Risikoadaptierte Prävention des Zervixkarzinoms. Das Wolfsburger Vorsorge-Projekt nach 18 Monaten

OBJECTIVE: In February 2006 a pilot project was started in the city of Wolfsburg offering regular routine screening for cervical cancer to members of the Deutsche BKK, a large German health insurance company. The aims of the project are to investigate the feasibility and acceptance of primary HPV screening with defined patient pathways and extended screening intervals. METHODS: The project consists of screening using conventional cytology plus HPV testing with HC2 (for high-risk persons only) for all participants. Women need to be 30 years or older, must be a member of the DBKK and give their written consent. Women with negative results on cytology and HC2 will be retested after 5 years instead of annual intervals as is usually the case in Germany. When both tests are positive, women are called immediately for colposcopy; in women with a negative cytology but positive HC2 test, cytology will be repeated after 6 and HC2 testing after 12 months. In the event of positive findings women will be referred for colposcopy. Women with inconspicuous cytological findings (Pap I/II) and a negative HPV HR test will only be retested again after 5 years but will continue to report for their annual gynaecological preventive medical examinations. RESULTS: From February 2006 to September 2007 12 885 women agreed to participate in the project. 657 (5.1 %) had positive HC2 results and 258 (2 %) had atypical Pap smears at recruitment. 127 (1 %) women were referred for colposcopy, 42 of whom were diagnosed with CIN3 or worse, including 3 invasive cancers and 4 adenocarcinoma in situ. 19/42 women in the CIN3+ group were detected by HPV testing alone; all patients with CIN3+ were HC2 positive. Acceptance of the screening concept is high, less than 1 % of the screening population did not want to participate. No case of severe anxiety related to HPV testing was reported.