Kaljouw Sylvia, Jansen Erik E L, Aitken Clare A, de Kok Inge M C M
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
BJOG. 2022 Oct;129(11):1862-1869. doi: 10.1111/1471-0528.17190. Epub 2022 May 6.
To calculate the changes in harms and benefits of cervical cancer screening over the first three screening rounds of the Dutch high-risk human papillomavirus (hrHPV) screening programme.
Microsimulation study.
Dutch hrHPV screening programme; women are invited for screening every 5 or 10 years (depending on age and screening history) from age 30 to 65.
Partly vaccinated population of 100 million Dutch women.
Microsimulation model MISCAN was used to estimate screening effects. Sensitivity analyses were performed on test characteristics and attendance.
Harms (screening tests, unnecessary referrals, treatment-related health problems), benefits (CIN2 diagnoses) and programme efficiency (number needed to screen [NNS]) over the first (period 2017-2021), second (period 2022-2026) and third (period 2027-2031) rounds of hrHPV-based screening.
The number of screening tests and CIN2 diagnoses decreased from the first to the second round (-25.8% and -23.6%, respectively). In the third screening round, these numbers decreased further, albeit only slightly (-2.7% and -5.3%, respectively). NNS to detect a CIN2 remained constant over the rounds; however, it increased in younger age groups while decreasing in older age groups.
Both harms and benefits of hrHPV screening decreased over the first screening rounds. For younger women, the efficiency would decrease, whereas longer screening intervals would lead to increased efficiency in older women. Programme efficiency overall remained stable, showing the importance of longer intervals for low-risk women.
Cervical cancer screening: both harms and benefits of hrHPV screening will decrease in the future.
计算荷兰高危型人乳头瘤病毒（hrHPV）筛查项目前三轮筛查中宫颈癌筛查的危害与益处的变化情况。
微观模拟研究。
荷兰hrHPV筛查项目；30至65岁的女性每5年或10年（取决于年龄和筛查史）受邀进行筛查。
1亿名部分接种疫苗的荷兰女性。
使用微观模拟模型MISCAN估算筛查效果。对检测特征和参与率进行敏感性分析。
在基于hrHPV的筛查的第一轮（2017 - 2021年期间）、第二轮（2022 - 2026年期间）和第三轮（2027 - 2031年期间）中的危害（筛查检测、不必要的转诊、治疗相关的健康问题）、益处（CIN2诊断）和项目效率（筛查所需人数[NNS]）。
从第一轮到第二轮，筛查检测次数和CIN2诊断数均下降（分别下降25.8%和23.6%）。在第三轮筛查中，这些数字进一步下降，尽管降幅较小（分别下降2.7%和5.3%）。各轮中检测出一例CIN2的NNS保持不变；然而，在较年轻年龄组中增加，而在较年长年龄组中减少。
在前三轮筛查中，hrHPV筛查的危害和益处均有所下降。对于较年轻女性，效率会降低，而较长的筛查间隔会使较年长女性的效率提高。总体项目效率保持稳定，表明低风险女性采用较长筛查间隔的重要性。
宫颈癌筛查：hrHPV筛查的危害和益处未来均会下降。
