. Type of practice/organisation for nurses Of the CSTs collected by nurses during 20176, the majority were conducted in General Practice or in a Community Health setting. The combined proportion of CSTs collected in General Practice or in a Community Health setting has remained stable at 87.2% compared to 87.1% in 2016. There was a small increase in collection by nurses located in General Practice and Private Pathology Services between 2016 and 2017. Table 3.1 Number of CSTs collected by nurses in 20176 by practice/organisation type

Practice/organisation type

Number of practices/

organisations

Number of nurses

practicing7

Number of CSTs by nurses in

20176

% of CSTs by practice/

organisation

General Practice 225 245 17,584 65.1%

Community Health setting 80 86 5,988 22.2%

Women’s Health Service8 1 3 237 0.9%

Sexual Health9 4 36 516 1.9%

Other (eg: hospitals and dysplasia clinics) 23 32 1,412 5.2%

Private Pathology Service 1 1 987 3.7%

Aboriginal Health Service 14 16 291 1.0%

Total 348 419 27,015 100%

Figure 3.1 Comparison of the proportion of CSTs collected by nurses 2015 to 20176 by

practice/organisation type

6 2017 data is for the period 01/01/2017 to 30/11/2017 only 7 For nurses who worked at more than one type of practice/organisation, their most frequent location of collection was used 8 Women’s Health Service represent state wide health services such as Women’s Health Loddon Mallee 9 Sexual Health includes: Melbourne Sexual Health Centre, Family Planning Victoria-Box Hill, Action Centre-Family Planning Victoria and Young People’s Health Service

GeneralPractice

CommunityHealth Setting

Women’s Health Service

SexualHealth

Other(eg: hospital anddysplasia clinics)

PrivatePathology

Service

AboriginalHealthService

2015 62.5% 25.5% 0.9% 2.7% 4.8% 2.8% 0.8%2016 64.1% 23.0% 0.8% 2.5% 5.6% 3.1% 0.9%2017 65.1% 22.2% 0.9% 1.9% 5.2% 3.7% 1.0%

0%

10%

20%

30%

40%

50%

60%

70%

PERC

ENTA

GE

PRACTICE/ORGANISATION TYPE

5

4. Practice and woman location at time of CST During January to November 201710, 419 nurses performed CSTs in Victoria. The VCSR recorded 387 certified nurses whose tests were reported by VCS Pathology. Cancer Council provided the details of 32 additional unique nurses whose CSTs were reported to the Registry through Private Pathology Services under a doctor’s name. The geographical location of nurses (by practice) and the women whose CSTs were collected by a nurse during the 2017 period are classified below using the Australian Statistical Geography Standard (ASGS) Remoteness Areas. The ASGS Remoteness Areas classification was developed by the Australian Bureau of Statistics (ABS), and classifies areas of Australia which share common characteristics of remoteness into broad geographical regions. The ASGS Remoteness Areas classification divides Australia into five areas:11

• Major Cities of Australia: includes capital cities such as Melbourne, as well as major urban areas such as Geelong

• Inner Regional Australia: includes towns such as Ballarat, Bendigo and Shepparton • Outer Regional Australia: includes towns and cities such as Bairnsdale and Horsham • Remote Australia: includes towns such as Mallacoota and Ouyen • Very Remote Australia: represents much of central and western Australia and includes towns

such as Tennant Creek, Longreach and Coober Pedy Using the ASGS classification, Table 4.1 shows that the majority of nurses who collected CSTs during the 2017 period were based in a major city or inner regional area, as were the women tested. Table 4.1 Nurse practice and CST location in 201710 by Australian Statistical Geography

Standard Remoteness Areas, Victoria12

ASGS Remoteness Area Nurses located in the area13 CSTs in the area

Number % Number %

Major Cities of Australia 205 49.2 11,668 43.2

Inner Regional Australia 156 37.4 11,010 40.8

Outer Regional Australia 55 13.2 4,269 15.8

Remote Australia 1 0.2 68 0.2

Very Remote Australia14 0 0.0 0 0.0

10 2017 data is for the period 01/01/2017 to 30/11/2017 only 11 Australian Bureau of Statistics (2016). Australian Statistical Geography Standard (ASGS): Volume 5, Remoteness Structure July 2016. Cat.

no.1270.0.55.005. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202016?OpenDocument 12 Courtesy of the Australian Institute of Health and Welfare (AIHW) (May 2014). Postal Area to ASGS RA conversion file. Customised for 2016

census data 13 The postcodes for two nurses could not be mapped as there was no clinic name recorded 14 Very Remote Australia areas are not represented within Victoria

6

5. Proportion of CSTs collected by nurses by Department of Health and Human Services (DHHS) area

The Victorian DHHS operates across the state from within seventeen local areas, of which nine are in rural Victoria and eight in metropolitan Melbourne. The table and map below show that, consistent with previous years, nurses collected a higher proportion of CSTs in rural areas than in metropolitan areas. The proportion of CSTs collected by nurses increased by almost 2% and 3% respectively in the Mallee and Ovens Murray areas in 201715. Table 5.1 CSTs collected by nurses for women with a cervix in 201715 by Department of Health and Human Services (DHHS) area,16 Victoria

Area name

Number of CSTs

collected by nurses in 201715 17

Number of nurses in each area in 201715 18

% of all CSTs per area

collected by nurses in

2017

% of all CSTs per area

collected by nurses in

2016

Barwon 1,970 27 8.5% 8.0%

Bayside Peninsula 1,053 15 1.3% 1.5%

Brimbank Melton 798 13 3.2% 5.2%

Central Highlands 1,857 19 13.6% 12.9%

Goulburn 1,119 27 10.1% 10.9%

Hume Moreland 1,094 14 3.7% 3.6%

Inner Eastern Melbourne 546 20 1.0% 1.5%

Inner Gippsland 948 15 7.0% 6.8%

Loddon 2,935 43 16.9% 16.8%

Mallee 1,948 23 31.4% 29.6%

North Eastern Melbourne 1,538 27 2.8% 2.4%

Outer Eastern Melbourne 1,048 15 3.0% 3.2%

Outer Gippsland 890 13 14.8% 16.7%

Ovens Murray 2,144 24 23.5% 20.7%

Southern Melbourne 1,783 20 4.3% 4.2%

Western District 1,987 27 19.4% 18.5%

Western Melbourne 2,667 63 5.1% 5.4%

15 2017 data is for the period 01/01/2017 to 30/11/2017 only

16 Department of Health and Human Services LGA by Area Region Division concordance file – confirmed for use 03.12.2018 Australian Bureau of Statistics Geospatial Solutions (2016). ASGS Geographic Correspondences CG Postcode 2017 to Local Government Area

2016: Published 04/04/2018 https://data.gov.au/dataset/23fe168c-09a7-42d2-a2f9-fd08fbd0a4ce 17 Excludes 214 post-hysterectomy CSTs, 476 CSTs with interstate postcodes or unable to be mapped 18 Excludes 14 nurses with interstate postcodes or unable to be mapped

7

Figure 5.1 Proportion of CSTs collected by nurses in 201719 by DHHS area

6. Socio-Economic Index for Areas (SEIFA)

Socio-Economic Index for Areas (SEIFA)20 is a summary measure developed by the Australian Bureau of Statistics (ABS), which includes a suite of four indexes that have been created from social and economic Census information. Each index ranks geographic areas across Australia in terms of their relative socio-economic advantage and disadvantage. This report uses the Index of Relative Socio-economic Disadvantage (IRSD), which is a general socio-economic index that summarises a range of information about the economic and social conditions of people and households within an area. The ABS broadly defines relative socio-economic advantage and disadvantage in terms of people’s access to material and social resources and their ability to participate in society.21 Index of disadvantage scores have been grouped into quintiles (1 to 5) for analysis. The highest quintile (5) represents the highest 20% of postcode scores (20% of the population) and includes the least disadvantaged areas. The lowest quintile (1) represents the lowest scores and the most disadvantaged areas. As seen in both the table and figure, almost 60% of women screened by nurses during 201719 are categorised in the most disadvantaged quintiles (1 and 2).

19 2017 data is for the period 01/01/2017 to 30/11/2017 only 20 SEIFA 2016 was released 27/03/2018 and is based on 2016 social and economic Census data 21 Australian Bureau of Statistics (2016) Census of Population and Housing: Socio-Economic Indexes for Areas 2016, Postal Area IRSD, SEIFA 2016 Cat. no. 2033.0.55.001. Accessed: 25/09/2018 URL: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~SOCIO-ECONOMIC%20INDEXES%20FOR%20AREAS%20(SEIFA)%202016~1

8

Table 6.1 Distribution of women screened by nurses in Victoria by SEIFA category in 201722

Quintile Number of women23 Percentage24

1 (most disadvantaged) 9,566 36.0% 2 6,242 23.5% 3 4,718 17.8% 4 3,901 14.7% 5 (least disadvantaged) 2,152 8.1%

Figure 6.1 SEIFA distribution of women screened by nurses in Victoria in 201722

7. Age distribution of CSTs The age distribution of women whose CSTs was collected by nurses and other provider types is shown in Table 7.125 26. Other provider types include GPs, obstetricians and gynaecologists and hospital clinics. A comparison of 2016 and 201722 data show the percentage of CST for each age group to be similar for both nurses and other provider types. Consistent with the findings for 2016, the aggregated percentage of CSTs collected by nurses during 201722 for women aged 50 years or older was greater than those collected by other provider types (43.5% compared with 33.7%).

22 2017 data is for the period 01/01/2017 to 30/11/2017 only 23436 women could not be aggregated into SEIFA quintiles, as there was no postcode to Postal Area match in the concordance file (1) or postcode

was interstate (435). NB: SEIFA calculations are based on women with a Victorian postcode only. 24 Due to the rounding of percentages, there may be some discrepancy in totals 25 Age range for Compass trial participants is 25-64 years 26 Analysis is based on the number of tests, not the number of women

36.0%

23.5%

17.8%14.7%

8.1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

1 (mostdisadvantaged)

2 3 4 5 (leastdisadvantaged)

PERC

ENTA

GE

SOCIO-ECONOMIC QUINTILE

9

Table 7.1 Age distribution at time of CST in 2016 and 201727 28

Age group

CSTs collected by:

Nurses Other Provider types

2016 201727 2016 201727

<20 yrs 1.1% 0.8% 1.2% 1.0%

20-29 yrs 15.2% 15.0% 18.8% 18.4%

30-39 yrs 18.8% 19.3% 24.3% 24.4%

40-49 yrs 21.8% 21.4% 22.3% 22.5%

50-59 yrs 22.0% 21.9% 18.7% 18.8%

60-69 yrs 19.4% 19.7% 13.1% 13.2%

70+ yrs 1.7% 1.9% 1.6% 1.7%

Total 100% 100% 100% 100%

Figure 7.1 Age distribution at time of CST in 201727

27 2017 data is for the period 01/01/2017 to 30/11/2017 only 28 For the 2016 and 2017 data, there were 25 and 9 tests respectively which were excluded where the woman DOB was not provided or was

incorrect and unable to be verified.

0.8%

15.0%

19.3%

21.4% 21.9%

19.7%

1.9%1.0%

18.4%

24.4%

22.5%

18.8%

13.2%

1.7%

0%

5%

10%

15%

20%

25%

30%

< 20yrs

20-29yrs

30-39yrs

40-49yrs

50-59yrs

60-69yrs

70+yrs

PERC

ENTA

GE

AGE GROUP

% CSTscollected bynurses

% CSTscollected byother providers

10

8. Endocervical status The presence of endocervical cells within a cytology test specimen is considered to be a reflection of smear quality. Of the technically satisfactory cytology tests collected by nurses from women with a cervix in 201729, 71% were reported as including an endocervical component. The proportion of cytology tests with an endocervical component for other provider types during the same time period was 66%. The graph below shows that the proportion of cytology tests collected by nurses having an endocervical component, which had slightly increased in 2016, declined again in 2017. The proportion for other provider types has continued to decrease during 2017. Over the decade prior to 2013, a general decline in the proportion of cytology tests with an endocervical component has been observed across all provider types. Preliminary investigation indicates that the decline is likely to be due to the increasing use of liquid based cytology (LBC) in the time period, with lower rates detected in LBC specimens compared to conventional. This could be due to practitioners lacking familiarity with robust techniques for ensuring cervical cells are effectively transferred into the liquid media and cytology screeners lacking familiarity with identifying these cells in LBC samples.30 Figure 8.1 Proportion of Victorian cytology tests collected by nurses and other provider

types with an endocervical component, 2003 to 201729 31

29 2017 data is for the period 01/01/2017 to 30/11/2017 only 30 G Tan, D Stockman, F Sultana, and M Saville. The Falling Rates of Endocervical Component – Cause and Remedy. Presented at Australian Society of Cytology’s 47th Annual Scientific Meeting, October 2017, Canberra. 31 Excludes Compass HPV tests (without LBC)

60%

65%

70%

75%

80%

85%

90%

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

PERC

ENTA

GE

YEAR

Nurses

Otherprovidertypes

11

9. Profile of CSTs The following tables show the result categories for CSTs collected by nurses and other provider types during 201732. Note that cytology tests and HPV (without LBC) tests are shown in separate tables. Table 9.1 shows the cytology test result categories for tests collected by nurses and other provider types during 201732 for women with a cervix. Compared with Victorian cytology tests collected by other provider types, nurses had a significantly higher proportion of tests with negative results (p<0.0001) and a significantly lower proportion of unsatisfactory tests (p<0.0001). In addition, nurses had a lower proportion of high-grade results (p=0.021).

Table 9.1 Profile of cytology test results collected in 201732 for women with a cervix33

Result category34 Number (%) of cytology tests

collected by nurses35

% of cytology tests collected by other provider

types35

High-grade abnormality 143 (0.6%) 0.7%

Low-grade abnormality 1,133 (4.4%) 4.8%

Inconclusive 148 (0.6%) 0.6%

Negative 23,414 (91.7%) 90.6%

Unsatisfactory 695 (2.7%) 3.2%

No reported result* 4 (<0.1%) -

Total 25,537 (100%) 100%

*This indicates cytology tests where there were no reported results by nurses using Private Pathology Services Table 9.2 shows the HPV (without LBC) test result categories for tests collected by nurses during 201732. These results are part of cervical screening completed in the Compass trial. Over 95% of HPV (without LBC) tests returned a negative result, with the remaining tests returning a positive result (not type 16/18) and one unsatisfactory result.

Table 9.2 Profile of HPV (without LBC) test results for women in 201732 36

Test result Number (%) of tests

Negative 1208 (95.6%)

Positive (not type 16/18*) 55 (4.3%)

Unsatisfactory 1 (<0.1%)

Total 1264 (100%) *type 16/18 data = 0

32 2017 data is for the period 01/01/2017 to 30/11/2017 only 33 Excludes Compass HPV (without LBC) tests and 214 post-hysterectomy CST 34 Based only on the squamous cell code within the VCSR Cytology Coding Schedule 2006 35 Due to the rounding of percentages, there may be some discrepancy in totals 36 Includes HPV tests (without LBC) completed as part of Compass. It does not represent the total number of Primary HPV tests across both the

Pilot and Main trial.

12

10. Time since previous screening The following table shows the length of time since any previous CST, as known to the Registry, for tests collected by nurses during 201737. Compared with CSTs collected by other Victorian provider types, and similar to the findings of 2016, a higher proportion of CSTs were collected by nurses where the time interval since the last test was between 21-27 months (on time for a two year screening interval) (p<0.0001). There was also strong evidence (p< 0.0001) that nurses were more likely than other providers to collect CSTs from those whose last test was greater than 48 months ago.

Table 10.1 Time since previous CST during 201737 for women with a cervix38

Time since previous test Number (%) of CSTs collected

by nurses39 % of CSTs collected by

other provider types

No previous test 2,330 (8.7%) 11.2%

<21 months 3,701 (13.8%) 21.8%

21-27 months 9,542 (35.6%) 22.7%

28-36 months 6,395 (23.9%) 27.6%

37-48 months 2,157 (8.0%) 7.9%

>48 months 2,632 (9.8%) 8.8%

Unknown 44 (0.16%) -

Total 26,801 (100%) 100%

11. Collection of Aboriginal and Torres Strait Islander status, Country of Birth and Language Spoken at Home

The Victorian Cancer Plan 2016-2020 recognises that there are inequities for Aboriginal Victorians across the entire cancer pathway including cancer screening. The plan seeks to achieve equitable cancer outcomes for Aboriginal communities. It is acknowledged that there is now improved cancer screening program participation for under screened groups including Aboriginal communities.40 41 For a number of years now, the nurses who work with VCS Pathology have recorded Aboriginal and Torres Strait Islander status on the VCS Pathology Request Forms.

The standard nationally approved format used on data collection forms is as follows:42

• Aboriginal but not Torres Strait Islander origin • Torres Strait Islander but not Aboriginal origin • Both Aboriginal and Torres Strait Islander origin • Neither Aboriginal nor Torres Strait Islander origin

37 2017 data is for the period 01/01/2017 to 30/11/2017 only 38 The number of CST includes cytology tests and both cytology tests and HPV tests completed as part of Compass. It excludes 214 post-

hysterectomy CSTs. 39 Due to the rounding of percentages, there may be some discrepancy in totals 40 Department of Health and Human Services (2016) Victorian Cancer Plan 2016-2020 Improving cancer outcomes for all Victorians, State

Government of Victoria, Melbourne 41 Department of Health and Human Services (2015) Victorian Public Health and Wellbeing Plan 2015-2019, State Government of Victoria,

Melbourne 42 Australian Institute of Health and Welfare (AIHW) (2010) National best practice guidelines for collecting Indigenous status in health data sets, Australian Government, Canberra

13

Table 11.1 Number and percentage of CSTs collected by nurses in 201743 by Aboriginal

and Torres Strait Islander status

201743 2016

Victorian women aged 20-69 years

reporting status in 2016 census44

Status Number

(all ages)45 (%)46 % %

Aboriginal 412 (1.5%) 1.4% 0.66% Torres Strait Islander 11 (<0.1%) <0.1% 0.03% Aboriginal and Torres Strait Islander 34 (0.1%) 0.1% 0.02% Neither Aboriginal nor Torres Strait Islander 25,508 (94.4%) 95.6% 99.3% Declined to answer 3 (<0.1%) <0.1% 0.00% Data not collected 1047 (3.9%) 2.8% -

Total 27,015 (100%) 100% 100%

The overall percentage of CSTs collected by nurses for which an Aboriginal and Torres Strait Islander status was reported in 201743 was 96.1%, a decrease of 1.1% from 97.2% in 2016. The distribution of Aboriginal and Torres Strait Islander status for the women that had a CST collected by nurses has remained consistent between 2016 and 201743.

Since the data collection expansion to include Country of Birth and Language Spoken at Home, the collection of this additional information continues to assist with understanding and addressing the screening needs of women from culturally diverse backgrounds. Figure 11.1 Percentage of CSTs collected by nurses for which Aboriginal and Torres

Strait Islander status, Language Spoken at Home and Country of Birth were recorded for each month of 201743

43 2017 data is for the period 01/01/2017 to 30/11/2017 only 44 Australian Bureau of Statistics, 2016 Census of Population and Housing-Table Builder Basic, Victorian data as at 30/01/2019 45 97.3% of women with status reported were 20-69 years 46 Due to rounding of percentages, there may be some discrepancy in totals

50%

60%

70%

80%

90%

100%

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV

PERC

ENTA

GE

2017Aboriginal and Torres Strait Islander data Language Spoken data Country of Birth data

14

In 201747, the overall percentage of CSTs recorded by nurses for which Language Spoken at Home was collected was 93.4%. The most common Non-English languages were as follows (most common first): Vietnamese, Khmer, Mandarin, Chinese (not elsewhere classified), Arabic, Greek, Italian, Karen, Cantonese and Filipino. The overall percentage of CSTs recorded by nurses for which Country of Birth was recorded was 95%. The most common countries of birth outside of Australia were as follows (most common first): Vietnam, Cambodia, England, China (excludes SARS and Taiwan), Myanmar, New Zealand, Philippines, India, United Kingdom (includes Channel Islands and Isle of Man) and Italy.

VCSR continues to work closely with VCS Pathology and Cancer Council to capture these data items on the registry database from nurse notifications, including from nurses who use Private Pathology Services. Figure 11.2 below represents the continued success in the recording of Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth. The high percentage figures shown illustrate the strong commitment to complete data collection by nurses involved in cervical screening. Figure 11.2 Percentage of CSTs collected by nurses for which Aboriginal and Torres

Strait Islander status, Language Spoken at Home and Country of Birth were recorded, 2012 to 201747

47 2017 data is for the period 01/01/2017 to 30/11/2017 only

94.4%96.6% 97.1% 97.6% 97.2% 96.1%

86.9%

91.7%93.3%

94.6% 95.0% 93.4%89.8%93.4% 94.6% 95.9% 96.3% 95.0%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

2012 2013 2014 2015 2016 2017

PERC

ENTA

GE

YEAR

Aboriginal and Torres Strait Islander data Language Spoken data Country of Birth data

15

12. Conclusion There were 419 active certified nurses collecting CSTs in Victoria during 201748. Of these, 387 reported CSTs directly to VCS Pathology and the remaining 32 reported to the Registry through other Private Pathology Services under a doctor’s name. During 201748, the number of tests collected by these certified nurses and reported to the Registry was 27,015 tests (88.2% reported through VCS Pathology and 11.8% reported through Private Pathology under a doctor’s name). The CSTs collected by nurses represented 5.2% of all CSTs performed that year, which was a slight reduction from 5.4% in 2016. General Practice and Community Health settings continued to represent the main practice/ organisation types where nurses collected CSTs. There was also a slight increase in collection by nurses based at other practice types including General Practices and Private Pathology services. The majority of nurses who collected CSTs, and Victorian women who had CSTs collected by nurses, during 201748 were located in major cities or inner regional areas of Victoria. In 201748 nurses continued to collect a higher proportion of tests from women over the age of 50 years than other provider types. Although a general downward trend has been observed over the last decade, the proportion of cytology tests with an endocervical component continued to be higher for nurses than other provider types during 201748. The data in this report highlight the important role that nurses have in the success of the Victorian Cervical Screening Program, particularly in relation to the rising number of CSTs performed by them over the past two decades and the high quality of their tests. Also of note is the commitment of nurses to complete data collection, which assists with identifying and meeting the needs of under screened groups.

48 2017 data is for the period 01/01/2017 to 30/11/2017 only

16

13. References Australian Bureau of Statistics (ABS) (2016). Australian Statistical Geography Standard (ASGS): Volume 5, Remoteness Structure July 2016. Cat. No.:1270.0.55.005. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202016?OpenDocument Australian Bureau of Statistics (ABS) (2016). Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA) Cat. No. 2033.0.55.001. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012016?OpenDocument Australian Bureau of Statistics (ABS) (2016) Geospatial Solutions. ASGS Geographic Correspondences (2016) CG Postcode 2017 to Local Government Area 2016 https://data.gov.au/dataset/23fe168c-09a7-42d2-a2f9-fd08fbd0a4ce Australian Institute of Health and Welfare (AIHW) (2010). National best practice guidelines for collecting Indigenous status in health data sets. Cat no. IHW 29. Canberra https://www.aihw.gov.au/reports/indigenous-australians/national-guidelines-collecting-health-data-sets/related-material Courtesy of the Department of Health and Human Services (DHHS), Health and Wellbeing Division, Prevention and Population Health Branch, Screening and Prevention Services Unit (2017). LGA by DHHS Area Region Division concordance file. Courtesy of the Australian Institute of Health and Welfare (AIHW) (May 2014). Postal Area to ASGS RA conversion file. Customised for 2016 Census data. Department of Health and Human Services (DHHS), Victoria (2016). Victoria's Cancer Plan 2016-2020. State Government of Victoria, Melbourne. https://www2.health.vic.gov.au/about/health-strategies/cancer-care/victorian-cancer-plan Department of Health and Human Services (DHHS), Victoria (2015). Victorian Public Health and Wellbeing Plan 2015-2019. State Government of Victoria, Melbourne. https://www2.health.vic.gov.au/about/health-strategies/public-health-wellbeing-plan G Tan, D Stockman, F Sultana, and M Saville. The Falling Rates of Endocervical Component – Cause and Remedy. Presented at Australian Society of Cytology’s 47th Annual Scientific Meeting, October 2017, Canberra. Victorian Cervical Screening Registry (VCSR) (2006). 2006 Cytology Coding Schedule. VCS Foundation. Compass: Future Directions in Cervical Screening. URL: http://www.compasstrial.org.au

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