Title thesis: Opportunities for improvement of cervical cancer prevention – from invitation to clinical care

De Bie evaluates in her thesis the weaknesses of the current cervical cancer screening program and treatment options of patients with (pre)malignancies. Furthermore, opportunities for improvement of the cervical screening program, such as self-sampling for hrHPV detection were described in this thesis.

De Bie described the screening history of women with invasive cervical cancer. Attention in the screening program must be directed towards minimizing false-negative smears. The normal smears within the preceding screening interval of five years were subsequently reviewed. A substantial part we scored as sampling and interpretation errors.

Two different treatment strategies for two consecutive ASC-US smears, aggressive versus less aggressive, were described and the clinical outcome after follow-up was compared. Both strategies were equally safe and showed good clinical outcomes.

De Bie described in her thesis the relation between HPV related vulvar cancer (u-VIN) and cervical abnormalities, and gives some suggestions for clinicians to improve uptake of HPV related malignancies.

Finally, the potential use of the FTA elute cartridge in combination with the Viba Brush to detect (pre)malignancies of cervical cancer is tested with the clinically validated Hybrid Capture 2 and GP5+/6+-HPV DNA detection assays. The FTA cartridge showed only a reasonably good overall agreement for hrHPV detection with liquid-based media when using GP5+/6+-PCR.