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Article History

Received: 29 August 2025

Revised: 3 February 2026

Accepted: 10 March 2026

First Online: 10 April 2026

Competing interests

: The authors received no specific funding for this work. PS was funded by a postgraduate research scholarship from Cancer Council NSW, the 45 and Up PhD Scholarship in Cancer Research. KC is co-principal investigator of an unrelated investigator-initiated trial of cervical screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), which is conducted and funded by the VCS Foundation (VCS), a government-funded health promotion charity. KC is also an investigator of Compass New Zealand (ACTRN12614000714684), which was conducted and funded by Diagnostic Medlab (DML), now Auckland District Health Board. The VCS Foundation received equipment and a funding contribution from Roche Molecular Systems and Ventana USA and DML received equipment and a funding contribution for Compass from Roche Molecular Systems. However, neither KC nor her institution on her behalf receives direct funding from industry for this trial or any other project. EB and KC are supported by Investigator Grants from the National Health and Medical Research Council of Australia (NHMRC) (references 1136128 and 1194679, respectively). EB was Deputy Chair of the NHMRC Alcohol Working Group (2016-2020) which advised on the updated national Australian guidelines on alcohol consumption. NH is supported by a National Breast Cancer Foundation Chair in Breast Cancer Prevention grant (reference: EC-21-001) and an NHMRC Investigator Grant (reference: 1194410). The other authors have no interests to declare. Funding sources did not have any role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

: Ethics approval for the 45 and Up Study was granted by the University of New South Wales Human Research Ethics Committee (reference: HC210602), and for this specific analysis by the NSW Population Health Services Research Ethics Committee (reference: 2014/08/551). Written informed consent was obtained from all participants in the study. The study was performed in accordance with the Declaration of Helsinki.