New publication on cancer prevention by the Chair of Epidemiology in the journal “Cancer Epidemiology, Biomarkers & Prevention”

In Germany, women aged twenty and over are entitled to have a cancer screening examination once a year at their gynaecologist. During this visit, a cell smear is taken from the cervix in addition to a gynaecological examination. This so-called Pap smear test is used to detect cell changes.

An organized screening program for all women aged twenty and over has been offered since January 2020. Within this framework, all women aged thirty-five and over are also offered a Pap smear test every three years in combination with a test for human papillomavirus (HPV), known as co-testing.

The Chair of Epidemiology headed by Prof. Dr. Stefanie Klug has now studied and compared the accuracy of the different tests both individually and in combination within the context of the co-testing strategy. The results of the study were published under the title “Cervical Cancer Screening: Comparison of Conventional Pap Smear, Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-Alone or Cotesting Strategies” in the “Cancer Epidemiology, Biomarkers & Prevention” journal. This journal has an impact factor of 4.344.

The data was collected as part of the MARZY study, a randomized population-based cohort study aimed at the early detection of cervical cancer (cervical carcinoma). The study was conducted from 2005 to 2012 at the Institute of Medical Biometry, Epidemiology, and Informatics at the University Medical Center Mainz together with practising gynaecologists in the city of Mainz and the district of Mainz-Bingen. The study management was headed by Prof. Klug.

During this, more than 9,000 women between the ages of 30 and 65 were randomly selected with the help of the respective population registration offices. Women who met the inclusion and exclusion criteria were divided into two intervention groups and a control group. The 5,275 participants in the two intervention groups were invited for cancer screening, of which a total of 2,627 women underwent screening between 2005 and 2007. The test was positive in nine percent of the subjects, which led to 65 percent undergoing a cervical endoscopy (colposcopy).

A range of different methods were used during the screening examinations which were subsequently assessed to determine their accuracy. “We determined that regardless of the method used, none of the cotesting strategies produced more accurate results than HPV screening alone,” explains Linda Liang, research associate at the Chair of Epidemiology and lead author of the publication. The study also confirms previous observations that the HPV test is superior to cytology in detecting changes in the cervix.

“Internationally, this is a discussion that has been in progress for quite some time,” explains Prof. Klug. “From a scientific point of view, the international data is now relatively clear and demonstrates that the HPV test alone is the better testing option. Next, we need to discuss how these results can be implemented in Germany. The data from the MARZY study provides further evidence obtained in Germany and should be considered in the planned evaluation of the new screening programme,” says Prof. Klug.

“We have also observed that in some cases potential harm can occur as a result of over-diagnosis and over-treatment,” Liang said. “Therefore, we recommend that the data that is currently being generated in the first years of the new screening programme should also be made available for very detailed scientific evaluations in order to be able to provide further evidence.”


To the homepage of the Chair of Epidemiology

To the publication „Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomvirus Testing as Stand-Alone or Cotesting Strategies“ in the journal „Cancer Epidemiology, Biomarkers & Prevention“



Prof. Dr. Stefanie Klug
Chair of Epidemiology
Georg-Brauchle-Ring 56
80992 München

phone: 089 289 24950
e-mail: stefanie.klug(at)

Linda Liang
Chair of Epidemiology
Georg-Brauchle-Ring 56
80992 München

phone: 089 289 24961
e-mail: linda.liang(at)

Text: Romy Schwaiger
Cancer Epidemiology, Biomarkers & Prevention“/private