Title thesis: Improving cervical cancer screening in the HPV era

Bosgraaf describes in his thesis on the results of a large self-sampling study (PROHTECT-3B: PRotection by Offering HPV TEsting on Cervico-vaginal specimens Trial). In this randomized controlled trial (PROHTECT-3B), Bosgraaf compared two novel self-sampling devices for HPV detection on such a large scale.

In this study, 30,130 eligible women were randomly assigned (1:1 ratio) to receive either a Evalyn Brush or Delphi Screener for HPV testing. Bosgraaf found that the Evalyn Brush is noninferior to the Delphi Screener in terms of participation rate, with a higher participation rate for the Evalyn Brush (34.6% vs 31.9%). The Cervex-Brush was in this study used for physician-taken triage scrapes of HPV self-sampling positive women. Moreover, similar HPV-positivity rates and CIN2+/CIN3+ rates were observed in the two groups. A questionnaire that was sent to all invitees reported a similar user comfort with both self-sampling devices.

Furthermore, Bosgraaf explored the value of hrHPV genotyping combined with cytology as triage tool for hrHPV-positive women. In both studies the Cervex-Brush was used for physician-taken triage scrapes of HPV self-sampling positive women. Bosgraaf concluded that triage by cytology testing can be improved by adjusting its threshold, and combining it with HPV16/18 genotyping. These strategies improve the referral rate and specificity for detecting CIN3+ lesions, while maintaining adequate sensitivity.