Dutch cervical cancer screening
| PhD ceremony: | Ms K.M. (Melisa) Castañeda Vanegas |
| When: | October 08, 2025 |
| Start: | 12:45 |
| Supervisors: | prof. dr. G.H. (Truuske) de Bock, prof. dr. E.M.D. (Ed) Schuuring |
| Co-supervisors: | dr. G.B.A. (Bea) Wisman, dr. M.J.W. (Marcel) Greuter |
| Where: | Academy building RUG / Student Information & Administration |
| Faculty: | Medical Sciences / UMCG |
Dutch cervical cancer screening
Despite continued efforts, cervical cancer prevention in the Netherlands faces persistent challenges, including declining screening participation and increased colposcopy referrals following the introduction of high-risk human papillomavirus (hrHPV) testing. This thesis of elisa Castañeda Vanegas evaluates the national screening program by examining trends in cervical cancer incidence and HPV prevalence, participation patterns and influencing factors, and the potential of molecular triage strategies.
Cervical cancer incidence declined between 1989 and 2003 but increased from 2003 to 2023, particularly among younger women. This reversal aligns with the shift to hrHPV-based screening and reduced participation. Among hrHPV-positive, non-vaccinated women aged 30–60, HPV16, HPV31, and HPV52 are most prevalent, with HPV16 most strongly associated with CIN3 and cancer. Vaccine-related HPV types are detected in all cancer cases and most high-grade lesions.
Participation between 2014 and 2018 ranged from 71% to 77%, depending on the timeframe considered. Delays, often due to pregnancy, occurred in 8% of participants. Health-related factors such as smoking, obesity, inadequate sleep, and low physical activity were linked to lower participation, while hormonal contraceptive use increased attendance. Among older women, participation often coincided with symptoms or previous diagnoses, suggesting self-selection.
Molecular triage was found to be cost-effective across different scenarios, with optimal pricing depending on test performance. A triage approach combining HPV16 with ANKRD18CP and LHX8 methylation markers improved CIN3+ detection and reduced missed diagnoses.
Overall, improving vaccination uptake, increasing screening participation, and integrating molecular triage may enhance program effectiveness and contribute to cervical cancer elimination in the Netherlands.