Early detection of cervical cancer in Germany: evidence and implementation

Cervical cancer is the third most common cancer among women worldwide, with an estimated 529,000 new cases in 2008. The incidence of cervical cancer in Germany is still among the highest in Western Europe. For more than 40 years women in Germany have had legal and free access to a conventional cytologic smear test starting at the age of 20 years. The introduction of the Pap smear subsequently led to a reduction in the incidence and mortality of cervical cancer. However, the low sensitivity of the Pap smear and the evidence regarding human papillomavirus (HPV) in the context of cervical cancer have led to a critical view of the existing early detection of cervical cancer. In the meantime, new screening methods have been developed and different HPV tests, liquid-based cytology, and novel biomarkers have become available. Several randomized studies have investigated HPV testing as a primary cervical cancer screening test, generating a large body of evidence. It is expected that a combination of HPV testing and cytology will improve cervical cancer screening. In the near future, the early detection of cervical cancer in Germany will be restructured on the basis of the German National Cancer Plan as well as the new Cancer Screening and Registers Act (KFRG). The European guidelines for quality assurance in cervical cancer screening will be taken into account, and an organized, population-based, and quality-assured cervical cancer screening program will be implemented.