"Risikofaktoren und primäre Präventionsstrategien des Zervixkarzinoms" (Risk factors and primary prevention strategies of cervical carcinoma) - this is the title of an essay published in "Der Onkologe" (The Oncologist) by Sandra Weinmann and Prof. Dr Stefanie Klug from the Chair of Epidemiology together with the Institute of Medical Virology at the University Hospital of Tübingen and the Department of Obstetrics and Gynaecology at the University Hospital of the Ruhr University Bochum. The journal deals with practical questions on the diagnosis and treatment of oncological diseases. It has an impact factor of 0.137.
Cervical cancer is the fourth most common cancer in women worldwide. In 2018, around 311,000 women died of invasive cervical cancer. The cause of cervical cancer is a persistent infection with the sexually transmitted human papilloma viruses (HPV). For this reason, the Standing Committee on Vaccination (STIKO) in Germany recommends HPV vaccination for all girls and boys between the ages of nine and 14. HPV can cause not only cervical carcinomas but also a number of other cancers, such as carcinomas of the vagina, vulva, penis, anus, mouth and throat. It can also cause genital warts.
The current publication serves as a review article in which, on the one hand, the risk factors of cervical carcinoma are presented. These include infection with HPV, of which more than 225 different types are now known. In women, the worldwide prevalence of HPV infection is estimated to be around twelve percent. There are regional differences. In South Africa the figure is 21.1 percent, in Europe 9.7 percent. Young women under the age of 25 are particularly likely to be infected with HPV. "We have compiled the epidemiology of HPV infections both internationally and with a view to Germany and have drawn incidence comparisons between countries," Prof. Klug explains the methodology.
Other risk factors for the development of cervical cancer include frequent changes in sexual partners, smoking and long-term use of oral contraceptives (more than five years). There is also a positive correlation between the number of births (more than seven) and the risk of developing the disease. A weakened immune system also promotes the development of the disease. Other sexually transmitted infections such as "herpes simplex" and "chlamydia" are also discussed as risk factors.
On the other hand, the publication presents prevention strategies. One of the most important is vaccination against HPV. Since 2018, the HPV vaccination for girls and boys has been part of the service catalogue of all statutory health insurance schemes. In Germany, HPV vaccination rates have risen only slightly in recent years. The vaccination rate for 15-year-old girls was around 26.5 percent in 2011 and only around 31.3 percent in 2015. Vaccination rates of over 40 percent with complete immunisation are only reached at the age of 17.
"We have collated the vaccination rates in Germany and compared them with other countries. Australia, for example, was the first country worldwide to introduce a school-based vaccination programme for girls aged twelve years in 2007," says Prof. Klug. As a result, vaccination rates of over 80 percent were achieved. "Therefore, since 2013, boys aged twelve to 13 years have also been vaccinated there."
The authors therefore concluded that the introduction of an organised, school-based vaccination programme could also significantly improve vaccination rates in Germany. Only with high vaccination rates could HPV infection be prevented and thus contribute to a long-term decrease in the incidence of cervical cancer.
Prof. Dr. Stefanie Klug
Chair of Epidemiology
phone: 089 289 24950
Text: Romy Schwaiger
Photos: „Der Onkologe”/Chair of Epidemiology