In the course of their lives, 85 to 90 percent of all sexually active people become infected with HPV. Infections are often asymptomatic, which is why there is often a lack of awareness of their spread and possible consequences. In most cases, the virus is eliminated by the immune system within one to two years. However, if the infection persists, it can lead to cell changes. These cell changes can manifest themselves as benign lesions, but can also develop into precancerous lesions or invasive tumors. Prevention therefore plays a crucial role.

"There are patients who could not even imagine that they could develop cervical cancer. These are patients who simply go into life with such optimism, which is actually very much to be encouraged, but which then leads to a certain blindness to the risk of developing the disease and therefore the screening tests and smear tests have not been carried out," says PD Dr. Julius Emons, Senior Consultant at the Women's Clinic at Erlangen University Hospital. Although there is a well-structured and fully funded screening system in Germany, "we see gaps in its implementation," says Emons. These include women who do not attend screening examinations at all, as well as patients for whom abnormal findings are not consistently followed up. Both can lead to diseases only being diagnosed at an advanced stage.

"When you think of cervical cancer, unfortunately it is often young patients who come in with the disease," says Emons. "A disease that could have been avoided if we had managed to get all patients to take advantage of the screening tests and, in particular, the vaccination that is available," he continues. The fact that many women are in the middle of their lives, already have children or are still in the family planning phase is particularly burdensome. "So this is by no means a rare exception, but a disease that we see regularly in everyday clinical practice," says Emons.

The Pap smear has been a central component of early cervical cancer detection for decades. The cervical smear test can detect cell changes or precancerous lesions at an early stage and initiate appropriate treatment. Since 2020, this method has been supplemented by the HPV test and is used in particular for women aged 35 and over as part of screening.

In Germany, women aged 20 to 34 receive a Pap smear once a year, while women aged 35 and over receive a combined Pap smear and HPV test every three years. Statistically, HPV infections are more common in younger women, but these heal more quickly and without serious consequences. In older women, however, a positive HPV test can be an indication of a long-lasting HPV infection.

"Cervical cancer screening differentiates between age groups and risk profiles. The important thing is not which test is carried out when, but that screening as a whole is taken seriously - as is follow-up care in the event of abnormal findings," emphasizes Emons. More tests at shorter intervals do not automatically mean more safety. A regularly inconspicuous co-test offers a very high level of significance over several years.

At the same time, diagnostic procedures are constantly evolving. The added value of modern diagnostics lies in the improved differentiation of findings. Julia Sauer, Marketing Manager Molecular Solution at Roche Diagnostics Deutschland GmbH, mentions extended HPV genotyping, among other things. This promises an even more precise risk assessment, as it can not only determine the presence of a high-risk infection, but also identify the specific HPV types involved. The use of artificial intelligence in digital pathology is also becoming increasingly important in order to identify and classify conspicuous cell changes.

Cytological biomarker tests also examine the cell material for endogenous substances that occur specifically in cancer cells or their precursors. "A classic HPV test only shows whether an infection with high-risk types is present, but says nothing about an actual disease," says Sauer. Biomarker-based tests offer certainty here and distinguish between a mere suspicion of infection and an actual pathological change.

Looking to the future, Sauer sees HPV self-sampling as a game changer. Self-sampling could break down barriers such as shame or lack of time. Prof. Dr. Marion Kiechle, Director of the Clinic and Polyclinic for Gynaecology at TUM Klinikum Rechts der Isar, shares this opinion: "In my opinion, the HPV self-test could also be a measure to increase willingness in Germany and reach women who do not regularly go for screening. If you send them the test - some health insurance companies in Germany are already doing this in a pilot project - you could possibly increase the participation rate."

Since 2006, the HPV vaccination has been an effective prophylactic measure to prevent HPV-associated cancers. Ideally, girls and boys should receive the vaccination between the ages of 9 and 14 before their first sexual contact, because "men are carriers just like women," explains Kiechle. "They can also develop penile carcinoma or laryngeal carcinoma, for example," Kiechle continues.

However, the vaccination rate in Germany is still well below the EU target. In 2023, 55% of 15-year-old girls and 34% of 15-year-old boys in Germany were fully vaccinated. The aim is to achieve a vaccination rate of 90 percent for 15-year-old girls by 2030.

"The HPV vaccination is a huge medical success," says Emons. There is clear scientific evidence of its effectiveness and data from countries with high vaccination rates shows that HPV-associated cervical carcinomas are declining significantly there. "In an ideal world, these cancers would even disappear completely in the long term as a result of vaccination," Emons continues.

Emons sees the reasons for the low vaccination rates less in medical concerns than in practical and communicative hurdles: a lack of fixed vaccination appointments for the U-examinations, reservations about vaccinations in general and a partial misperception of the HPV vaccination as sexual prevention instead of cancer prevention. Effective education is needed here.

Despite prevention and early detection, around 4,400 new cases are diagnosed in Germany every year. In early stages, cervical cancer is often easily treatable with surgery, while in advanced stages, combined treatment approaches of radiotherapy and chemotherapy are usually used.

A better understanding of tumour biology and advances in imaging and surgical techniques have made it possible to further individualize treatment strategies. "If the disease is detected early, we can now perform fertility-preserving surgery on many young women, for example," explains Emons. Despite a cancer diagnosis, this gives patients the opportunity to have children later on.

In addition to traditional therapy pillars, immunotherapies are becoming increasingly important. The aim of these treatment approaches is to specifically activate the body's own immune system and restore its ability to recognize and fight tumour cells. Checkpoint inhibitors are already being used for cervical cancer. These revolutionary drugs interfere with mechanisms that tumor cells use to evade the immune response and can thus strengthen the immune response against the cancer cells.

Ulf Grawunder, PhD, CEO and co-founder of T-Curx GmbH, a spin-off of the University of Würzburg, takes a look at new therapeutic approaches - the so-called CAR-T cell therapies. In CAR-T cell therapy, the body's own immune cells are removed, genetically modified and reintroduced. As a result, they are able to recognize and fight cancer cells. While CAR-T cells already achieve high cure rates in certain blood cancers, solid tumors such as cervical cancer are much more complex. Tumors could specifically make themselves "invisible" to immune cells or suppress their activity. The first clinical trials are currently underway to test whether this form of therapy can also be used for solid tumors in the long term.

Cervical cancer is one of the most preventable cancers today. Nevertheless, the reality shows that screening services, the HPV vaccination and knowledge about this disease are not yet sufficiently utilized. Awareness Month makes it clear how important it is to combine medical advances with education and low-threshold services.

Innovative technologies in early detection, diagnostics and treatment are opening up new opportunities to detect diseases at an early stage and protect human lives. These opportunities are constantly evolving and require close networking between all stakeholders involved. As a strong partner, the Bayern Innovativ GmbH network supports the development of new, forward-looking solutions and promotes the exchange between science, industry and practice. In this way, promising approaches are sustainably transformed into marketable solutions, medical care is improved and Bavaria is strengthened as an efficient innovation region. The joint commitment to greater health awareness forms a central basis for this.