Title thesis: Towards a more objective way of cervical cancer screening: cervical cancer screening 2.0

Dijkstra describes in her thesis work evaluating opportunities of hrHPV and subsequent triage testing on the way towards a more objective manner of cervical cancer screening.

In one of her studies, Dijkstra concluded that brush-based self-sampling with the Viba Brush in combination with GP5+/6+-PCR EIA hrHPV testing is acceptable to women and valid for assessing the risk of CIN2+ in comparison to hrHPV testing on regular a cervical scrape using a the Cervex-brush. In addition, there was high concordance of HPV genotyping results.

The POBASCAM trial is a large population-based screening trial in which the Cervex Brush is used for cytology. Dijkstra used in a substudy of the POBASCAM trial, a large cohort of hrHPV-positive women to evaluate different triage strategies, involving testing at baseline and six months with combinations of cytology, HPV16/18 genotyping, and/or repeat hrHPV testing. Dijkstra concluded in this study that triaging hrHPV-positive women by cytology at baseline and after 6 to 12 months, possibly in combination with baseline HPV16/18 genotyping, seems acceptable for cervical cancer screening.

In a long-term follow up study of the POBASCAM trial, published in the BMJ, Dijkstra describes that the absolute risks of CIN3+ and cancer among hrHPV screen-negatives were low, justifying an extension of the screening interval beyond the current 5-year interval in the Netherlands, in particular for women aged 40 and older. HrHPV positive, triage negative women have an elevated CIN3+ risk and should be rescreened within 5 years.