Cervical cancer is the fourth most common cancer in women worldwide. According to the WHO, around 600,000 women become ill every year and over 340,000 die from it. The main cause of cervical Ca is an infection with human papilloma viruses (HPV).
In Germany, the incidence has been significantly reduced through early detection measures and HPV vaccination programs. Since the introduction of statutory early cancer detection in 1971, there has been a long-term decline in both new cases and mortality.
How has the incidence of cervical Ca developed?
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Despite these advances, cervical cancer remains of high clinical relevance – especially in older patients, who are often diagnosed in advanced stages. The current study by the Center for Cancer Registry Data (RKI) comprehensively analyzes the incidence trends and survival rates in Germany over almost two decades.
The focus of the study was on the question of how the incidence, age of onset, histological subtypes and survival rates of cervical cancer developed between 2003 and 2021. Also: Are there differences between age groups and tumor stages? Can the HPV vaccination have an influence on the frequency of the disease?
Register data from ten federal states
Data from the epidemiological state cancer registries from ten federal states were evaluated for the analysis. The basis was the cases of cervical cancer collected at the Robert Koch Institute (RKI) (ICD-10: C53).
The data was differentiated according to the following criteria:
- Tumor stage (T1–T4)
- Histologischer Subtyp (Plattenepithelcarcinoma, Adenocarcinoma and others)
- Histopathologisches Grading (G1–G3)
- Age of the patients
The results can be summarized in four main statements:
1. Declining incidence but stagnating survival rates
The mean age of onset during the observation period was 53.5 years.
The 5-year overall survival remained unchanged at 65.4% between 2003 and 2021, indicating a lack of progress in therapy or early detection.
2. Decrease in squamous cell carcinoma
The most common subtype, squamous cell carcinoma, showed a significantly declining incidence:
- 2003: 11.5 per 100,000 women
- 2021: 7.7 per 100,000 women (age standardized)
This development particularly affected younger women, which is in the context of the HPV vaccination programs introduced since 2007.
3. Differences by age group
- Women ≥65 years accounted for 25.4% of cases. They more often had advanced tumor stages (T3/T4), G3 tumors and a lower 5-year survival rate.
- Women <35 years old represented 10.8% of cases. In this group, the incidence fell particularly sharply (from 5.1 to 3.1 per 100,000 women). What was noticeable was a high proportion of early tumor stages (T1a/T1b), which indicates successful early detection.
4. Survival development
Despite improved early detection and access to specialized centers, survival has remained constant over two decades. This suggests that diagnostic and therapeutic advances have led to earlier detection but not to a significant improvement in long-term prognosis.
Success of prevention, but need for progress in therapy
The results support the assumption that HPV vaccination and screening programs have contributed significantly to the decline in incidence – particularly among young women. Organized early detection, which was reformed in 2020 (invitation process with co-testing using a Pap smear and HPV test), is likely to further strengthen this trend in the future.
At the same time, the stagnation of survival rates raises important questions. Possible causes are:
- Advanced tumor stages in older patients
- Comorbidities that limit treatment options
- Differences in quality of care outside certified centers
These factors indicate that the success of treatment depends not only on early detection, but also on structured follow-up care and interdisciplinary therapy.
Further strengthen vaccination rates and early detection
Even if the results underline the effect of HPV vaccination as a primary prevention measure, there is still potential for optimization, according to the authors. A higher vaccination rate – especially among girls and increasingly also among boys – remains crucial to further reduce the incidence in the long term. In addition, measures for early detection of older patients should be strengthened, as this group has an increased risk of advanced stages and poorer prognosis. The certification of gynecological cancer centers plays a central role in ensuring standardized, guideline-compliant treatment.
Future studies should evaluate the impact of early detection programs reformed in 2020, centralized care, and HPV vaccination coverage on morbidity and mortality.
