44 Chapter 2 Appendix A. Description of the three Dutch national cancer screening programmes Cervical cancer screening programme The cervical CSP was nationally implemented in 1979 and currently invites women aged between 30-60 years to participate at 5-year intervals.1, 2 Over the past few years several adjustments have been made to the design of this CSP.3 In 2016 the invitation strategy was altered; whereas potential participants used to be invited by their own GP or by the local screening organization, nowadays this is the exclusive responsibility of the local screening organization. In 2017 adjustments were made regarding the testing procedure and the time interval of the cervical CSP. First, instead of performing a classical Papanicolaou (Pap) smear for cytological abnormalities at the GP’s office, a new test for high-risk human papilloma virus (hrHPV) was added prior to investigation of aberrant cells. Several studies have shown that adding an HPV test is both more sensitive and specific in the detection of cervical cancer than cytology alone.4-6 A second modification was the introduction of the self-sampling test for hrHPV. Before 2017 all women who wanted to participate had to see their GP for a smear, whereas they can now choose to use the self-sampling test instead. However, if this test gives a positive result, they still need to see their GP in order to have a smear that can be checked for cytological abnormalities. The outcome of the hrHPV test is sent by letter by the local screening organization. In case of a positive cytological result, hospital referral will be handled via the GP. A final change, also implemented in 2017, is an adjustment to the length of the interval between individual tests. Women aged between 45 and 55 only receive an invitation if they tested positive in previous rounds or did not attend. The maximum screening interval can therefore be extended by 10 years for women from the age of 40. Breast cancer screening programme The breast CSP became nationally available in 1990.7 All women aged between 50 and 75 years (till 1998 age boundaries were 50-70 years) are biennially invited by letter, via a local screening organization, for a mammography. Women are able to refuse participation by unsubscribing from the invitation letters, either temporarily or for all future invitations. Most mammography’s take place at mobile research units, where two independent radiologists assess the mammogram (double reading). The results are shared with the participants via the screening organizations. In case of an unclear outcome of a mammogram or when a disorder is detected, further investigation will be needed, and the GP will be informed. The GP will contact the participant and arrange a hospital referral. Women are informed about the outcome by letter via the screening organization, which also provides information on the subsequent follow-up.8
RkJQdWJsaXNoZXIy MTk4NDMw