Although the incidence of cervical cancer in Germany has been declining for decades, it is still slightly elevated compared to other Western European countries. In 2020, there were 4,666 new cases and 2,075 deaths from cervical cancer, corresponding to age-standardized incidence and mortality rates of 9.6 and 4.2 per 100,000 women, respectively.
The Chair of Epidemiology of Prof. Dr. Stefanie Klug has now published a study entitled „Impact of opportunistic screening on squamous cell and adenocarcinoma of the cervix in Germany: A population-based case-control study“ in the Journal „PLOS ONE“, which has an impact factor of 3.240.
This was a case-control study examining the use of opportunistic cancer screening and various other risk factors and their association with cervical cancer in Germany.
The results are based on the TeQaZ study (Case Control Study on Frequency of Participation in Cancer Screening and Quality of Cytology), which was conducted by the Tumor Epidemiology Department (Head: Prof. Klug) at the University Cancer Center, Carl Gustav Carus University Hospital at the Technical University of Dresden.
The study, which was funded by the German Federal Ministry of Health as part of the "Research in the National Cancer Plan" call for proposals, investigated participation in and the quality of cancer screening. Differences between women who had cervical cancer (cases) and women who did not have cervical cancer (controls) were analyzed. Cases and controls were also compared with respect to other risk factors.
The current study compared cases with cervical cancer diagnosed between 2012 and 2016 with three population-based controls. For each case, a healthy woman of the same age from the same region of residence was included (matched). A total of 217 cases and 652 matched controls were analyzed. Fifty-three percent of cases and 85.7 percent of controls frequently attended cervical cancer screenings.
"We could see that half of the women who had cervical cancer had been to a cancer screening in the last three years," says Prof. Klug. "So we wanted to look primarily at attendance and the impact that opportunistic screening has on the development of cervical cancer."
The main finding was that no or infrequent participation in screening, more than one sexual partner, and obesity were associated with cervical cancer. Twelve years of schooling and a monthly net income of more than 3000 euros, on the other hand, were protective factors.
Nevertheless, regular participation in cancer screening in particular reduces the risk of developing cervical cancer by 80 percent for invasive cancer and by 90 percent for more advanced tumors with a poorer prognosis.
"We particularly wanted to look at the risk factor of lack of participation in cervical cancer screening," explains Dr. Luana Tanaka, Research Associate at the Chair of Epidemiology and first author of the publication. "However, the results on the risk factor of obesity, which has now been shown to be significant, are also interesting. One argument could be that overweight women go for examinations less often because they feel insecure due to their body weight. But it could also be that this makes cancer screening difficult for severely overweight women."
Starting in January 2020, Germany is phasing in an organized screening program to replace the opportunistic system, informing women about screening every five years, with the last information at age 65.
"The invitations are likely to increase participation, but will not by themselves remove all the barriers that prevent women from attending screening more frequently," Dr. Tanaka said. "Therefore, other strategies need to be considered to increase and maintain optimal participation, such as offering to collect HPV samples from oneself at home or actively reminding women to screen, possibly through modern communication tools."
Prof. Dr. Stefanie Klug
Chair of Epidemiology
phone: 089 289 24950
Dr. Luana Tanaka
Chair of Epidemiology
phone: 089 289 24960
Text: Romy Schwaiger
Photos: „PLOS ONE“/private