Kelly Melisa Castañeda

Trends in cervical cancer incidence in the Netherlands: A join‐point and age–period–cohort analysis (1989–2023)

Abstract Cervical cancer remains a significant public health issue, ranking as the fourth most common cancer in women globally. In the Netherlands, cervical cancer incidence declined steadily from 1989 to 2001 but increased between 2001 and 2007. This study updates trends in cervical cancer incidence from 1989 to 2023 in the Netherlands and evaluates the impact of screening practices and participation rates in the national population‐based screening program. This ecological study uses group‐level data from the Netherlands Cancer Registry (1989–2023) to analyze trends across three temporal dimensions—age, period, and cohort—using age–period–cohort analysis and join‐point regression to identify significant changes in trends over time. Cervical cancer incidence declined steadily from 1989 to 2003 but increased from 2003 to 2023, particularly among younger birth cohorts (1976–1995). This increase aligns with the decline in screening participation, which dropped from over 77% before 2003 to below 60% in subsequent years, as well as the introduction of primary high‐risk human papillomavirus testing in 2017, which has higher sensitivity than cytology, leading to more cases being detected and, consequently, an increase in incidence. Trends in cervical cancer incidence in the Netherlands indicate a positive impact of the screening program, with a steady decline over the years. However, efforts should focus on increasing participation in both screening and vaccination, as this is crucial for achieving the goal of reducing incidence to below 4 per 100,000 women, in line with the global strategy to eliminate cervical cancer.

Distribution of Human Papillomavirus Genotypes in Real‐World Cervical Self‐Collected Scrapings From the Dutch Cervical Cancer Screening Program

ABSTRACTHigh‐risk HPV (hrHPV) is the necessary cause of cervical cancer with HPV16/18 accounting for around 70% of the cases worldwide, while other non‐HPV16/18 hrHPV genotypes prevail in ~95% of high‐grade lesions. Understanding regional genotype distribution of hrHPV types not covered by the nonavalent vaccine is crucial for evaluating vaccine effectiveness and enhancing population‐based screening (PBS). The objective of the present study is to update hrHPV genotype prevalence in a non‐vaccinated cohort of 1200 hrHPV‐positive women from the Dutch PBS using INNO‐LiPA HPV Genotyping Extra‐II to identify 32 individual HPV genotypes in self‐sampled material. HrHPV prevalence for all 32 genotypes, also grouped by bivalent, quadrivalent, and nonavalent vaccine types (2vHPV, 4vHPV, and 9vHPV), was reported by histologic diagnosis and age. The most common genotypes were HPV16 (394,33%), especially in younger women, followed by HPV31 (216,18%) and HPV52 (199,17%). 2vHPV genotypes were found in 23% (n = 90) of NILM cases, 27% (n = 84) of CIN0/CIN1, 45% (n = 74) of CIN2, 71% (n = 219) of CIN3, and 92% (n = 12) of cervical cancers. In comparison, 9vHPV genotypes appeared in 60% (n = 240) of NILM, 69% (n = 218) of CIN0/CIN1, 88% (n = 145) of CIN2, 94% (n = 289) of CIN3, and all cervical cancers (n = 13). HrHPV types not included in 9vHPV had an overall prevalence of 19% (n = 225), with 88% (197/225) found in NILM or CIN0/CIN1. This study highlights vaccine‐type HPV in all cancer cases and many high‐grade lesions, reinforcing the need for improved vaccination efforts and broader protection.

Comparison of Hybribio-H13 and Hybrid Capture® 2 human papillomavirus tests for detection of CIN2+ and CIN3+

Introduction. Low-cost, accurate high-risk HPV tests are needed for cervical cancer screening in limited-resource settings.Objective. To compare the performance of the low-cost Hybribio-H13 test with the Hybrid Capture® 2 to detect cervical intraepithelial neoplasia grade 2 or 3 (CIN2 and CIN3).Materials and methods. Archived baseline samples tested by the Hybrid Capture® 2 from women of the ASCUS-COL trial, aged 20 to 69 years, with biopsy-colposcopy directed diagnosis of CIN2+ (n = 143), CIN3+ (n = 51), and < CIN2 (n = 632) were blindly tested by the Hybribio-H13 test.Results. The relative sensitivity of the Hybribio-H13 test versus the Hybrid Capture® 2 for detecting CIN2+ was 0.89 (90% CI = 0,80-0,98; NIT = 0,66), and for CIN3+ was 0,92 (90% CI = 0,85-0,98; NIT = 0,35). Relative specificity was 1.19 (90% CI = 1.05-1.33; NIT <0.00001). In the analysis restricted to women older than 30 years, the relative sensitivity of the Hybribio-H13 for CIN3+ was marginally below unity (ratio = 0.97; 90% CI = 0.95-0.99), and the specificity remained higher than the Hybrid Capture® 2 test.Conclusion. The Hybribio-H13 test was as specific as the Hybrid Capture® 2 for detecting CIN2+ or CIN3+ but less sensitive. Considering these results and the young age of the population recruited for screening because of ASCUS cytology, we suggest our results warrant the evaluation of the Hybribio-H13 for screening cervical cancer, especially in the evaluated population.