PhD defence E.E.L (Erik) Jansen

Cervical cancer is an important but largely preventable health problem. Vaccination for human papillomavirus (HPV) can prevent infections that cause the majority of cervical cancers, and organised screening can detect pre-invasive lesions so that they can be treated or detect cancer at an earlier stage to improve treatment options. The health policy cycle can be used to continuously improve the balance between harms, benefits and costs of cervical cancer prevention. In this thesis we focused on the first three steps of the health policy cycle: monitoring, evaluation and barriers. We monitored the current situation by performing a systematic literature review on the effect of cervical cancer screening on cervical cancer mortality and by comparing cancer risks after different test results. We evaluated the effects of the current situation and optimized strategies for the future by applying microsimulation models to quantify the effects of cervical cancer screening and HPV vaccination, taking into account existing barriers. These models were integrated in a user-friendly web-based evaluation tool for researchers and policymakers in the EU-TOPIA project (www.eu-topia.org).