{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:18:08Z","timestamp":1771481888819,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T00:00:00Z","timestamp":1551225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007192","name":"Rijksinstituut voor Volksgezondheid en Milieu","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007192","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The aim of this study was to describe trends in the diagnosis and treatment of women referred from the national screening program with cervical intraepithelial neoplasia (<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content>) in the Netherlands, and to compare these trends with national guidelines and identify potential areas for improvement for the new primary high\u2010risk <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content> screening program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We conducted a population\u2010based cohort study using data from the Dutch pathology archive. Women aged 29\u201063\u00a0years who took part in the Dutch cervical screening program between 1 January 2005 and 31 December 2014 were selected. Three referral groups were identified: direct referrals and those referred after either one (first indirect referrals) or two (second indirect referrals) repeat cytology tests, totaling 85\u00a0239 referrals for colposcopy. The most invasive management technique and the most severe diagnosis of each screening episode was identified. Rates of management techniques were calculated separately by referral type, highest <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> diagnosis and age group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 85.1% of <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 3 lesions were treated with excision (either large excision or hysterectomy) and 26.4% of <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 1 lesions were treated with large excision. Rates of overtreatment (<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 1 or less) in see\u2010and\u2010treat management were higher for indirect referrals than for direct referrals and increased with age. Large excision rates increased with <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> diagnosis severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite guideline recommendations not to treat, <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 1 lesions were treated in just over 25% of cases and approximately 15% of <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 3 lesions were possibly undertreated. Given the expected increase in <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> detection in the new primary high\u2010risk <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content> screening program, reduction in <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 1 treatment and <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> 2 treatment in younger women is needed to avoid an increase in potential harm.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13547","type":"journal-article","created":{"date-parts":[[2019,1,28]],"date-time":"2019-01-28T08:59:09Z","timestamp":1548665949000},"page":"737-746","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Management and treatment of cervical intraepithelial neoplasia in the Netherlands after referral for colposcopy"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9973-7376","authenticated-orcid":false,"given":"Clare A.","family":"Aitken","sequence":"first","affiliation":[{"name":"Department of Public Health Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert G.","family":"Siebers","sequence":"additional","affiliation":[{"name":"PALGA, the nationwide network and registry of histo\u2010 and cytopathology in the Netherlands Houton the Netherlands"},{"name":"Department of Pathology Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzette M.","family":"Matthijsse","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands"},{"name":"BresMed Health Solutions Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik E. L.","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruud L. M.","family":"Bekkers","sequence":"additional","affiliation":[{"name":"Department of Gynecology Catharina Hospital Eindhoven Eindhoven the Netherlands"},{"name":"Department of Gynecology Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen H.","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology St. Antonius Hospital Nieuwegein Nieuwegein the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bram","family":"ter Harmsel","sequence":"additional","affiliation":[{"name":"Department of Gynecology Roosevelt Kliniek Leiden the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan\u2010Paul W. R.","family":"Roovers","sequence":"additional","affiliation":[{"name":"Bergman Clinics (Gynecology) Amsterdam, Amsterdam the Netherlands"},{"name":"Department of Obstetrics and Gynecology Amsterdam University Medical Center Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Folkert J.","family":"van Kemenade","sequence":"additional","affiliation":[{"name":"Department of Pathology Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inge M. C. M.","family":"de Kok","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,2,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969141315580836"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.06.095"},{"key":"e_1_2_9_4_1","unstructured":"SK Naber SM Matthijsse EEL Jansen IM Kok H Koning M Ballegooijen 2016 Erasmus Medical Centre Rotterdam"},{"key":"e_1_2_9_5_1","first-page":"1215","article-title":"Harms of cervical cancer screening in the United States and the Netherlands","volume":"40","author":"Habbema D","year":"2016","journal-title":"Int J Cancer"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1284"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3633"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6223"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02263.x"},{"key":"e_1_2_9_10_1","unstructured":"National Guidelines: Cervical Intra\u2010epithelial Neoplasia (CIN) version 1.1 (in Dutch).Nijmegen:Integraal Kankercentrum Nederland;2004."},{"key":"e_1_2_9_11_1","unstructured":"Rijksinstituut voor Volksgezondheid en Milieu (RIVM) (Internet). Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu; c2018 (cited 2 March 2018). 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