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Feasibility study for improvements to the population screening for cervical cancer 2013

Uitvoeringstoets verbeteringen van het bevolkingsonderzoek baarmoederhalskanker


A lengthy period of infection with a high-risk types of the human papillomavirus (hrHPV) causes a precancerous stage of cervical cancer. A feasibility study on population screening for cervical cancer which was conducted by the Centre for Population Screening at the National Institute for Public Health and the Environment (RIVM) showed that early detection of a precancerous stage of cervical cancer through hrHPV screening as the primary test, can be coordinated and implemented. The Dutch Minister of Health, Welfare and Sport will use the study in its decision-making process on whether the proposed population screening will be implemented.

The screening organisations will invite women aged between thirty and sixty years to have a cervical smear taken at their GP practice once every five years. Women who do not respond will receive a self-sampling kit so that they can take a sample themselves. The collected material is tested for the presence of hrHPV. Women aged between forty and fifty years who have tested negatively for hrHPV, will subsequently be sent a new invitation for screening after ten years. If hrHPV is found in the sample, then a cytological test will be performed to detect for any presence of abnormal cells. Depending on this result, referral to a gynaecologist will follow or a follow-up consultation with the woman's GP. Women who are eligible for follow-up consultations will receive an invitation from the screening organisations. The hrHPV and the cytological tests are done in a limited number of screening laboratories.

The proposed population screening will provide extra health gain for women and the costs of implementation will be lower than those of the current population screening.

The feasibility study was brought about through a collaborative effort involving professional groups, patient associations, screening organisations and other stakeholders, which provide sufficient support for the implementation of the hrHPV screening and the self-sampling. The feasibility study has documented how the primary process, the organisation, the quality policy, the communication, the monitoring and the evaluation must be coordinated.

In order to implement the proposed population screening in its entirety from the start, a two-year preparation phase is required to prepare important areas of concern that include drawing up the quality requirements, arranging the tendering procedures and configuring the IT technology required. All women who are eligible for an invitation, will be offered an hrHPV test. Intensive monitoring of any possible negative health effects, such as overtreatment, is an important issue to be considered.

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