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Olthof EMG, Aitken CA, Siebers AG, van Kemenade FJ, de Kok IMCM. The impact of loss to follow-up in the Dutch organised HPV-based cervical cancer screening programme. Int J Cancer 2024; 154:2132-2141. [PMID: 38436201 DOI: 10.1002/ijc.34902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Loss to follow-up (LTFU) within cervical screening programmes can result in missed clinically relevant lesions, potentially reducing programme effectiveness. To examine the health impact of losing women during the screening process, we determined the proportion of women LTFU per step of the Dutch hrHPV-based screening programme. We then determined the probability of being LTFU by age, screening history and sampling method (self- or clinician-sampled) using logistic regression analysis. Finally, we estimated the number of missed CIN2+/3+ lesions per LTFU moment by using the CIN-risk in women compliant with follow-up. Data from the Dutch nationwide pathology databank (Palga) was used. Women eligible for screening in 2017 and 2018 were included (N = 840,428). For clinician collected (CC) samples, the highest proportion LTFU was found following 'referral advice for colposcopy' (5.5% after indirect referral; 3.8% after direct referral). For self-sampling, the highest proportions LTFU were found following the advice for repeat cytology (13.6%) and after referral advice for colposcopy (8.2% after indirect referral; 4.3% after direct referral). Self-sampling users and women with no screening history had a higher LTFU-risk (OR: 3.87, CI: 3.55-4.23; OR: 1.39, CI: 1.20-1.61) compared to women that used CC sampling and women that have been screened before, respectively. Of all women LTFU in 2017/18, the total number of potentially missed CIN2+ was 844 (21% of women LTFU). Most lesions were missed after 'direct referral for colposcopy' (N = 462, 11.5% of women LTFU). So, this indicates a gap between the screening programme and clinical care which requires further attention, by improving monitoring of patients after referral.
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Affiliation(s)
- E M G Olthof
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C A Aitken
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A G Siebers
- Palga (The Dutch Nationwide Pathology Databank), Houten, The Netherlands
| | - F J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - I M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Olthof EMG, Aitken CA, Siebers AG, van Kemenade FJ, de Kok IMCM. Resilience of the Dutch HPV-based cervical screening programme during the COVID-19 pandemic. Public Health 2024; 227:42-48. [PMID: 38103276 DOI: 10.1016/j.puhe.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Organisation of a screening programme influences programme resilience to a disruption as COVID-19. Due to COVID-19, the Dutch human papillomavirus-based cervical screening programme was temporarily suspended. Afterwards, multiple measures have been taken to catch-up participation. This study aimed to investigate programme resilience by examining the effect of COVID-19 and programme measures taken on participation in cervical screening. STUDY DESIGN Observational cohort study. METHODS Data from the national screening registry and Dutch nationwide pathology databank (Palga) were used on invitations and follow-up in 2018/2019 (pre-COVID) and 2020 (COVID). Sending invitations, reminders and self-sampling kits were suspended from March to July 2020. Main outcome measures include distribution of participant characteristics (age, region and screening history), participation rates by age and region, time between invitation and participation (i.e. response time) and self-sampling use per month. RESULTS Participation rate was significantly lower in 2020 (49.8%) compared to 2018/19 (56.8%, P < 0.001), in all ages and regions. Compared to 2018/19, participation rates decreased most in women invited from January to March 2020 (-6.7%, -9.1% and -10.4%, respectively). From August, participation rates started to recover (difference between -0.8% and -2.7%). Median response time was longer in February and March (2020: 143 and 173 days; 2018/19: 53 and 55 days) and comparable from July onwards (median difference 0-6 days). Self-sampling use was higher in 2020 (16.3%) compared to 2018/19 (7.6%). CONCLUSIONS The pandemic impacted participation rates in the Dutch cervical screening programme, especially of women invited before the programme pause. Implementation of self-sampling in national cervical screening programmes could increase participation rates and could serve as an alternative screening method in times of exceptional health care circumstances, such as a pandemic. Due to the well-organised programme and measures taken to catch-up participation, the impact of COVID-19 on the screening programme remained small.
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Affiliation(s)
- E M G Olthof
- Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands.
| | - C A Aitken
- Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Erasmus MC University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - A G Siebers
- The Dutch Nationwide Pathology Databank (PALGA Foundation), Houten, the Netherlands
| | - F J van Kemenade
- Erasmus MC University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - I M C M de Kok
- Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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Goetgebuer RL, Kreijne JE, Aitken CA, Dijkstra G, Hoentjen F, de Boer NK, Oldenburg B, van der Meulen AE, Ponsioen CIJ, Pierik MJ, van Kemenade FJ, de Kok IMCM, Siebers AG, Manniën J, van der Woude CJ, de Vries AC. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. J Crohns Colitis 2021; 15:1464-1473. [PMID: 33609353 PMCID: PMC8653760 DOI: 10.1093/ecco-jcc/jjab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Women with inflammatory bowel disease [IBD] may be at higher risk for cervical intraepithelial neoplasia [CIN]. However, data are conflicting. The aim of this study was to assess the risk of high-grade dysplasia and cancer [CIN2+] in IBD women and identify risk factors. METHODS Clinical data from adult IBD women in a multicentre Dutch IBD prospective cohort [PSI] from 2007 onwards were linked to cervical cytology and histology records from the Dutch nationwide cytology and pathology database [PALGA], from 2000 to 2016. Patients were frequency-matched 1:4 to a general population cohort. Standardised detection rates [SDR] were calculated for CIN2+. Longitudinal data were assessed to calculate CIN2+ risk during follow-up using incidence rate ratios [IRR] and risk factors were identified in multivariable analysis. RESULTS Cervical records were available from 2098 IBD women [77%] and 8379 in the matched cohort; median follow-up was 13 years. CIN2+ detection rate was higher in the IBD cohort than in the matched cohort (SDR 1.27, 95% confidence interval [CI] 1.05-1.52). Women with IBD had an increased risk of CIN2+ [IRR 1.66, 95% CI 1.21-2.25] and persistent or recurrent CIN during follow-up (odds ratio [OR] 1.89, 95% CI 1.06-3.38). Risk factors for CIN2+ in IBD women were smoking and disease location (ileocolonic [L3] or upper gastrointestinal [GI] [L4]). CIN2+ risk was not associated with exposure to immunosuppressants. CONCLUSIONS Women with IBD are at increased risk for CIN2+ lesions. These results underline the importance of human papillomavirus [HPV] vaccination and adherence to cervical cancer screening guidelines in IBD women, regardless of exposure to immunosuppressants.
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Affiliation(s)
- R L Goetgebuer
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - J E Kreijne
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - C A Aitken
- Erasmus MC, University Medical Center, Public Health, Rotterdam, The Netherlands
| | - G Dijkstra
- University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, The Netherlands
| | - F Hoentjen
- Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, The Netherlands
| | - N K de Boer
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - B Oldenburg
- University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, The Netherlands
| | - A E van der Meulen
- Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, The Netherlands
| | - C I J Ponsioen
- Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, the Netherlands
| | - M J Pierik
- Maastricht University Medical Center, Gastroenterology and Hepatology, Maastricht, The Netherlands
| | - F J van Kemenade
- Erasmus MC, University Medical Center, Pathology, Rotterdam, The Netherlands
| | - I M C M de Kok
- Erasmus MC, University Medical Center, Public Health, Rotterdam, The Netherlands
| | - A G Siebers
- PALGA, The Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands, Houten, The Netherlands,Radboud University Medical Center, Pathology, Nijmegen, The Netherlands
| | - J Manniën
- Leiden University Medical Center, Biomedical Data Sciences, Leiden, The Netherlands
| | - C J van der Woude
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - A C de Vries
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands,Corresponding author: Annemarie C. de Vries, MD, PhD, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Verloop J, van Leeuwen FE, Helmerhorst TJM, de Kok IMCM, van Erp EJM, van Boven HH, Rookus MA. Risk of cervical intra-epithelial neoplasia and invasive cancer of the cervix in DES daughters. Gynecol Oncol 2016; 144:305-311. [PMID: 27939984 DOI: 10.1016/j.ygyno.2016.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Women exposed to diethylstilbestrol in utero (DES) have an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, while their risk of non-CCA invasive cervical cancer is still unclear. METHODS We studied the risk of pre-cancerous (CIN) lesions and non-CCA invasive cervical cancer in a prospective cohort of 12,182 women with self-reported DES exposure followed from 2000 till 2008. We took screening behavior carefully into account. Incidence was obtained through linkage with the Netherlands Nationwide Pathology database (PALGA). General population data were also derived from PALGA. RESULTS The incidence of CIN1 was increased (Standardized Incidence Ratio (SIR)=2.8, 95% Confidence Interval (CI)=2.3 to 3.4), but no increased risk was observed for CIN2+ (CIN2, CIN3 or invasive cancer) compared to the screened general population (SIR=1.1, 95% CI=0.95 to1.4). Women with DES-related malformations had increased risks of both CIN1 and CIN2+ (SIR=4.1, 95%CI=3.0 to 5.3 and SIR=1.5, 95%CI=1.1 to 2.0, respectively). For CIN2+, this risk increase was largely restricted to women with malformations who were more intensively screened. CONCLUSIONS An increased risk of CIN1 among DES daughters was observed, especially in women with DES-related malformations, probably mainly due to screening. The risk of CIN2+ (including cancer) was not increased. However, among DES daughters with DES-related malformations a true small risk increase for non-CCA cervical cancer cannot be excluded.
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Affiliation(s)
- J Verloop
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Th J M Helmerhorst
- Department of Obstetrics and Gynaecology, Erasmus MC, University Hospital Rotterdam, The Netherlands
| | - I M C M de Kok
- Department of Public Health, Erasmus MC, The Netherlands
| | | | - H H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M A Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Hofman R, van Empelen P, Richardus JH, de Kok IMCM, de Koning HJ, van Ballegooijen M, Korfage IJ. Predictors of HPV vaccination uptake: a longitudinal study among parents. Health Educ Res 2014; 29:83-96. [PMID: 24041721 DOI: 10.1093/her/cyt092] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
To assess among parents longitudinal predictors of human papillomavirus (HPV) vaccination uptake for their daughters, random samples of parents were identified via municipal services and sent baseline questionnaires in June 2009 and follow-up questionnaires in November 2011 after their uptake decision. Hierarchical logistic regression analysis was used to assess whether demographic characteristics, and affective and social cognitive factors, predicted uptake at follow-up. Response rates of the baseline and follow-up questionnaire were 29.8% (1762/5918) and 74.3% (793/1067), respectively. Uptake was predicted by a later (2011) versus earlier (2010) decision about uptake as HPV vaccination implementation [odds ratio (OR) 2.48; 95% confidence interval (CI) 1.11-5.52], anticipated regret about no uptake (OR 1.43; 95% CI 1.08-1.89) and intention (OR 2.61; 95% CI 1.47-4.61). There was an interaction between ambivalence and attitude (OR 1.68; 95% CI 1.14-2.47); parents with a positive attitude and a high ambivalence toward vaccination were more likely to have their daughter vaccinated than parents with a positive attitude and a low ambivalence. An informed choice about uptake (5/7 correct items) was made by 44%. In conclusion, uptake was predicted by intention, a later (2011) versus earlier (2010) decision and by anticipated regret about no uptake. Decisions regarding new vaccines are difficult to make, we recommend a well-balanced implementation process.
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Affiliation(s)
- R Hofman
- Department of Public Health, Erasmus University Medical Centre, 3000 CA Rotterdam, the Netherlands, Department of Health Promotion, TNO Quality of Life, 2333 AL Leiden, the Netherlands and Municipal Public Health Service Rotterdam-Rijnmond, 3011 EN Rotterdam, the Netherlands
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Abstract
OBJECTIVE To determine the most cost-effective screening programme for cervical cancer. DESIGN Cost-effectiveness analysis from a societal perspective. SETTING The Netherlands. POPULATION Dutch women who have not been invited for human papillomavirus (HPV) vaccination. METHODS We calibrated the microsimulation screening analysis (MISCAN) model to Dutch epidemiological data. We used this model to consider nine screening strategies that use: (i) cytological testing with cytology triage for borderline/mildly abnormal smears; (ii) HPV testing with cytology triage for HPV-positive smears; or (iii) cytological testing with HPV triage for borderline/mildly abnormal smears. For each strategy, we varied the number of screening rounds, the time interval, the age of the first screening, and the type of cytological testing (conventional or liquid-based cytology). MAIN OUTCOME MEASURES Quality-adjusted life years (QALYs) gained and costs from a societal perspective. RESULTS Under the base-case assumptions, primary HPV testing with cytology triage is the most cost-effective strategy. Using cost-effectiveness thresholds of € 20,000 and € 50,000 per QALY gained yields optimal screening programmes with three and seven screening rounds, respectively. The results are sensitive to several uncertain model inputs, most importantly the costs of the HPV test. For women aged 32 years or younger, primary cytology screening is more cost-effective than primary HPV testing. CONCLUSIONS Increasing the interval between screening rounds and changing the primary test from cytology to HPV testing can improve the effectiveness and decrease the costs of cervical cancer screening in the Netherlands.
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Affiliation(s)
- J van Rosmalen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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de Kok IMCM, van Ballegooijen M, Habbema JDF. Response Re: Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands. J Natl Cancer Inst 2010. [DOI: 10.1093/jnci/djp524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Kok IMCM, van Ballegooijen M, Habbema JDF. Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands. J Natl Cancer Inst 2009; 101:1083-92. [DOI: 10.1093/jnci/djp183] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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de Kok IMCM, Habbema JDF, Mourits MJE, Coebergh JWW, van Leeuwen FE. [Grounds for the inclusion of vaccination against cervical cancer within the National Immunisation Programme]. Ned Tijdschr Geneeskd 2008; 152:2639-2641. [PMID: 19105259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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de Kok IMCM, Habbema JDF, Mourits MJE, Coebergh JWW, van Leeuwen FE. [Insufficient basis for the inclusion of Human papillomavirus vaccination in the National Immunisation Programme in The Netherlands]. Ned Tijdschr Geneeskd 2008; 152:2001-2004. [PMID: 18825885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Dutch Minister of Health, Welfare and Sportintends to implement Human papillomavirus (HPV) vaccination for 12-year-old girls and catch-up vaccination for 13- 16-year-old girls, as part of the National Immunisation Programme from September 2009 onwards. However, due to a well-organised screening programme, cervical cancer is not an important public health problem in the Netherlands any more, which limits the possible impact of HPV vaccination. Vaccine trials thus far have involved a relatively small number ofparticipants with limited follow-up, so the efficacy of the vaccine in preventing cervical cancer is not yet known. There are no data on frequency and severity of possible adverse events and the vaccine has not yet been tested in the intention-to-vaccinate group of 12-year-old girls. Even when we assume that HPV16/18-related cervical cancer is prevented on a lifelong basis, the cost-effectiveness ratio of HPV vaccination is estimated not to be favourable. In conclusion, HPV vaccination does not seem to be urgent in the Netherlands. Therefore we advise studying the safety in 12-year-old girls first while at the same time waiting for the longer follow-up results of ongoing trials.
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Affiliation(s)
- I M C M de Kok
- Erasmus MC, afd. Maatschappelijke Gezondheidszorg, Postbus 2040, 3000 CA Rotterdam.
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