For many years, by the time women arrived at the hospital in Timor‑Leste’s capital, Dili, it was usually too late. Cervical cancer has long been the second most common cancer among women in the small nation, just an hour’s flight from Darwin. For years, obstetrician‑gynaecologist Dr José António Gusmão Guterres – also known as Dr Zetó – saw the same pattern: advanced cancer, few treatment options, and families preparing for loss.
“There was no proper screening service,” he explains. “All women presenting were at late stages, and those referred overseas had poor prognoses, with almost no‑one surviving”. Dr Zetó describes these times as “a very painful moment”. Now, at the Vera Cruz Community Health Centre clinic in Dili, the situation is starting to change.
Women can now collect their own screening samples in privacy, without having to undergo a pelvic examination. Tests are processed onsite, with results ready within two hours, and anyone who tests positive can be assessed for treatment the same day.
This new approach has been made possible through a partnership between the Timor‑Leste Ministry of Health, local clinicians, and researchers from the University of Sydney’s Cancer Elimination Collaboration, working with the Elimination Partnership in the Indo‑Pacific for Cervical Cancer (EPICC) consortium and other regional partners.
EPICC’s work, which began in 2021 and is supported by the Australian Government and the Minderoo Foundation, aims to adapt Australia’s success to develop sustainable, locally owned programs in nine countries across the Indo‑Pacific.
“For the first time,” says Dr Zetó, “we can screen women early enough to prevent cancer.” The model is simple, but the science behind it was decades in the making – and much of it began in Australia, which is now on the verge of making history.
If current efforts continue, Australia is poised to become the first country in the world to eliminate cervical cancer as a public health problem by 2035, a feat the World Health Organization (WHO) has now set as a global objective.
“Australia has become an exemplar of what’s possible,” says Professor Karen Canfell AC FAHMS (BE (Electrical) ’91), who leads the Cancer Elimination Collaboration (CEC) at the University of Sydney’s School of Public Health. “Elimination isn’t one breakthrough.
It’s the result of decades of innovation involving vaccination, new screening technologies and approaches, equitable access to treatment, and empowering communities to take control of their own health.”
Australia’s roadmap to elimination
The success story began in 1991, with the launch of the National Cervical Screening Program. Within just over a decade of the Pap‑smear‑based program being rolled out, both the incidence and mortality rates of cervical cancer in Australia had halved – representing one of the most dramatic reductions in cancer burden in the nation’s history.
The introduction in 2007 of a first‑generation vaccine for human papillomavirus (HPV) – the virus that causes almost all cervical cancers – then presented a new opportunity to protect younger populations and provided the impetus to reinvigorate the screening program.
In 2017, Australia replaced Pap smears with HPV testing, a highly sensitive approach that detects the virus long before precancerous changes appear. This major development was made possible by years of research by the now‑CEC team and its partners, working closely with governments to assess the international evidence and evaluate the potential impacts and cost‑effectiveness of HPV screening in Australia.
“This transition greatly improved our ability to identify early changes that might increase future risk,” Karen explains. “By changing to HPV‑based screening in the National Cervical Screening Program, more lives are being saved every year.”
Research continues through the CEC’s Compass trial, run in collaboration with the Australian Centre for the Prevention of Cervical Cancer in Victoria. Involving more than 80,000 participants, it’s providing world‑first evidence to guide the future of Australia’s cervical cancer screening program.
In 2022, Australia introduced universal access to self‑collection of cervical cell samples for the Cervical Screening Test, again supported by the CEC team’s work, enabling people to collect their own samples in private, with medical supervision. This change has been critical in improving access for those who might otherwise avoid screening for reasons of accessibility, privacy or past trauma.
Recent Australian Institute of Health and Welfare data show that more than 5.5 million people aged 25–74 underwent cervical screening for HPV between 2020 and mid‑2025, reflecting strong participation in the renewed National Cervical Screening Program. The 2025 Cervical Cancer Elimination Progress Report also found that in 2021, for the first time, not a single case of cervical cancer was documented among those aged under 25 years nationwide, demonstrating the efficacy of Australia’s HPV vaccination program in younger people.
As Karen explains, “Each of these steps builds upon the last. Together, they give us the tools not just to control cervical cancer but to eliminate it – and, critically, to do so equitably.
Incidence of cervical cancer in Australia
5.8 Non-Indigenous women in Australia per 100,00 women in 2017-21
11.7 Indigenous women in Australia per 100,00 women in 2017-21
3x as high for Indigenous women and twice as high in remote and very remote areas (compared to the WHO elimination target).
Equity the true test
Elimination is not simply about driving national averages down; the real measure lies in how evenly these gains are distributed. “It is not enough to reduce incidence in the population overall,” says Professor Deborah Bateson AM, who also works with the CEC and leads the EPICC program in Timor‑Leste. “We must ensure elimination across all communities, including First Nations peoples, those living rurally, people with disability, and others historically under‑served by health systems.”
With almost half of all screening tests now self‑collected, the greatest uptake has been among groups who previously were least likely to screen – including those from disadvantaged socioeconomic groups and those living in very remote areas. Aboriginal Community Controlled Health Organisations are also leading culturally safe, community‑designed screening initiatives to overcome longstanding inequities.
However, the 2025 Cervical Cancer Progress Report warns that in recent years there has been a drop‑off in vaccination coverage. Screening rates have also slipped slightly, with more than one in four women overdue for their screening test and 15 percent of 25–39‑year‑olds never having had one.
A renewed focus on both vaccination and screening access and uptake – including services better targeted to marginalised communities – is critical for Australia to achieve elimination by 2035.
A student receiving an HPV vaccination at a school in Dili, as part of Timor’s highly successful national HPV vaccination campaign
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LinkA partnership with global potential
As effective as Australia’s public health programs have been in positioning the country towards achieving elimination, cervical cancer remains a devastating reality for communities in many neighbouring countries.
Globally, it is the fourth most common cancer in women, but the vast majority of cases (more than 90 percent) occur in low‑ and middle‑income countries, due to a historical lack of access to screening in such nations.
This stark reality is what drove a range of global research projects led by Karen’s team, now at the University of Sydney’s CEC, to work closely with WHO and other partners to develop the evidence base to support its global strategy for the elimination of cervical cancer, launched in 2020. The team’s modelling showed that vaccination, screening and treatment could save 62 million lives over the long term, and its ongoing work continues to support WHO in its development of global cervical screening guidelines.
The situation in low‑ and middleincome countries also motivated the formation of the EPICC partnership. Timor‑Leste is just one of the many countries being supported, with critical work ongoing in Indonesia, Malaysia, Vanuatu, Fiji, Papua New Guinea, Tuvalu, Nauru and the Solomon Islands. In Timor‑Leste, EPICC is working with local leaders to drive change. And in February this year, the University of Sydney formalised its relationship with the Timor‑Leste Ministry of Health, through the signing of a memorandum of understanding.
So far, through both clinic‑based screening and outreach events across the nation’s capital of Dili, more than 1500 women have been screened and more than 140 treated with thermal ablation, a simple treatment performed using a lightweight and easily portable device, typically without the need for general anaesthesia.
For Dr Zetó, this represents a profound turning point. “This is a huge step in terms of service provision,” he says. “It offers a bright and promising future in terms of prevention, reduction of cervical cancer incidence, and even elimination in 50 or 60 years to come. I am hopeful and confident that success can be achieved, one step at a time. We are just at the beginning.”
As an Australia Awards Fellow and EPICC’s technical lead, Dr Zetó visited the University of Sydney to gain hands‑on experience in women’s health and cancer care in the Australian context, returning home to put this learning into practice.
For him, the impact is measured not just in statistics but in lives. Each diagnosis made earlier means a family kept intact and a community protected. After years of witnessing loss, the change is as emotional as it is clinical.
“I remember the women who came too late,” he says. “That memory drives me. Now, with the help of our Australian partners, we can give women the chance to live.”
Deborah sees the same transformation through the eyes of the women and communities she works with. “Every person in Timor‑Leste knows someone affected by cervical cancer,” she says. “Too often, women die at the peak of their lives, leaving behind young children and families, with profound intergenerational health and social consequences. To work with our colleagues in Timor‑Leste towards eliminating this terrible disease – to offer women hope instead of fear – is extraordinarily meaningful.”
For CEC lead Karen, that sentiment captures the heart of elimination. “This is about equity and sustainability,” she says. “It’s about ensuring that where a person is born no longer determines whether they experience – or survive – cervical cancer.”
If Australia reaches its goal of elimination by 2035, it is expected to be a world first – but certainly not, the researchers hope, the last. With programs like EPICC forging new regional pathways, the University of Sydney and its international partners are working with communities to ensure that the benefits of prevention and control reach far beyond Australia’s shores.
And if that happens, the story of cervical cancer will ultimately become proof that with evidence‑based research, strong partnerships and a shared sense of humanity, a once major cancer can be consigned to history.
The EPICC consortium is led by the CEC at the University of Sydney and includes the Australian Centre for the Prevention of Cervical Cancer, the Kirby Institute at UNSW Sydney, Family Planning Australia, the National Centre for Immunisation Research and Surveillance, Unitaid, the International Union for Cancer Control and the International Gynecological Cancer Society.