Conclusions Are in Part Inexplicable

Letters to the editor regarding the article The Epidemiology of Cervical Cancer in Germany A Register-Based Analysis of Incidence, Survival, and Tumor Characteristics by Frederik A. Stübs, Matthias W. Beckmann, Patrik Pöschke, Felix Heindl, Julius Emons, Paul Gaß, and Lothar Häberle in issue 18/2025

The data on the epidemiology of cervical cancer in Germany in 2003–2021 impressively confirm the declining incidence of squamous cell carcinoma. For adenocarcinoma, on the other hand, they showed over a period of 8 years a relative increase of >50% among all cancers, from 13.0% to 19.7%. Both incidence rates rose by >10%, from 1.8 to 2.0 and from 1.7 to 1.9 per 100 000 women, respectively (Table 2 in the article [1]). A notable increase in the relative incidence was also seen for neuroendocrine cancers.

The statements in the results section and the discussion—namely, that the incidence of adenocarcinoma is unchanged or remained stable—are inexplicable in view of the data in Table 2 (1). The green lines in Figure 1b when considered carefully make it difficult to identify the rise in the crude and age-standardized incidence from 2003 to 2021. Increasing the spaces between the incidence rates in the range 0–4 on the ordinate of the curve, however, would render the increases clearly visible.

Other industrialized countries have also reported a relative and absolute increase in adenocarcinoma for more than a decade (2, 3). An analysis of the “oKFE-RL Krebsfrüherkennungsprogramme. Evaluationsbericht Zervixkarzinom, Version 2013, Gesundheitsforen Leipzig” (2024) [the guideline for organized cancer screening programs; cervical cancer evaluation report, version 2013, by Gesundheitsforen Leipzig, a German service provider for the healthcare sector that offers consulting, software development, data analysis, and networking services] for 2021 and 2022 showed that 29% of all invasive epithelial tumors diagnosed in dysplasia consultations were adenocarcinomas (n=230). Among histologically confirmed precancerous conditions, only 1145 were adenocarcinomas in situ (AIS), but cervical intraepithelial neoplasias (n=32 742) were 30 times as common. A recent study of non-screened women found that adenocarcinomas accounted for 35% of all invasive tumors (4).

DOI: 10.3238/arztebl.m2025.0199

Prof. Dr. Wolfgang Kühn, Prof. Dr. Michael Menton, Dr. Susanne Menton
Institut für Zytologie und molekulare Diagnostik, Reutlingen

Dr. Friederike Gieseking
Frauenärztin, Hamburg

References

1. Stuebs FA, Beckmann MW, Poeschke P, et al.: The epidemiology of cervical cancer in Germany: A register-based analysis of incidence, survival, and tumor characteristics (2003–2021). Dtsch Arztebl Int 2025; 122: 483–8

2. Islami F, Fedewa SA, Jemal A: Trends in cervical cancer incidence rates by age, race/ethnicity, histological subtype, and stage at diagnosis in the United States. Prev Med 2019; 123: 316–23

3. Wang M, Huang K, Wong MCS, Huang J, Jin Y, Zheng Z: Cancer incidence by histological subtype and implications for screening methods. J Epidem and Global Health 2024; 14: 94–101

4. Chao CR, Chubak J, Beaber EF, et al.: Gaps in the screening process for women diagnosed with cervical cancer in four diverse US health care settings. Cancer Med 2023; 12: 3705–717