Gynecologists are well paid

From the coming year, millions of women will receive personal invitations from the health insurance company. Letters urging you not to miss the cancer screening at the gynecologist. In future, these letters will be sent out every five years, but this does not mean that women should only go to the examination every five years. Strange? Absolutely. And that's not the only weird thing about the new guidelines for preventing cervical cancer in the future. The most striking thing is that women in Germany should still sit on the gynecologist's chair significantly more often than their contemporaries in many other countries.

A Dutch woman, for example, is recommended a total of seven tests up to the age of 65, while British women and Swedes are recommended about eleven tests. In the US, women can choose to go ten or fifteen times for cancer screening. In Germany, on the other hand, according to the recommendations currently valid, a woman has to visit the gynecologist 45 times in the same period. According to the new official recommendations, there are still 25 tests to be carried out up to the age of 65 from 2020.

Many experts consider it unnecessary for people under the age of 25

On the one hand, this is due to the unusually early start of the series examinations. In the future, women as early as 20 years old will be asked to have what is known as a Pap smear, in which the doctor takes cells from the cervix and examines them for changes in the laboratory. The World Health Organization recommends that you only start testing from the age of 30. The priority is to screen women between the ages of 30 and 49, rather than maximizing the number of tests per woman, it is very clear.

What is changing

So far, all women aged 20 and over in Germany have been recommended to have an annual Pap smear, which is supposed to detect changed cells in the cervix. Starting next year, this examination will continue to be recommended to all women between 20 and 34 years of age at annual intervals. From the age of 35, women should only have a check-up every three years. Then the Pap test is combined with the HPV test, which determines whether there is an infection with the human papillomavirus, which is responsible for almost all cases of cervical cancer. Both examinations can be carried out at the same time. Up to what age the tests should be carried out is not precisely regulated. Women are officially invited for the last time at the age of 65. After that, however, they are still entitled to the pension. Regardless of this, all women aged 20 and over are still entitled to an annual clinical examination by a gynecologist. It is also used to detect other diseases such as breast cancer.

Many German experts also consider provision to be superfluous, at least for those under the age of 25. According to Karl Ulrich Petry, chief physician at the women's clinic at Wolfsburg Clinic, "there is a higher probability that they will be involved in a traffic accident on the way to the gynecologist than that cervical cancer can be prevented through preventive measures."

The frequency with which the young women should continue to go to the examination is also questionable. Up to the age of 34 years, the annual examination is recommended to them also in the future. Only: "The fact is, you don't have to have a Pap smear every year if it is done with high quality," says Stefanie Klug, who holds a chair for epidemiology at the Technical University of Munich. There is no evidence that a one-year interval produces more reliable results than a two-year interval. Nevertheless, the new guidelines adhere to this practice.

In future there will only be changes for women aged 35 and over. You will then be tested twice, with the usual Pap smear and additionally with an HPV test. He is investigating whether the women have become infected with human papillomavirus (HPV) - the pathogens that are responsible for almost all cases of cervical cancer.

It is controversial whether both tests are really necessary. What is certain is that the interval for this double examination is also unusually short. For this purpose, women will be appointed to the doctor's practice every three years. According to the guidelines of the WHO, however, a woman without HPV infection should be tested again at the earliest after five years. The authors of the European guideline also recommend it; they even consider a ten-year break to be justifiable. Because it takes an average of at least ten years for an HPV infection to develop into a carcinoma of the cervix, says Thomas Iftner, Director of the Virological Institute at the University of Tübingen.