Prävention des Zervixkarzinoms. Leitlinie der DGGG und DKG (S3-Level, AWMF-Register-Nummer 015/027OL, Dezember 2017) – Teil 1 mit Einführung, Screening und Pathologie von zervikalen Dysplasien

Zusammenfassung

Ziele Seit 1971 erfolgt in Deutschland die jährliche, opportunistische Früherkennungsuntersuchung des Zervixkarzinoms. Durch die Etablierung dieser S3-Leitlinie wird zum einen eine wichtige Forderung des Nationalen Krebsplans zum Zervixkarzinom-Screening erfüllt. Zum anderen kann die S3-Leitlinie wesentliche Informationen und Hilfestellungen für das geplante organisierte Zervixkarzinomscreening in Deutschland geben.

Methoden Mit finanzieller Unterstützung durch die Deutsche Krebshilfe wurden durch 21 Fachgesellschaften evidenzbasierte Statements und Empfehlungen (GRADE-System) zu Screening, Management und Behandlung von Zervixkarzinom-Vorstufen erarbeitet. Zwei unabhängige wissenschaftliche Institute haben systematische Reviews für diese Leitlinie erarbeitet.

Empfehlungen Der erste Teil dieser Kurzzusammenfassung behandelt pathologische Grundlagen und Fragen zum Screening. Ähnliche wie in früheren Reviews konnte auch die Metaanalyse durch Kleijnen Systematic Reviews einen besseren Schutz vor einem invasiven Zervixkarzinom durch ein HPV-basiertes Screening im Vergleich zur Zytologie zeigen. Daher empfiehlt die Leitliniengruppe – entsprechend den Richtlinien des Gemeinsamen Bundesauschusses (G-BA) – ein HPV-basiertes Screening mit Intervallen von mind. 3 Jahren für Frauen ab 35 Jahren. Ein Co-Testing kann ebenfalls durchgeführt werden. Frauen zwischen 20 und 35 sollten ein zytologisches Screening alle 2 Jahre erhalten.

Schlüsselwörter

Zervixkarzinom - zervikale intraepitheliale Neoplasie (CIN) - zervikale Präkanzerosen - HPV

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