Benefit and burden in the Dutch cytology-based vs high-risk human papillomavirus-based cervical cancer screening program

BackgroundIn 2017, the Dutch cervical cancer screening program had replaced primary cytology-based with high-risk human papillomavirus-based screening, including opportunity to participate through self-sampling. Evaluation and balancing benefit (detection of high-grade intraepithelial neoplasia) burden (unnecessary referrals, invasive diagnostics, overtreatment) is needed.ObjectiveThis study aimed compare referral rates, detection neoplasia, overdiagnosis, overtreatment in new program, physician-sampled self-sampled material, previous Netherlands.Study DesignA retrospective cohort was conducted within population-based program. Screenees referrals for colposcopy between 2014 2015 (cytology-based screening) 2017 2018 (high-risk were included. Data retrieved from Pathology Registry (PALGA) compared 2 programs. The main outcome measures rate, neoplasia or worse, overdiagnosis (cervical grade 1 less histologic specimen), treatment specimen).ResultsOf women included study, 19,109 received 26,171 screening. Referral rates increased 2.5% 4.2% (+70.2%). Detection 46.2% 32.2% 3 31.0% cancer, 143.4% Overtreatment similar both periods. positive predictive value worse 34.6% 40.2% Women screened self-sampling at higher risk (odds ratio, 1.38; 95% confidence interval, 1.20–1.59) receiving 1.31; 1.16–1.48) than those physician-sampling.ConclusionCompared increases 462 more cases per 100,000 but expense 850 diagnostics indicating less. In needed. This Netherlands. A specimen). Of physician-sampling. Compared