COHEAHR: METHODS - THE PROJECT

Offering self-sampling for hrHPV testing is a feasible and effective mean for detecting CIN2+ in screening non-attendees but the clinical accuracy of hrHPV self-sampling versus clinician sampling had never been studied in a proper randomized manner.
Screening HPV self-sampling with HPV screening on clinician-collected samples were compared in:

• A randomized pilot implementation trial in the Dutch and Finnish screening settings, and
• A pooled comparative analysis using data imported in the national cervical screening registry in Sweden.

Moreover, proficiency panels specially designed to evaluate the performance of HPV screening were distributed for comparison of HPV testing laboratory performances.

Cancer risk will be significantly reduced in vaccinated women. If screening programmes are not changed for vaccinated women - the number of unnecessary referrals will likely increase, leading to unnecessary costs.
To evaluate the impact of vaccination in screening, two studies were conducted:

• Study A: 4-year follow-up of a Finnish community trial to evaluate different screening policies in adolescents vaccinated at age 13-15
• Study B: A randomized trial in Sweden and Italy to evaluate the influence of vaccination at age 22-23 (two years prior to screening start age) on the performance of cervical HPV-based screening

Vaccination trials have documented that vaccine efficacy among adult women up to age 45/55 is excellent provided they are HPV negative at the time of vaccination. However, HPV vaccination coverage of adult women in Europe is low to very low.
A multinational study in 9 European countries was conducted to identify global and local determinants of acceptability, HPV vaccine compliance, logistics and programmatic issues of vaccinating women 25-45 years attending routine cervical cancer screening

In order to provide direct estimates of positive and undesired effects of different preventive policies for cervical cancer as well as to estimate parameters of the natural history of HPV infection and pre-cancer/cancer, the following activities were performed:

• Update and extension of a previously stablished standardized data warehouse of European trials on HPV screening conducted in vaccinated and unvaccinated women as part of the PreHdict project (European funded project FP7-HEALTH-242061).
• Conduction of pooled analyses using such standardised datasets.
• Conduction of meta-analyses using such standardised datasets and other studies not included.

Mathematical models can be used to describe the natural history of HPV infection and therefore predict the impact of different screening and vaccination strategies at a population level.
As part of the activities conducted within this project, two dynamic transmission models were optimised and extended with the aim to assess different cervical cancer prevention strategies and their cost-effectiveness.