Harms of cervical cancer screening in the United States and the Netherlands

Habbema, Dik; Weinmann, Sheila; Arbyn, Marc; Kamineni, Aruna; Williams, Andrew E.; Kok, Inge M.C.M. de; Kemenade, Folkert van; Field, Terry S.; Rosmalen, Joost van; Brown, Martin L.

doi:10.1002/ijc.30524

Cited by 53 publications

(66 citation statements)

References 48 publications

(100 reference statements)

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“…The high sensitivity of high-risk hpv tests will inevitably detect transient infections that would otherwise resolve without the need for treatment, especially among young women aged 25 to 34 39 . This could lead to excessive referral to colposcopy, biopsy, and treatment 40 , which is not only a burden and cost to the health care system but can be harmful to women 38,[41][42][43] . For these reasons, the recommended age to start screening (between 25 and 30 years) is older with hpv screening than with cytology.…”

Section: Health Care System Considerationsmentioning

confidence: 99%

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented 1 . However, cytology for primary cervical cancer screening has a number of limitations including poor sensitivity, a taxing demand on human and operational infrastructure, high health system costs, and limited uptake rates, leading researchers and policy-makers to question whether further gains in public health are possible using this approach 2 . Persistent infection with high-risk genotypes of human papillomavirus (hpv) is well established as the necessary cause for development of cervical cancer 3 . Research has shown a 30% improvement in sensitivity in detecting high-grade lesions, cervical squamous intraepithelial neoplasia (cin) grade 2 or greater (cin2+), can be achieved with high-risk hpv dna testing compared with cytology 4 . A negative hpv test confers two-fold greater reassurance against the development of cervical cancer over three years compared with a negative cytology test 2,5 . The Netherlands has recently transitioned from cytology to hpv testing for primary cervical cancer screening in their National program. Many organized screening programs intend to implement primary hpv screening 6-9 , including Australia, which will begin implementation in December 2017.A consistent barrier to cytology-based cervical cancer screening is non-attendance, which can be addressed through hpv testing using self-collected samples. Primary cervical cancer screening with hpv dna testing allows for the opportunity of self-collected samples, which is not possible with cytology. In hpv self-collection the sample is obtained vaginally by the woman herself, using a device such as a swab or brush. The swab is subsequently tested for high-risk strains of hpv in a laboratory. With this approach to screening, programs can mail self-collection kits directly to women who are overdue for screening as an alternative to a clinic-based visit. Self-collected cervical samples receiving hpv testing show comparable cin2+ sensitivity compared with clinician-collected samples tested with cytology and with hpv 10-12 . Self-collection has proven to be highly acceptable among women 13 .Huma n papillomav ir us self-collection has t he potential to overcome many of the personal and systemlevel barriers to screening that exist for cytology or other clinic-based screening methods. Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer...

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Section: Health Care System Considerationsmentioning

confidence: 99%

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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“…2 Recent Dutch modeling estimated that the number of detected CIN lesions would increase by 196% for CIN 1 and 54% for CIN 2 over the lifetime of women entering the program in 2017 due to primary hrHPV screening. 4 Evidence suggests that there is an association between excisional treatments for CIN and adverse obstetric outcomes including preterm birth and low birthweight. 4 Evidence suggests that there is an association between excisional treatments for CIN and adverse obstetric outcomes including preterm birth and low birthweight.…”

Section: Introductionmentioning

confidence: 99%

“…3 As more CIN lesions are detected, there is concern about overtreatment, which could result in increased harm associated with screening. 4 Evidence suggests that there is an association between excisional treatments for CIN and adverse obstetric outcomes including preterm birth and low birthweight. 5,6 Increasing excision volume has been associated with increased risk.…”

Section: Introductionmentioning

confidence: 99%

Management and treatment of cervical intraepithelial neoplasia in the Netherlands after referral for colposcopy

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Siebers

Matthijsse

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to describe trends in the diagnosis and treatment of women referred from the national screening program with cervical intraepithelial neoplasia (CIN) in the Netherlands, and to compare these trends with national guidelines and identify potential areas for improvement for the new primary high‐risk HPV screening program. Material and methods We conducted a population‐based cohort study using data from the Dutch pathology archive. Women aged 29‐63 years who took part in the Dutch cervical screening program between 1 January 2005 and 31 December 2014 were selected. Three referral groups were identified: direct referrals and those referred after either one (first indirect referrals) or two (second indirect referrals) repeat cytology tests, totaling 85 239 referrals for colposcopy. The most invasive management technique and the most severe diagnosis of each screening episode was identified. Rates of management techniques were calculated separately by referral type, highest CIN diagnosis and age group. Results In all, 85.1% of CIN 3 lesions were treated with excision (either large excision or hysterectomy) and 26.4% of CIN 1 lesions were treated with large excision. Rates of overtreatment (CIN 1 or less) in see‐and‐treat management were higher for indirect referrals than for direct referrals and increased with age. Large excision rates increased with CIN diagnosis severity. Conclusions Despite guideline recommendations not to treat, CIN 1 lesions were treated in just over 25% of cases and approximately 15% of CIN 3 lesions were possibly undertreated. Given the expected increase in CIN detection in the new primary high‐risk HPV screening program, reduction in CIN 1 treatment and CIN 2 treatment in younger women is needed to avoid an increase in potential harm.

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“…8 For example, we can decrease harms decreasing the 'intensivity' of the screening: compared to the less intensive screening practice in the Netherlands, US practice of cervical cancer screening may have resulted in two-to threefold higher harms, while the effects on cervical cancer incidence and mortality are similar. 9 Overdiagnosis harms also family members as cancer screening and 'scrutiny-dependent' cancers is a snow ball. The push for 'early detection' leads to more scrutiny-dependent cancers being found which, in turn, gives the false impression of an increased incidence of some cancers.…”

mentioning

confidence: 99%