The Epidemiology of Cervical Cancer in Germany: A Registry-Based Analysis of Incidence, Survival, and Tumor Characteristics (2003–2021).

backgroundCervical cancer is the fourth most common type of cancer in women worldwide. Its incidence and mortality have been declining in Germany since 1971, when cervical cancer screening began to be offered to all women in the German statutory health care system. In this study, we examine the trends in incidence and survival since 2003.

methodsWe analyzed data from the epidemiological cancer registries of 10 German federal states concerning the incidence of cervical cancer (ICD-10 C53) from 2003 to 2021. The data, obtained via the Center for Cancer Registry Data at the Robert Koch Institute, were classified according to tumor stage, histological subtype, histopathological grade, and patient age. Survival rates were calculated with Cox regression models.

resultsDuring the study period, the mean age at diagnosis was 53.5 years. The 5-year overall survival rate did not change (2003 and 2017: 65.4% in both years). The age-standardized incidence of squamous cell carcinoma declined from 11.5 per 100 000 women in 2003 to 7.7 per 100 000 in 2021. 25.4% of women with the disease were ≥ 65 years old; compared to younger women, they more often had stage T3 and T4 disease and grade G3 tumors, and their 5-year survival rate was lower. 10.8% of the women with cervical cancer were under 35 years old. The incidence fell most sharply in this age group, from 5.1 per 100 000 women per year in 2003 to 3.1 per 100 000 per year in 2021, and women in this age group were also the most likely to have stage T1a or T1b disease.

conclusionThe incidence of squamous cell carcinoma of the cervix declined most markedly in the youngest age group, and this may be attributable to vaccination against HPV. The 5-year survival rates have not changed. The impact on survival of the organized screening program and treatment in certified gynecological cancer centers remains to be seen.