Consumers have many possibilities to undergo a form of screening to acquire health information via the Internet or otherwise by purchasing health checks, medical check-ups, total body scans and... Show moreConsumers have many possibilities to undergo a form of screening to acquire health information via the Internet or otherwise by purchasing health checks, medical check-ups, total body scans and direct-to-consumer (DTC) genetic tests. More and more providers place screenings on the market before they have been assessed properly. In the Netherlands the Act on population screening ( __Wet op het bevolkingsonderzoek__) sets strict quality criteria for screening. In accordance with this Act a licence is required for offering and performing screening with ionising radiation or for detecting (risk factors of) cancer and untreatable diseases. This system, which aims to protect individuals against health damage and also to ensure patients (rights), wards off __commercial screening__ of the Dutch market. In society this meets with criticism. Individuals increasingly perceive the limited access to screening as an unnecessary restriction of their self-determination. However, the Dutch State has a special responsibility regarding the health of individuals. This thesis focuses on the following central question: __What are the normative criteria for the access to and supply of genetic screening from constitutional and European law perspectives?__ As a corollary the author will explore what this means for the Dutch legal framework regulating genetic screening, particularly DTC genetic tests. Show less
Cervical cancer remains one of the leading causes of death from cancer among women worldwide. Organised screening programmes aim to trace precursor lesions in order to reduce cervical cancer... Show moreCervical cancer remains one of the leading causes of death from cancer among women worldwide. Organised screening programmes aim to trace precursor lesions in order to reduce cervical cancer incidence. Human papillomavirus (HPV) is a necessary cause for cervical carcinogenesis. Most HPV infections are cleared and mild cervical abnormalities regress because of an efficient cellular immunity. A high prevalence of moderate and severe dysplasia was observed in Surinamese cervical smears, which correlates with the high cervical cancer incidence in Suriname. When compared with smears from Surinamese women living in the Netherlands their age-adjusted odds of having dysplasia appeared to be higher. HLA class I, important for the immune defence against virally induced lesions, is frequently and early altered in the HPV induced cervical carcinogenesis. This might allow premalignant lesions to escape immune surveillance and progress to cervical cancer. In part of the HLA class I altered tumours low TAP expression was detected. Multiple HPV infections are present in cervical tumours from high- and low-risk populations. They can be present in an episomal state in both diploid and aneuploid tumour cells, but integrated HPV genomes were detected only in the aneuploid tumour cell populations. Show less
