In Reply

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

Kühn et al. pointed out the increased incidence rates of adenocarcinoma in different publications. Furthermore, they drew attention to the fact that the absolute incidence of adenocarcinoma in our population had also risen notably.

While it is true that the incidence rates of adenocarcinoma of 1.8/100 000 and 2.0/100 000 (2003–2021) signify a rise of more than 10%, this percentage suggests an epidemiologically relevant increase in such tumors, which in absolute terms is far less dramatic. The difference is only 0.2/100 000, or 1 incident case in 500 000 women. The situation is different for squamous cell carcinoma. The decline in incidence from 12.1/100 000 to 8.0/100 000 over the same time period corresponds to a decline of more than 20 incident cases per 500 000 women. For this reason we mentioned a decline in the incidence of squamous cell carcinoma and unchanged incidence rates in adenocarcinoma.

Changing the graphical representation (1) would not show any increase in the incidence; rather, it would visually show more clearly the possible accidental fluctuations over the observation period.

The publication by Islami et al., which our correspondents mentioned, shows an increase in adenocarcinoma only in certain subpopulations in the USA, and in these, only in certain age groups. In other subpopulations, the incidence rates were stable or declined slightly (2).

Wang et al, also cited by our correspondents, did not study the course over time (3). A publication mentioned there even confirms our results: “(…) the incidence of adenocarcinoma in the Netherlands remained stable during 2004–2013 (…)” (4).

In principle we agree with Kühn et al: adenocarcinoma will gain in importance in future and will introduce new challenges for the diagnostic evaluation and treatment.

DOI: 10.3238/arztebl.m2025.0200

On behalf of the authors
PD Dr. med. Frederik Stübs

Conflict of interest statement
The authors of both letters to the editor declare that no conflict of interest exists.

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. van der Horst J, Siebers AG, Bulten J, Massuger LF, de Kok IM: Increasing incidence of invasive and in situ cervical adenocarcinoma in the Netherlands during 2004–2013. Cancer Med 2017; 6: 416–23