Abstract

A lengthy period of infection with a high risk type of the human Papillomavirus (hrHPV) can be the cause of a pre-cancerous stage of cervical cancer. Early detection of a pre-cancerous stage of cervical cancer through hrHPV screening as the primary test, can be organized and carried out. This has become clear from 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. The Dutch Minister of Health, Welfare and Sport will use the study in the decision-making process on whether or not the proposed population screening will be implemented.

The proposed population screening is for women aged between thirty and sixty years. They will be invited by the screening organizations 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 cytology testing will be carried out to see if there are any abnormal cells present. Depending on this result, referral to a gynaecologist will follow or a follow-up consultation with the woman's GP practice. Women who are eligible for follow-up consultations will receive an invitation from the screening organizations. 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 the professional groups of patient organizations, screening organizations and other stakeholders. Among them there is sufficient support for the implementation of the hrHPV screening and the self-sampling. The feasibility study has documented how the primary process, the organization, the quality policy, the communication, the monitoring and the evaluation must be laid out.

In order to implement the proposed population screening, two years of preparation time is needed. During the preparation phase, special areas of attention will include drawing up the quality requirement, the tendering procedure and the IT technology required.

The proposed population screening will be implemented in its entirety from the start. 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.