Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study
Abstract Background In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch...
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2019-12-01
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Online Access: | https://doi.org/10.1186/s12916-019-1460-0 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Clare A. Aitken Heleen M. E. van Agt Albert G. Siebers Folkert J. van Kemenade Hubert G. M. Niesters Willem J. G. Melchers Judith E. M. Vedder Rob Schuurman Adriaan J. C. van den Brule Hans C. van der Linden John W. J. Hinrichs Anco Molijn Klaas J. Hoogduin Bettien M. van Hemel Inge M. C. M. de Kok |
spellingShingle |
Clare A. Aitken Heleen M. E. van Agt Albert G. Siebers Folkert J. van Kemenade Hubert G. M. Niesters Willem J. G. Melchers Judith E. M. Vedder Rob Schuurman Adriaan J. C. van den Brule Hans C. van der Linden John W. J. Hinrichs Anco Molijn Klaas J. Hoogduin Bettien M. van Hemel Inge M. C. M. de Kok Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study BMC Medicine Cervical cancer screening hrHPV screening Population-based screening Cancer screening programmes |
author_facet |
Clare A. Aitken Heleen M. E. van Agt Albert G. Siebers Folkert J. van Kemenade Hubert G. M. Niesters Willem J. G. Melchers Judith E. M. Vedder Rob Schuurman Adriaan J. C. van den Brule Hans C. van der Linden John W. J. Hinrichs Anco Molijn Klaas J. Hoogduin Bettien M. van Hemel Inge M. C. M. de Kok |
author_sort |
Clare A. Aitken |
title |
Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study |
title_short |
Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study |
title_full |
Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study |
title_fullStr |
Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study |
title_full_unstemmed |
Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study |
title_sort |
introduction of primary screening using high-risk hpv dna detection in the dutch cervical cancer screening programme: a population-based cohort study |
publisher |
BMC |
series |
BMC Medicine |
issn |
1741-7015 |
publishDate |
2019-12-01 |
description |
Abstract Background In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme. Methods We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion). Results Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme. Conclusions This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening. |
topic |
Cervical cancer screening hrHPV screening Population-based screening Cancer screening programmes |
url |
https://doi.org/10.1186/s12916-019-1460-0 |
work_keys_str_mv |
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doaj-c1443b23039449f2bf3d016c5489553c2020-12-13T12:23:20ZengBMCBMC Medicine1741-70152019-12-0117111410.1186/s12916-019-1460-0Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort studyClare A. Aitken0Heleen M. E. van Agt1Albert G. Siebers2Folkert J. van Kemenade3Hubert G. M. Niesters4Willem J. G. Melchers5Judith E. M. Vedder6Rob Schuurman7Adriaan J. C. van den Brule8Hans C. van der Linden9John W. J. Hinrichs10Anco Molijn11Klaas J. Hoogduin12Bettien M. van Hemel13Inge M. C. M. de Kok14Department of Public Health, Erasmus MC University Medical CenterDepartment of Public Health, Erasmus MC University Medical CenterPALGA, the nationwide network and registry of histo- and cytopathology in the NetherlandsDepartment of Pathology, Erasmus MC University Medical CenterDivision of Clinical Virology, Department of Medical Microbiology, The University of Groningen, University Medical Center GroningenDepartment of Medical Microbiology, Radboud University Medical CenterDepartment of Pathology, Radboud University Medical CenterFacilitaire Samenwerking BevolkingsonderzoekenJeroen Bosch Hospital, Pathologie-DNAJeroen Bosch Hospital, Pathologie-DNASymbiant Pathology Expert Centre Hoorn (Westfriesgasthuis)NMDL-LCPLNMDL-LCPLDepartment of Pathology and Medical Biology, the University of Groningen, University Medical Center GroningenDepartment of Public Health, Erasmus MC University Medical CenterAbstract Background In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme. Methods We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion). Results Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme. Conclusions This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening.https://doi.org/10.1186/s12916-019-1460-0Cervical cancer screeninghrHPV screeningPopulation-based screeningCancer screening programmes |