HPV screening detects serious abnormalities earlier and the risk of cervical cancer is reduced for longer after a negative HPV test. As a result, people need to be screened less often. Instead of seven rounds with cytological screening, five rounds of screening are sufficient.
As far back as in 2011, the Health Council of the Netherlands advised that, when introducing primary HPV screening, screening should be performed at the ages of 30, 35, 40, 50 and 60. Clients aged 45 and 55 are only invited if they did not take part five years earlier or if they were HPV-positive five years earlier. Clients aged 65 are only invited if they were HPV-positive five years earlier and were not referred to a gynaecologist at that time.

Yes, the same invitation schedule applies for HPV-vaccinated persons (for the time being).
From 1 January 2023, the first HPV-vaccinated persons will be eligible for cervical cancer screening. After vaccination with the bivalent HPV 16/18 vaccine, other hrHPV types can still cause cervical cancer. Because vaccination does not offer complete protection, screening of HPV-vaccinated persons remains important. The invitation schedule for HPV-vaccinated persons will be reconsidered when more monitoring data are available.
 

Yes, all persons in the target group receive an invitation according to the invitation schedule. Individual medical histories cannot be taken into account. After all, the diagnosis and possible treatment are not known to the screening organisation. Clients who do not feel safe at an interval of 10 years due to their personal history can visit their GP for an indicative smear test in the meantime, outside the screening programme.

Yes, all persons from the target group receive an invitation according to the invitation schedule.
However, the screening programme is intended for people without symptoms that could indicate cervical cancer. Clients with symptoms are better off having a smear test done on indication. The screening programme only covers a cytological evaluation if a participant is HPV-positive. A smear test done on indication is always sent for cytological evaluation.
 

Yes, the 10-year interval for screening is safe.
The risk of developing cervical cancer or its precursors is related to the persistence of the HPV infection. When an HPV infection persists, it can lead to cell abnormalities in the cervix. The time between infection with hrHPV and the eventual development of cervical cancer is on average 10–15 years. Without intervention, at most 1% of all hrHPV infections lead to cervical cancer. After a negative HPV test, participants do not need to be screened for a long time. Therefore, the Health Council of the Netherlands advised as far back as in 2011 to use a 10-year interval for HPV-negative participants aged 40 and 50.

The change in the invitation schedule is related to the introduction of primary HPV screening in 2017. Because the HPV status of the target group was not known at that time, all persons aged between 30 and 60 were invited every five years. On 1 January 2022, people were screened for the first time if their HPV results from the previous round were known. Since that time, the (modified) invitation schedule has been used.

It is not yet known whether a change in the starting age and/or finishing age of the cervical cancer screening programme is planned. The Health Council of the Netherlands will reconsider the starting and/or finishing age in the integral evaluation of the screening programme in 2024.

The screening examines whether a participant is carrying the HPV virus and if so, what type of HPV it is. If a participant is HPV-positive, it will be examined whether abnormal cells have developed in the cervix. The type of HPV infection in combination with the severity of the abnormal cells determines the follow-up policy. If there is a good chance that the body will clear up the infection or the abnormal cells itself, it will be given time and a follow-up examination will follow after 12 months. Otherwise, participants are immediately referred to a gynaecologist for a follow-up examination.

There are many different types of the human papillomavirus (approximately 170). Only some of these types can lead to cervical cancer after a persistent infection: high-risk HPV (hrHPV). In the case of hrHPV types 16 and 18, the risk is clearly increased. These two types are responsible for 70% of all cervical cancers. The other 12 hrHPV types present a moderately increased risk. Including which HPV type is present in the screening makes it possible to implement a more targeted referral policy and refer fewer participants unnecessarily.

If a participant is found to have HPV 16 and/or HPV 18, cytological evaluation follows.

• If no abnormal cells are found (NILM), a check-up is recommended.
  An HPV infection alone is not enough to develop cervical cancer. The body often clears this infection itself. As long as there are no abnormal cells, the risk of cervical cancer is low. After 12 months, it is possible to check that no abnormal cells have developed.
• If abnormal cells are found (ASC-US, LSIL or HSIL), referral to a gynaecologist is recommended. A follow-up examination in hospital is then necessary to determine its severity.
• If the cytology is unreviewable, the participant will be invited for a repeat smear test after six weeks.

If HPV other is detected in a participant, cytological evaluation follows.

• If no abnormal cells are found (NILM), a check-up is recommended.
  An HPV infection alone is not enough to develop cervical cancer. The body often clears this infection itself. As long as there are no abnormal cells, the risk of cervical cancer is low. After 12 months, there will be a follow-up cytological evaluation to check that no abnormal cells have developed.
• If slightly abnormal cells are found (ASC-US or LSIL), a check-up is recommended.
  The body often clears this infection and the slightly abnormal cells itself.
• If severe abnormal cells are found (HSIL), referral to a gynaecologist is recommended. A follow-up examination in hospital is then necessary to determine its severity.
• If the cytology is unreviewable, the participant will be invited for a repeat smear test after six weeks.

The body often clears an HPV infection and mildly abnormal cells itself within one to two years. Research has shown that it is better to check for clearance of cell abnormalities after 12 months rather than after six months. After one year, it is also easier to assess whether an HPV infection has led to cell abnormalities in the cervix. The Health Council of the Netherlands has advised that this extension of the control examination could reduce the number of unnecessary referrals.

Yes, a 12-month monitoring period is safe.
During the control examination, all participants with cell abnormalities from ASC-US and above are referred to a gynaecologist. Abnormalities can then be properly treated because the development of abnormal cells into cervical cancer takes 10–15 years. The Health Council of the Netherlands has advised that a period of 12 months is justified for a control examination using cytology.
 

The control examination as part of the cervical cancer screening programme cannot be carried out earlier. After 12 months, participants receive a new invitation letter asking them to make an appointment with their GP for a smear test.
Earlier checks, for example if a patient has symptoms, are possible but are not covered by the cervical cancer screening programme. For this, the patient must be referred for a smear test. The costs of the cervical smear test on referral are covered by health insurance. Depending on the amount of the excess and how much of it has already been used, patients may have to pay all or some of the costs themselves.

An HPV infection alone is not enough to cause cervical cancer. For this to happen, abnormal cells must also be present. The control examination is not intended to show that the HPV infection has been cleared, but to exclude the possibility that the infection has led to cell abnormalities. Clearing of an HPV infection by the body itself can take one to two years. This means that there is a chance that the HPV infection is still present at the time of the follow-up examination. However, this is not a cause for concern if no abnormal cells are present in the cervix.