Results of cytologic mass screening in the Federal Republic of Germany

Since July 1971, the national screening program for cancer has provided all women 30 years of age and older in the Federal Republic of Germany with the opportunity of undergoing a medical checkup for uterine and mammary cancer once a year. Within this program, more than 27 million cytologic screenings of cervical smears were carried out by the end of 1976. At the Cytologic Institute of the Bavarian Cancer Society, Munich, 503,870 cytologic screenings in 226,428 women were carried out from 1971 to 1976, and the rate of positive and suspicious cytologic findings declined from 2.6% to 0.9% in that period. Whereas the detection rate of cytologic findings suggestive of invasive carcinoma, carcinoma in situ and severe dysplasia was 0.5% on the first screening, it was 0.16% on the second screening and 0.08% on the third screening. A total of 272 invasive carcinomas of the cervix and 948 carcinomas in situ and severe dysplasias was detected by the examinations and verified histologically. According to the number of women screened per annum, an incidence peak for carcinoma in situ (including severe dysplasias) was observed between 25 and 29 years of age, with a second, lower peak at about 65 years. The curve of invasive carcinoma of the cervix, however, rose continuously to old age. From 1963-66 to 1976, the rate of histologically verified invasive carcinoma of the cervix declined continuously, from 0.36% to 0.03%. At first, the rate of carcinoma in situ and severe dysplasia increased slightly, from 0.44% to 0.5%, but since 1971 it also decreased markedly, reaching 0.16% in 1976. Although similar curves are found in foreign studies, morbidity and mortality from cervical carcinoma has decreased relatively slowly within the total population. The possible reasons for this finding are discussed.