The new German S3 guideline ‘Prevention of Cervical Cancer' published in 2016 is based on the latest available evidence about cervical cancer screening and treatment of cervical precancer. Large randomized controlled trials indicate that human papillomavirus (HPV)-based screening may provide better protection against cervical cancer than cytology alone through improved detection of premalignant disease in the first screening round prior to progression. Therefore, women aged 30 years and older should preferably be screened with HPV testing every 3-5 years (cytology alone every 2 years is an acceptable alternative). Co-testing is not recommended. Screening should start at 25 years using cytology alone every 2 years. The preferred triage test after a positive HPV screening test is cytology. Women positive for HPV 16 and HPV 18 should receive immediate colposcopy. Another alternative triage method is p16/Ki-67 dual stain cytology. The mean yearly participation rate in Germany is between 45 and 50%. Offering devices for HPV self-sampling has the potential to increase participation rates in those women who are at higher risk of developing cervical cancer. Regarding primary prevention, the 9-valent vaccine may provide protection against up to 85% of cervical intraepithelial neoplasia (CIN) 3 and 90% of cervical cancer, and is available in Europe as a 2-dose schedule from May 2016.

IARC Working Group, Human Papillomaviruses: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, volume 90, 2007. Lyon, International Agency for Research on Cancer. (accessed 24/9/ 2013).
Bosch FX, Lorincz A, Muñoz N, et al.: The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002;55:244-265.
Walboomers JM, Jacobs MV, Manos MM, et al.: Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12-19.
Bruni L, Diaz M, Castellsagué X, et al.: Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis 2010;202:1789-1799.
Hillemanns P: Krebsfrüherkennung: Zervixkarzinom - Doppelter Paradigmenwechsel. Dtsch Arztebl 2016;113:A-282-286.
Group IW: Cervix Cancer Screening. IARC Handbooks of Cancer Prevention, Volume 10, 2005. Lyon, International Agency for Research on Cancer. (accessed 18/9/2013).
Poljak M, Cuzick J, Kocjan BJ, et al.: Nucleic acid tests for the detection of alpha human papillomaviruses. Vaccine 2012;30(suppl 5):F100-106.
Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), Deutschen Krebsgesellschaft e. V. (DKG) und Deutschen Krebshilfe e. V. (DKH), 2016. German S3 Guideline for Cervical Cancer Prevention. 2016-03-15_S3_LL_Prävention_des_Zervixkarzinoms__Konsultationsfassung.pdf.
Higgins JP, Altman DG, Gøtzsche PC, et al.: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
Guyatt G, Oxman AD, Akl EA, et al.: GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383-394.
Sankaranarayanan R, Nene BM, Shastri SS, et al.: HPV screening for cervical cancer in rural India. N Engl J Med 2009;360:1385-1394.
Ronco G, Dillner J, Elfström KM, et al.: Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2014;383:524-532.
Kitchener HC, Fletcher I, Roberts C, et al.: The psychosocial impact of human papillomavirus testing in primary cervical screening - a study within a randomized trial. Int J Gynecol Cancer 2008;18:743-748.
Hecken GBP: Beschluss des Gemeinsamen Bundesauschuss. Erstellung von Einladungsschreiben zum Zervixkarzinom, 2015. 39-261- 2224/2015-03-19_IQWiG-Beauftragung_Einladung-Info-Zervixkarzinom-Sc.pdf.
IQWiG (Auftrag erteilt am 21.10.2013 vom Gemeinsamen Bundesausschuss): S13-03; Nutzenbewertung eines HPV-Tests im Primärscreening des Zervixkarzinoms - Rapid Report.
Whitlock EP, Vesco KK, Eder M, et al.: Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2011;155:687-697, W214-215.
Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force. NGC:009010, 2012.
American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. American Cancer Society. American Society for Clinical Pathology. American Society for Colposcopy and Cervical Pathology. NGC:009048. 2012.
Arbyn M, Anttila A, Jordan J, et al.: European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition - summary document. Ann Oncol 2010;21:448-458.
Karsa LV, Arbyn M, Vuyst H: European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination. Papillomavirus Research 2015;1:22-31.
Wright TC Jr, Stoler MH, Behrens CM, et al.: The ATHENA human papillomavirus study: design, methods, and baseline results. Am J Obstet Gynecol 2012;206:46.e1—46.e11.
Wright TC, Stoler MH, Behrens CM, et al.: Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gyncecol Oncol 2015;136:189-197.
Bergeron C, Ikenberg H, Sideri M, et al.: Prospective evaluation of p16/Ki-67 dual-stained cytology for managing women with abnormal Papanicolaou cytology: PALMS study results. Cancer Cytopathol 2015;123:373-381.
Uijterwaal MH, Polman NJ, Witte BI, et al.: Triaging HPV-positive women with normal cytology by p16/Ki-67 dual-stained cytology testing: baseline and longitudinal data. Int J Cancer 2015;136:2361-2368.
Uijterwaal MH, Witte BI, Van Kemenade FJ, et al.: Triaging borderline/mild dyskaryotic Pap cytology with p16/Ki-67 dual-stained cytology testing: cross-sectional and longitudinal outcome study. Br J Cancer 2014;110:1579-1586.
Ikenberg H, Bergeron C, Schmidt D, et al.: Screening for cervical cancer precursors with p16/Ki-67 dual-stained cytology: results of the PALMS study. J Natl Cancer Inst 2013;105:1550-1557.
Schmidt D, Bergeron C, Denton KJ, et al.: p16/ki-67 dual-stain cytology in the triage of ASCUS and LSIL papanicolaou cytology: results from the European equivocal or mildly abnormal Papanicolaou cytology study. Cancer Cytopathol 2011;119:158-166.
Petry KU, Schmidt D, Scherbring S, et al.: Triaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 dual-stained cytology. Gyncecol Oncol 2011;121:505-509.
Wentzensen N, Schiffman M, Palmer T, Arbyn M: Triage of HPV positive women in cervical cancer screening. J Clin Virol 2016;76(suppl 1):S49-55.
Geyer S, Jaunzeme J, Hillemanns P: Cervical cancer screening in Germany: group-specific participation rates in the state of Niedersachsen (Lower Saxony). A study with health insurance data. Arch Gynecol Obstet 2015;291:623-629.
Verdoodt F, Jentschke M, Hillemanns P, et al.: Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer 2015;51:2375-2385.
Joura EA, Garland SM, Paavonen J, et al.: Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ 2012;344:e1401.
Munoz N, Kjaer SK, Sigurdsson K, et al.: Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst 2010;102:325-339.
Lehtinen M, Paavonen J, Wheeler CM, et al.: Overall efficacy of HPV-16/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol 2012;13:89-99.
Ali H, Guy RJ, Wand H, et al.: Decline in in-patient treatments of genital warts among young Australians following the national HPV vaccination program. BMC Infect Dis 2013;13:140.
Donovan B, Franklin N, Guy R, et al.: Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. Lancet Infect Dis 2011;11:39-44.
Joura EA, Giuliano AR, Iversen OE, et al.: A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 2015;372:711-723.
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