Die noch nicht beendete Geschichte des Zervixkarzinomscreenings

Population-based Pap test screening, which was introduced following World War 2, was a milestone in modern prevention medicine and made early detection of cervical cancer possible for the first time. In many countries, population-based cytological screening led to a dramatic reduction in incidence and mortality. However, the classic morphology-based cytology of the Pap test has limited sensitivity and also a high number of inconclusive or borderline results, which often makes repeated follow-up examinations necessary. With the identification of persistent high-risk human papilloma virus (HPV) infections as a prerequisite for the development of cervical cancer, a paradigm shift occurred. HPV-based testing resulted in significantly more sensitive risk detection compared to classical cytology. Biomarker-based triage methods, such as the p16/Ki67 dual stain test (CINtec® Plus, Roche Diagnostics, Rotkreuz, Switzerland), now enables the functional identification of transforming HPV infections. The combination of primary HPV testing and evidence-based triage makes it possible to reduce diagnostic uncertainty, unnecessary follow-up examinations, and the financial burden on the healthcare system. Modern molecular screening strategies, thus, mark the transition to biologically driven and risk-adapted precision prevention.