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HPV-based cervical screening: Rationale, expectations and future perspectives of the new Dutch screening programme.

N J Polman1, P J F Snijders1, G G Kenter2

  • 1Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

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Summary

The Netherlands replaced cervical cytology with HPV testing for better protection against cervical precancer and cancer. This nationwide HPV screening program offers valuable insights for global cervical cancer prevention strategies.

Keywords:
Cervical cancer screeningCervical intraepithelial neoplasiaEarly detection of cancerHuman papillomavirus DNA testTriage testing

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Area of Science:

  • Public Health
  • Oncology
  • Virology

Background:

  • Cytology-based screening for cervical cancer has limitations in detecting precancerous lesions and cancer.
  • Human Papillomavirus (HPV) testing demonstrates superior efficacy in preventing cervical precancer and cancer compared to traditional cytology.
  • The Dutch Health Council recommended transitioning to HPV testing in 2011 based on scientific evidence.

Purpose of the Study:

  • To provide an overview of the studies guiding the implementation of HPV-based cervical screening in the Netherlands.
  • To detail the selection of HPV assays, triage strategies, and adjustments to screening parameters.
  • To review the cost-effectiveness and future perspectives of the Dutch HPV screening program.

Main Methods:

  • Review of studies supporting the choice of HPV assay and triage methods.
  • Analysis of adjustments to screening start/exit ages and intervals.
  • Evaluation of the implementation of HPV self-sampling.
  • Assessment of the cost-effectiveness of the new screening algorithm.

Main Results:

  • The Netherlands successfully implemented nationwide primary HPV testing for cervical screening in 2017.
  • The program involved careful selection of HPV assays and triage strategies.
  • Screening ages and intervals were adjusted, and HPV self-sampling was introduced.
  • The new risk-management-based algorithm is being evaluated for cost-effectiveness.

Conclusions:

  • The Dutch experience with nationwide HPV-based cervical screening offers a model for other countries.
  • The transition to HPV testing enhances protection against cervical precancer and cancer.
  • The program's success relies on evidence-based assay selection, optimized screening protocols, and cost-effectiveness analysis.