Title thesis: Improving cervical cancer screening by HPV self-sampling

Viola Verhoef gives in her thesis more insight in the clinical accuracy and acceptability of HPV self-sampling and the improvement of cervical screening among non-attendees by offering self-sampling. Moreover, several triage strategies were evaluated in different studies in women tested HPV positive on self-sampled material.

Verhoef compared in a study the current Delphi Screener with a former generation Delphi Screener among non-responders of the screening program in the Netherlands. Verhoef showed that both devices performed similar in clinical performance and response rates.

In a large randomized controlled trial, PROHTECT-3, Verhoef compared two different triage strategies of women tested HPV positive with the Delphi Screener. Triage of HPV positive women is needed to prevent over-referral and overtreatment. Verhoef compared cytology as a triage tool with a DNA methylation of biomarker (MAL-M1 and miR-124-2) to detect CIN3+ on self-collected cervico-vaginal lavage material of women with an HPV positive self-sample. Verhoef found similar CIN2+ detection rates in the molecular triage and cytology triage group. In addition, women who received molecular triage did not need an additional visit to the physician for triage testing, showed a better compliance and shorter diagnostic track, at the cost of a higher colposcopy referral rate.

Furthermore, Verhoef combined in other studies different triage strategies of HPV positive women by, for example, cytology, DNA methylation analysis at different thresholds and/or HPV16/18 genotyping. The good performance of these different triage strategies is attractive for full molecular screening, to identify women with cervical (pre)cancer among HPV self-sample positive women.