Since 1971, opportunistic screening for cervical cancer has been established in Germany. Women above the age of 20 are offered annual Pap smears (no upper age limit). In 2008, the German Federal Ministry of Health and other organizations launched the “National Cancer Plan”, which is the basis for the Law on Cancer Screening and Registration (KFRG). The KFRG enacted in 2013 demanded the development of an S3 clinical guideline to collect all available evidence on cervical cancer screening in order to define new algorithms for screening and management of cervical dysplasia.
In 2016, scientific societies of the German S3-guideline group “Cervical Cancer Prevention” published evidence-based statements and recommendations (GRADE approach) with financial support from the German Cancer Aid and under scientific guidance of the German Guideline Program in Oncology (GGPO) and the Association of the Scientific Medical Societies in Germany (AWMF).
Systematic guideline review and its included meta-analyses conducted by two independent institutes (M. Arbyn, WIV-ISP, Belgium; J. Kleijnen, KSR, England) by KSR showed a better protection from cervical cancer and CIN 3+ with HPV screening than with cytological screening. The guideline group preferentially recommends an organized HPV-based screening every 3 - 5 years for all women above 30 years. Women below 30-35 should be screened with cytology. In case of non-participation in the organized screening program, HPV self-sampling should be offered. After a positive HPV screening test, cytology triage is primarily recommended. In case of a positive cytological screening test, HPV testing is the primary recommended triage method. The S3 guideline was published in 2016 at http://awmf.org after a four week online consultation period along with several quality indicators for cervical cancer screening and management. A special guideline version for the public is provided additionally.
The Federal Joint Committee (G-BA) as the highest decision-making body of the joint self-government of physicians, dentists, hospitals and health insurance funds in Germany, issues directives for the benefit catalogue of the statutory health insurance funds (GKV) for more than 70 million insured persons and thus specifies which services in medical care are reimbursed by the GKV. In 9/2016, the G-BA published cornerstones for future cervical cancer screening in Germany with an organized screening program for women at 35 years of age and older with HPV-Pap co-testing at 3 yearly intervals and yearly Pap testing between 20 – 34 years (2).
1. http://leitlinienprogramm-onkologie.de/Zervixkarzinom-Praevention.89.0.html
2. https://www.g-ba.de/institution/presse/pressemitteilungen/641/