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