140 Chapter 6 screening program. While introducing the methylation test may entail upfront expenses, it is essential to recognise the downstream benefits of reducing unnecessary colposcopy referrals. This reduction in colposcopy referrals driven by improved risk stratification, has the potential to counterbalance the initial testing costs. Therefore, a comprehensive effectiveness analysis should not only consider the direct testing expenses but also encompass repeat testing within 12 months and additional diagnostic tests. In summary, our study demonstrates the potential of incorporating methylationbased strategies, specifically FAM19A4/miR124-2 and ASCL1/LHX8, along with HPV16/18 genotyping to significantly reduce the number of colposcopy referrals, thereby improving the efficacy of cervical cancer screening. However, it’s crucial to acknowledge that reducing colposcopy referrals also raises concerns about the potential risk of missing high-grade CIN lesions. Therefore, it is crucial to strike a balance between efficiency and effectiveness, ensuring a comprehensive screening and follow-up strategy to minimise the risk of missed high-grade CIN lesions.
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