# Impact of HPV Testing Based on the 2020 Update of the German Cervical Cancer Screening Program—Data from a Retrospective Monocentric Study

## TL;DR

Germany's updated cervical cancer screening program, which includes HPV testing, led to more high-grade dysplasia detection and increased colposcopic procedures.

## Contribution

This study evaluates the impact of Germany's 2020 cervical cancer screening update using real-world data from a single center.

## Key findings

- The updated screening program detected more high-grade cervical dysplasia cases compared to the previous method.
- The number of colposcopic and histological examinations increased after implementing HPV co-testing.
- HPV-positive results were strongly associated with high-grade dysplasia, while HPV-negative results showed remission.

## Abstract

In 2020, Germany transitioned from annual cytological screening to a combination screening for cervical cancer in women aged 35 and older. The updated Cervical Cancer Screening Program, now conducted every three years, includes both a Pap smear and an HPV test. To evaluate the impact of this new protocol on the detection of high-grade cervical dysplasia (CIN II/III) and the frequency of colposcopic and histological examinations, we conducted a retrospective, single-center study. We present relevant screening outcomes from women examined between 2018–2019 and 2020–2021. Consistent with previous international studies, our findings show a higher number of high-grade dysplasia as well as a higher number of colposcopic procedures following the implementation of the new screening program.

Background/Objectives: Since 2020, Germany has replaced its annual cytological screening for cervical cancer in women aged 35 and older with a combination screening program. This updated protocol, conducted every three years, includes both a cervical Pap smear and an HPV (human papillomavirus) test. In addition, the 2020 update of the German Cervical Cancer Screening Program mandates a more timely follow-up for certain abnormal findings compared to the previous approach. Methods: Results of cytologic, colposcopic, and histologic examinations between 2018 and 2021 were retrospectively retrieved from the electronic patient records of the Institute of Pathology Saarbrücken Rastpfuhl in order to present relevant findings within the years 2018–2019 and 2020–2021. The present study included all women who received appropriate follow-up based on the corresponding underlying screening modality. Results: Our reporting considered data from 30,715 women in 2018/19 (prior screening modality group) and 25,924 women in 2020/21 (updated screening modality group). In 2018/19, a total of 93 histological examinations were performed, compared to 237 in 2020/21. In 2018/19, 52 cases of CIN III and 12 cases of CIN II were identified, while in 2020/21, 78 cases of CIN III and 31 cases of CIN II were detected. In contrast, while women with negative cytological findings in 2018/19 were typically not referred for further colposcopic or histological evaluation, the updated program enabled earlier detection and treatment of cases with diagnosed high-grade dysplasia based solely on a positive HPV test. Notably, 31 women who were diagnosed at an earlier stage based solely on a positive HPV test initially presented with a cytological Pap I result (negative for intraepithelial lesion or malignancy; NILM). Conclusions: Additional HPV co-testing within the updated German cervical cancer screening program resulted not only in high rates of high-grade dysplasia detection but also a rise in the number of colposcopic procedures. While negative follow-up HPV findings regularly showed remission of the original finding, incidence of high-grade dysplasia was usually linked to a positive HPV test.