PhD defence C.A. (Clare) Aitken

Organised cervical cancer screening has been offered in the Netherlands for more than thirty years. A major reorganisation of the Dutch cervical cancer screening programme took place in 2017. The primary screening test changed from cervical cytology to high-risk human papillomavirus (hrHPV) testing. Other policy and organisational changes were implemented alongside with change in the test.

Monitoring and evaluation are essential for assessing the impact of these changes on the quality of the programme. Therefore, this thesis aimed to evaluate the Dutch cervical cancer screening programme as a whole, as well as each stage of the screening process - attendance, test and referral and clinical care –with a particular focus on the transition from cytology-based screening to hrHPV-based screening.

Our research found that one round of hrHPV-based screening resulted in more abnormal cervix lesions being detected compared to cytology-based screening, at the cost of more women being unnecessarily referred to the gynaecologist. Despite this, we found the hrHPV-based programme is more cost-effective than the cytology-based programme. We found that fewer women have participated in the hrHPV-based programme compared to the cytology-based programme. Furthermore, we found that adding hrHPV genotyping to the programme would reduce the number of unnecessary referrals. Finally, we found that following referral from the cytology-based programme, approximately a quarter of low-grade cervical abnormalities were treated, despite guideline recommendations not to treat. We recommend continued monitoring and evaluation of the screening programme to ensure high quality within the programme continues to be achieved.

Due to corona, the PhD defences do not take place publicly in the usual way in the Senate Hall or in the Professor Andries Querido Room. The candidates will defend their dissertation either in a small group or online.