Cervical Cancer
What You Need to Know About Human Papillomavirus, Vaccination, and Screening in Germany
Cervical cancer is a type of cancer that, in many cases, can be prevented. Vaccination against the human papillomavirus and regular preventive screenings help reduce the risk of developing the disease, and the detection of precancerous changes makes it possible to begin treatment before cancer develops.
For Ukrainians living in Germany, it is important to know what screenings are available, who to contact, and how the German cervical cancer early detection program works.
What is cervical cancer?
The cervix is the lower part of the uterus that connects it to the vagina. Cervical cancer occurs when cells in the lining of the cervix change and begin to multiply uncontrollably. This is usually preceded by precancerous changes, which can be detected during a preventive screening and, if necessary, treated.
Cervical cancer should not be confused with uterine cancer, or endometrial cancer. These are different diseases with different causes, courses, and treatment approaches.
According to the World Health Organization, in 2024, approximately 604,000 new cases of cervical cancer and about 280,000 deaths related to this disease were recorded worldwide. A significant portion of these cases could have been prevented through vaccination, screening, and timely treatment of precancerous changes.
How Is Cervical Cancer Linked to HPV?
Nearly all cases of cervical cancer are linked to long-term infection with certain types of the human papillomavirus, or HPV. This is a very common virus that can be transmitted through sexual contact. Most people become infected with HPV at some point in their lives, often without knowing it, since the infection usually causes no symptoms.
In most cases, the immune system clears the infection on its own. A positive HPV test does not mean that a person has cancer or that cancer will definitely develop. The risk lies in a persistent infection with certain high-risk HPV types. This can lead to changes in the cells of the cervix, which over time can become precancerous and then malignant.
This process usually occurs gradually. According to the Bundesministerium für Gesundheit, it typically takes at least ten years for a persistent HPV infection to develop into cervical cancer. That is why regular screening can detect changes long before invasive cancer develops.
What symptoms might occur?
In the early stages, cervical cancer and precancerous changes often cause no symptoms at all. A person may feel fine and be unaware of the changes. That is why it is important not to wait for symptoms to appear, but to undergo regular preventive screenings.
You should see a gynecologist if you experience:
unusual bloody discharge; bleeding after sexual intercourse; bleeding between periods; bleeding after menopause; unusual vaginal discharge; pain in the lower abdomen or pelvic area; pain during sexual intercourse.
These symptoms may be associated with many other conditions and do not necessarily indicate cancer. However, it is important to discuss them with a doctor and not wait until your next scheduled screening.
How does screening work in Germany?
Germany has an organized program for the early detection of cervical cancer. People with a cervix who have public health insurance can undergo preventive screenings free of charge. Participation in the program is voluntary.
Ages 20 to 34
An annual gynecological exam with a Papanicolaou test—also known as a Pap test or cytological smear—is provided. During the procedure, the doctor collects cells from the surface of the cervix and sends them to a laboratory, where specialists check for any cellular changes.
Ages 35 and older
An annual gynecological exam is provided, and a combined screening is conducted once every three years. It includes an HPV test and a Pap test. The HPV test detects the presence of high-risk virus types, while the Pap test helps identify changes in cervical cells.
There is no upper age limit for participation in the program. Insured individuals between the ages of 20 and 65 receive an informational invitation from their health insurance provider approximately once every five years, but they can undergo screening regardless of whether they receive such a letter.
Even after HPV vaccination, screening remains important because vaccines provide protection against the main oncogenic types of the virus, but not against all possible types.
What does a positive HPV test result mean?
A positive HPV test result means that a high-risk human papillomavirus was detected in the sample. This is not a diagnosis of cancer.
In many cases, the infection clears up on its own. Next steps depend on your age, Pap test result, the type of virus detected, and previous screening results. Your doctor may recommend retesting after a certain period of time or additional testing, such as a colposcopy.
Colposcopy is a detailed examination of the cervix using a special optical instrument. If a suspicious area is found, the doctor may take a small tissue sample for laboratory testing. The final decision on next steps is made after evaluating all results, not based solely on a single positive HPV test.
Can vaccination provide protection?
HPV vaccination is one of the most effective ways to prevent cervical cancer and other HPV-associated cancers. The best protection is achieved when vaccination is administered before potential exposure to the virus.
In Germany, the Ständige Impfkommission at the Robert Koch Institute recommends HPV vaccination for girls and boys aged 9 to 14. For full protection at this age, two doses of the vaccine are usually required, administered 5 to 13 months apart. It is recommended to catch up on any missed vaccinations by age 18.
The vaccine does not treat an existing HPV infection and is not a substitute for screening. However, even if a person has already been exposed to one type of HPV, vaccination can provide protection against other types included in the vaccine. The advisability of vaccination at an older age should be discussed individually with a doctor and the health insurance provider, as reimbursement conditions may vary.
Who is at increased risk?
The primary risk factor is a persistent infection with high-risk oncogenic HPV. Additionally, smoking, a weakened immune system, lack of regular screening, and a long-term HPV infection can increase the risk.
Regular monitoring is especially important for people living with HIV. According to the World Health Organization, women living with HIV have approximately six times the risk of developing cervical cancer compared to women without HIV. Different screening start dates and shorter intervals between screenings may apply to them. An individualized schedule should be agreed upon with a gynecologist and the doctor managing their HIV treatment.
How are precancerous changes and cervical cancer treated?
Not all cellular changes require immediate treatment. Some mild changes may resolve on their own, so your doctor may recommend monitoring and follow-up tests. If high-grade changes are detected, the affected area can be removed before it develops into cancer.
Treatment for confirmed cancer depends on the stage of the disease, the size of the tumor, how far it has spread, your overall health, and your reproductive plans. Surgery is often used in the early stages. For more advanced cases, a combination of radiation therapy and chemotherapy may be used. A treatment plan is always developed by a specialized medical team.
If the disease is detected at an early stage, the chances of successful treatment are significantly higher. That is why regular screening is one of the most important steps you can take to protect your health.
What can you do today?
✅ Check when you last had a Pap test or HPV test.
✅ If you’re over 20 and haven’t had a preventive checkup in a while, make an appointment with a gynecologist.
✅ Don’t delay seeking care if you have unusual bleeding, discharge, or pain.
✅ Check your vaccination status and make sure your children are vaccinated against HPV.
✅ If you are living with HIV or have a weakened immune system, discuss a personalized screening schedule with your doctor.
✅ Remember that a positive HPV test result does not mean cancer, but it does require proper medical follow-up.
Where to Find Help in Germany?
To undergo a preventive cervical screening, you can contact a gynecological practice directly—in German, a “Frauenarztpraxis” or “gynäkologische Praxis.” For those insured under the public health insurance system, the screening is covered by the health insurance fund as part of the official early detection program.
Don’t put off a preventive exam just because you aren’t experiencing any symptoms. Cervical cancer can often be prevented, and precancerous changes, when detected early, can be successfully treated.
💙 Vaccination, regular screening, and timely medical consultation can protect your health and save your life.