Analysis of Age, Period and Cohort Trends in Cervical In Situ and Invasive Carcinomas for Assessing the Utility of Screening Approaches—Results From the Saarland Cancer Registry

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BACKGROUND: Cervical cancer continues to pose a significant public health burden. In Germany, prevention relies heavily on regular screening and HPV vaccination. OBJECTIVE: To analyze trends in cervical cancer incidence over a 50-year period in Saarland, Germany, with a focus on cohort effects and the impact of screening programs. METHODS: Data from the Saarland Cancer Registry were evaluated for the period 1970-2023. Trends in cervical carcinoma (ICD-10: C53, ICD-9: 180) and carcinoma in situ (ICD-10: D06, ICD-9: 233.1) were analyzed, stratified by age and birth cohort. Additionally, model-based age-period-cohort analyses were derived. The D06/C53 ratio was calculated by age group and calendar period. RESULTS: Since the introduction of Pap smear screening in 1971, the age-standardized incidence of cervical cancer declined by 74%. Subsequently, sharp decreases were observed in women born in 1933 or earlier. Women who grew into screening never reached the high pre-screening rates. Concurrently, in situ carcinoma incidence rose more than tenfold, with detection concentrated in women aged 30-39, indicating a shift toward earlier detection. The D06/C53 ratio increased across all age groups, most strongly in women ≤ 39 years. Overall mortality fell by 71%, although no significant further decline was observed over the last two to three decades. CONCLUSION: This analysis underscores the substantial impact of cervical cancer screening in reducing both incidence and mortality, particularly among women of screening age. The increasing D06/C53 ratios point to a shift toward earlier detection and treatment of lesions, although cancer registry-based data cannot fully distinguish prevented progression from overdiagnosis. While the effects and benefits of screening are already well established, the first effects of HPV vaccination are only beginning to emerge. To build on these achievements, sustained efforts to enhance both screening uptake and HPV vaccine coverage are imperative.