Researcher profile: Dr Megan Smith

Dr Megan Smith

With a passion for data and engineering, Dr Megan Smith is using public health to work towards eliminating cervical cancer in Australia.

Dr Megan Smith has a 2019 Early Career Fellowship for her study ‘Optimising and Successfully Implementing Cervical Cancer Prevention Policies.’

What is the research?

Through her role as Cervix/HPV Group Lead for High-income Country Projects at Cancer Council NSW, Dr Megan Smith is researching how to deliver the HPV vaccine and Cervical Screening Test to more people across Australia.

“Cervical cancer is the most preventable cancer. It's a unique opportunity that we have,” Dr Smith explains.

“What I'm interested in and what my fellowship is around – we have these new tools, specifically the HPV vaccine and now the new Cervical Screening Test – how are they implemented in practice, and how can we further streamline that?”

The human papillomavirus (HPV) vaccine – also known as the cervical cancer vaccine – protects against the highest risk types of HPV.

The Cervical Screening Test can detect HPV, the infection that can cause cells in the cervix to change and become abnormal.

Together they can prevent cervical cancer, but the challenge is getting more people to take part in the programs.

“We have the tools to prevent cervical cancer, but the history of prevention – while it's had its successes through things like screening – the uptake hasn't been very equitable,” Dr Smith says.

“There have been issues in terms of getting prevention tools to everybody.

“We can really try and bring a focus on equity in this prevention, so that elimination of cervical cancer can become a reality for all women.”

How can the cervical cancer prevention reach more people?

Dr Megan Smith says access to services and awareness of the disease could be preventing many women from taking part in the Cervical Screening Program.

“In Australia, Aboriginal and Torres Strait Islander women are currently less likely to be screened and more likely to be diagnosed with cervical cancer, and four times as likely to die,” she explains.

“We also see women who live in more disadvantaged areas – they're less likely to be screened and more likely to be diagnosed with cervical cancer.”

Through Dr Smith’s fellowship she hopes to help the Program reach these people.

What impact are the HPV vaccine and Cervical Screening Test having?

HPV vaccination was first included in the Australian National Immunisation Program in 2007 for girls, with boys included in 2013.

The Cervical Screening Test replaced the Pap Test in December, 2017 as the method of screening for changes that can lead to cervical cancer.

“The impact of the HPV vaccine – we saw it very early. Within a couple of years of the program it was having an impact on genital warts and infections with the virus,” Dr Smith says.

“Since then we've seen very strong declines in rates of high-grade cervical abnormalities that are precursors to cervical cancer. We're seeing all the signs that the vaccine is working.”

Dr Smith says the impact on cancer will be seen in a matter of time.

“Within the next few years, as cancer data become available and more time passes where those infections that are being prevented would otherwise have turned into cancers, we'll start to see that as well.

“Everything else is pointing in that direction though.”

What comes next?

Being in the first year of her fellowship means Dr Smith is still in the early stages of her work.

“We're going to be trying to get insights into Australia's experience as a world leader in cervical cancer prevention, to share with the many other countries who are thinking about shifting to primary HPV screening.”

Dr Smith has also been working to adapt and extend a simulation model.

“It’s something we have already for the Australian population as a whole, but we want to develop specialised models for the Indigenous population.

“It means we can specifically look at: would it help if people in the groups at highest risk who missed the option to get the vaccine as a teenager could get it as young people? What impact would different screening strategies have potentially on improving outcomes?”

Dr Smith is also going to be moving on to look at how screening can be optimised in vaccinated populations, and communications strategies to increase screening.

How has support from Cancer Institute NSW impacted your work?

“The Cancer Institute NSW Early Career Fellowship has enabled me to look at getting more research support that will help things move a lot more quickly,” Dr Smith says.

“It's also given me the opportunity to do things in more depth than I might have otherwise been able to do – take on more projects in a leading role.

“It has provided great opportunities to connect and learn from other cancer researchers – particularly people who are quite senior in the field.”