Effects of HPV detection in population-based screening programmes for cervical cancer; a Dutch moment.

Presently, large randomised studies are investigating the value of incorporating HPV detection in population-based cervical screening programmes to improve the effectiveness of these programmes. None of these studies, however, has assessed the effect of HPV detection on the participation rate of women in these screening programmes. This paper draws attention to the fact that the effectiveness of cervical screening largely depends on the participation rate. A number of possibilities will be addressed on how HPV may affect cervical cancer screening. On the one hand, an option is described that addition of HPV detection, although increasing the sensitivity of screening, may in fact decrease the overall effectiveness of the screening. On the other hand, the possibility is put forward that incorporation of HPV will increase the reduction in mortality because of increased sensitivity and participation to the screening. Our manuscript thereby addresses an important aspect of screening, namely, the societal impact of new diagnostic tests on coverage in population-based screening programmes.