In 2011 the Health Council advised the Dutch Minister of Health, Welfare and Sport (VWS) that the current population screening for cervical cancer could possibly be improved. They advised to change the screening test from cytological screening to hrHPV screening. In reaction, VWS commissioned the RIVM Centre for Population Screening (RIVM-CvB) to perform a feasibility study. Based on the feasibility study, VWS decided to introduce hrHPV screening. The RIVM –CvB started implementing the new screening. This resulted in the new screening program that started in January 2017.
The feasibility study described the primary process, the organisation, the quality policy (including monitoring and evaluation) and the communication.(http://www.rivm.nl/Onderwerpen/B/Bevolkingsonderzoek_baarmoederhalskanker_voor_professionals). The study was performed involving all stakeholders. A three-year preparation phase was required that included drawing up the quality requirements, arranging the tendering procedures, adjusting guidelines, training and configuring the IT technology.
The screening
Women receive an invitation with a folder to take a cervical smear. This is tested for hrHPV and cytology-triage. HrHPV+/ cyt + women are referred to the gynecologist, hrHPV+/cyt - for cytology after 6 month. HrHPV positive women receive a folder. This folder contains information about the hrHPV, if the virus can be prevented or treated, the relationship between the virus and sex, the consequences for pregnancy, and the results. Non-responders can apply for a self-sampling. Women aged 40, 50 and 60 who are hrHPV- are invitated 10 years later. HrHPV+ or non-responders receive an invitation 5 years later.
Implementation of the screening tests
Five screening laboratories are involved in the new screening program based on the quality of the cytology, lower costs and sustainability (flexibility). Different acceptance tests were performed which showed that the HPV system performed comparable to the system at the time of clinical validation. Cytology training took place to prevent potentially unfavorable effects, such as a hrHPV-bias.
The tasks and responsibilities of the stakeholders and the requirements were specified and documented in the framework national requirements cervical cancer (http://www.rivm.nl/Onderwerpen/B/Bevolkingsonderzoek_baarmoederhalskanker_voor_professionals).
The new screening program is successfully implemented and the support of stakeholders is high. The organization is flexible to ensure fast introductions of improvements and innovations. The program is intensively monitored so that potentially unfavourable effects can be quickly adjusted.