Management and natural course of CIN 1 and CIN 2 before and after implementation of the revised cervical cancer screening in Germany

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BACKGROUND: In 2020, Germany implemented a revised cervical cancer screening program, incorporating co-testing with cytology and human papillomavirus (HPV) testing for women aged 35 and older. This study describes patient characteristics, referral patterns, and follow-up outcomes of histologically confirmed cervical intraepithelial neoplasia (CIN) 1 and CIN 2 lesions before and after the introduction of the organized cervical cancer screening program in Germany. METHODS: In a hybrid prospective-retrospective study, we analyzed two consecutive cohorts of patients with histologically confirmed CIN 1 or CIN 2 at the Department of Women's Health, University Hospital Tuebingen, between 2013 and 2022. Patient characteristics, referral indications, and follow-up outcomes were described and compared. RESULTS: Patients post-2020 were older (median 41 vs. 31 years), more often hrHPV-positive (93.4% vs. 63.3%), and more frequently presented with CIN 1 (62% vs. 51%). Immediate intervention was less common post-2020 (CIN 1: 7% vs. 25%; CIN 2: 37% vs. 67%). Among those followed, remission was higher in the post-2020 cohort (CIN 1: 63.5% vs. 42.2%; CIN 2: 61.6% vs. 41.0%). Progression to CIN 3 remained rare in both cohorts. Multivariable regression indicated that CIN 2 diagnosis and smoking reduced remission, while the post-2020 period was associated with increased remission odds. CONCLUSION: The differences in remission and persistence between cohorts likely reflect changes in referral pathways, patient age rather than causal program effects. These data provide a descriptive benchmark for clinicians, supporting conservative management of CIN 1 and selected CIN 2 under the new screening program.

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