The health screening organisation invites all women aged 30 to 60 years to participate in the cervical screening program. Around the time of their birthday, women aged 30, 35, 40, 45, 50, 55 and 60 years will receive an invitation from the health screening organisation to participate in the screening for free. Depending on the result, they will receive a further invitation five or ten years later. Women aged 45 and 55 years will only receive an invitation if they tested hrHPV positive during a previous screening. Women aged 65 will also receive an invitation if they were hrHPV positive and cytology negative when aged 60.
If your patient does not respond, the health screening organisation will send a reminder 16 weeks after the initial invitation. If your patient does not respond again, she will be invited again 5 years later until she is aged 60.
Participate or not?
Your patient cannot have a smear test if she is pregnant or recently gave birth. If she forwards the calculated or actual delivery date to us, she will receive a new invitation 6 months after the birth date. There are also other medical reasons for not participating. This includes if the cervix has been removed. Patients are then advised to consult their GP regarding the usefulness of participation. As GP, you know your patient’s medical history and you can use this to offer appropriate advice.
Smear tests for cervical screening can only be taken and sent by GPs and GP surgeries that have an AGB code and are registered in the health screening organisation’s GP Portal. Registration in the GP Portal is necessary to be able to order health screening laboratory forms and smear test equipment from the screening laboratories in your region.
Only use the health screening smear test equipment. Smear tests taken with other smear test equipment than those supplied by the screening laboratory cannot be processed.
The invitation letter that your patient receives from the screening organisation for the cervical screening has two stickers at the bottom with a personal barcode. One sticker should be placed with the barcode horizontal on the cervical screening laboratory pot. This is important as it enables the screening laboratory equipment to scan the barcode. The other sticker should be placed on the cervical screening laboratory form. The screening laboratory needs a laboratory pot and form with the stickers in place in order to process the smear test samples.
When taking the smear test you should place the collected cells in the sample pot and agitate the green Cervex-Brush 10 times against the bottom of the pot. Finally turn the brush around with some force to ensure that the sample is released. Do not leave the Cervex-Brush in the sample pot.
The instructions for the ‘Correct delivery of the cervical screening smear test’.
The cervical screening program smear tests are analysed by five screening laboratories. You will receive the smear test equipment from the screening laboratories in your region; this will be sent to the location you registered in the GP Portal. The screening laboratory is responsible for supplying and collecting the cervical screening equipment via a courier.
The following five screening laboratories analyse the smear tests for the cervical screening program:
- Universitair Medisch Centrum Groningen
- Symbiant (Hoorn)
- Radboud Universitair Medisch Centrum (Nijmegen)
- Nederland Moleculair Diagnostisch Laboratorium BV (Rijswijk)
- Stichting Jeroen Bosch Ziekenhuis (’s-Hertogenbosch)
If, during the smear test (as primary screening or after a self-test kit HPV+), you discover that the woman has a double cervix, then both smear tests will immediately be collected on the basis of a medical referral. A double uterus does not occur often and is not part of the cervical screening program. This does not mean that the women now has to pay the costs of the smear test herself. The costs for both smear tests made by her GP will be paid by the screening organisation if the health insurer does not cover this. The woman should forward the health insurer notification that states that she will be charged for the costs of such an examination to the screening organisation. Women with a double cervix must deregister from the cervical screening program. Patients can do this in 2 ways:
- Permanent deregistration: The woman will no longer receive an invitation for the cervical screening program. She can have a smear test taken at a GP surgery once in five years on the basis of a medical referral.
- Temporarily deregistration: The woman will receive a new invitation after 5 years so that she can use it as ‘reminder’ to have a smear test taken at the GP surgery.
The woman cannot use the self-test kit. It is the GP surgery’s responsibility to inform the patient about the results of this examination. It is also the GP surgery’s responsibility to inform the laboratory that the samples are from a double cervix.
Payment to GPs
The GP is eligible for a fixed fee per smear test. A condition is that the GP sends the smear tests to the laboratory indicated by the health screening organisation. The Ministry of Health, Welfare and Sports determines the fee for the tests each year.
As long as the correct AGB code is entered, the payment will be processed automatically by the healthcare screening organisation. You can view an overview of the paid examinations in the GP Portal. You do not need to claim the expenses for this yourself.
Smear test results
The healthcare screening organisation will send your patient the results by letter within 4 weeks. If the result is hrHPV positive, the same smear test will be used to conduct a cytological evaluation.
The result can be:
- No hrHPV:
If the result is hrHPV negative, your patient will receive a further invitation for the cervical screening in 5 or 10 years (depending on her age).
- hrHPV, but no abnormal cells:
A follow-up smear test at the GP after six months. Only a cytological evaluation will be carried out. This smear test forms part of the cervical screening program and is free of charge for the woman. Your patient will receive another invitation letter with two barcode stickers from the healthcare screening organisation. The follow-up smear test can only be taken on presentation of this invitation.
Please note: You should also use the cervical screening laboratory form for the follow-up smear test.
- hrHPV and slightly abnormal cells:
Result PAP2-PAP3a1, referral to the gynaecologist.
- hrHPV and abnormal cells:
Result PAP3a2, referral to the gynaecologist.
Repeat smear test after six weeks. This smear test forms part of the cervical screening program. It is important that there is at least a six-week period between the first and second smear test.
Self-test kit results
Your patient will receive the results by letter from the screening organisation within 4 weeks. The GP surgery will not receive any information about the results of the screening. This is due to privacy reasons: the GP is not the person who has requested the screening or taken the sample. If hrHPV is detected, the patient will be invited immediately by the screening organisation to have a further smear test taken at the GP (for cytological evaluation). This smear test forms part of the cervical screening program and is free of charge for your patient.
Referral to the gynaecologist
If your patient is hrHPV positive and abnormal cells are found, she - depending on the seriousness of the abnormality - will always be referred to the gynaecologist for a follow-up examination. The GP should include the complete result including KOPAC classification with the referral.
The follow-up consultation does not form part of the cervical screening program.
The costs of this should be paid from the health insurance. Depending on the insurance excess, your patient may have to pay the costs or some of the costs herself. It is important that you inform your patient about this.