Cervical cancer screening by co-testing in women 35 years and older: an analysis of the 1st round of screening in Germany

Background: Since 2020, co-testing for women over the age of 35 has been a new strategy for cervical cancer screening in Germany. In this study, we investigated the added value of co-testing in organized cervical screening for the German screening population. Methods: A total of 1956 women were referred to our large dysplasia consultation institution due to abnormal screening results in the first round of screening between 2020 and 2022. The endpoint of this retrospective study was the posttest probability of a CIN 2+/CIN 3+ lesion on the cervix uteri. In addition, the influence of HPV subtypes on the endpoints was investigated. Results: CIN 2+ or CIN 3+ lesions were diagnosed in 21.6% and 13.0%, respectively, of the patients. The risk of severe dysplasia increases with the grade of cytological abnormality and is dependent on the HPV subtype. The risk for detecting invasive cervical cancer (16 patients in total) was significantly greater for women with HPV16 infection than for women with HPV infection of other high-risk types (odds ratio 11.18; 95% confidence interval 3.01, 40.81). CIN 2+ lesions were diagnosed in 10.1% of patients with normal cytology. Conclusions: CIN 2+ lesions could be detected in more than every 5th woman with an abnormal screening result. Normal Pap smear results with HPV evidence must be confirmed by colposcopy. Risk stratification based on the underlying HPV subtype appears to be particularly useful if HPV 16 is detected. Trial registration: German Clinical trials register (ID: DRKS00027014, Registration date: 03.12.2021)