Bills to improve cancer screening

Critics criticize numerous cornerstones of the bill on improved cancer screening

23/08/2012

In the Cabinet of the black-yellow federal government, a bill for improved cancer screening was passed. This includes reforms in therapies, checkups and early detection. In addition, the cancer registry nationwide in the countries to be standardized. In the following, we show what is actually changing for the patients and what are the criticisms of the project.

Cancer prevention can save lives
Sandra W. from Hamburg is relieved. A few years ago, a breast lump was discovered in the course of a check-up. „It was a real shock when the gynecologist told me that tissue analysis detected a breast cancer in the lab“. But because the breast cancer was recognized in time, the clinic was able to defeat the disease with the help of surgery and chemo. „If I had not gone to the examination, I probably would not be alive“, the patient reports. To date, she goes to the aftercare and so far no other node was diagnosed.

Most women in Germany like Sandra W. regularly go for breast cancer screening. But not all cancers, the willingness of the insured is large enough to be examined regularly. With a new law that should be different, as Minister of Health Daniel Bahr emphasized in the presentation of the project. The reforms are intended to drastically reduce the death toll from cancer.

Expansion of cancer screening
The black-yellow federal government is therefore planning to expand cancer screening. Last Wednesday, the Federal Cabinet adopted the bill of the Federal Minister of Health Daniel Bahr (FDP). Essentially, the health policy project provides for improvements in early cancer detection and therapies. These should in the course of implementation, according to a government spokesman „be significantly improved“.

After cardiovascular diseases such as heart attack, cancer is the second leading cause of death in Germany. One in four Germans is now dying from the consequences of malignant tumors. According to estimates by the Robert Koch Institute, around 490,000 people will contract cancer again this year alone. For most cancer sufferers, the sooner the disease is detected, the greater the chance for the patient to beat the cancer. Therefore, a major component of the bill is to send a letter to all insured persons for colorectal cancer and cervical cancer screening. In addition, a unified cancer registry will provide researchers and physicians with more insight into the course of treatment and its development.

Already at the present time women in the first risk years between 50 and 69 years of age are continuously invited in writing for breast cancer screening. Insured persons over the age of 55 can undergo colonoscopy for colon cancer screening free of charge. The health insurance companies pay for the costs.

Regular colon cancer and cervical cancer screening
According to the ideas of the Federal Minister of Health, the health insurances should regularly invite special age groups by letter to colonoscopy and cervical cancer screening. Which age groups are specifically invited, the Joint Federal Committee (GBA) to elaborate and set. However, it is already clear that certain risk groups should be contacted at a young age by the coffers. Unlike the prevention of breast cancer, the insured should not receive an appointment, but decide for themselves whether a diagnosis is perceived or not. If the law is finally passed, the cancer screening program should start in 2016.

A central registry will record questions about the incidence of cancers, successful therapies and treatment options in clinics. Among other things, the patient data is collected for this purpose. However, the data can only be collected if the individual patient agrees to it.

Although such databases already exist today, the systems and issues of the institutions are quite different. For this reason, the patient and therapy data from outpatient and inpatient treatment should be given a uniform standard.

Databases in cancer therapies successful for children
In oncology for children, good experiences with standardized databases have already been made. To date, 98 percent of all childhood cancer patients have been statistically recorded. It was also possible to achieve uniform treatment in 98 percent of cancer cases. „That's why the cure rate for children in Germany is 80 percent, "says Dr. Heribert Jürgens from the Department of Pediatric Oncology at the University Hospital Münster." That's the best result in the world. "

Bahr wants to take the statutory health insurance funds for the project financially responsible. These are to finance the planned cancer registries with a lump-sum contribution. In addition, the health insurance companies should also pay the costs of the check-up invitations. Experts suggest that the additional expenditure will be around 120 million euros per year.

Health insurance companies see little benefit in the project
Already in the design of the bill, the coffers criticized that „the effort is not in proportion to the actual benefit“ stand. In addition, the Federal Minister of Health had left the private health insurance in the financing before, so the Central Association of Statutory Health Insurance (GKV). The CEO of the VDEK, Ulrike Elsner, fears a high „bureaucratic effort“ who will also be sent to the coffers. Even today, the funds are very caring and would inform the insured around risks. Also Gesamtverband der Allgemeine Ortskrankenkassen (AOK) sees little added value in the project. "For cervix cancer, over a three-year period, well over 80 percent of women between the ages of 20 and 30 can be examined today, which is hard to beat even with invitations."

Danger of over-diagnoses
The opposition also hailed criticism. According to the health expert of Alliance 90 / The Greens, give it „too much euphoria“ in the early detection of cancer. After all „The diagnostic investigations also include health risks“. In addition, they are stressful for the patients and „carry the risk of injury“. The politician sees the danger of „About diagnoses“. Not uncommon „to operations or therapies that would not be necessary at all“. Therefore, insured should also „be better informed about the risks of preventive examinations“, as the Green politician demanded. Such an enlightenment could for example „well-trained family doctors take over“.

Lauterbach: Citizens are kept stupid
The health expert, physician and SPD politician Karl Lauterbach, welcomed by principle the new cancer registry. As wrong he complains that the registers „decentralized in the countries“. But because cancer data are very important data, they would have to be recorded in a central location to make it easier for everyone to access. "Lauterbach also considers critically that the data obtained should not be accessible to the public For example, studies have found that extracting the lymph nodes under the armpits during breast surgery is not only unnecessary but also harmful to health, because of the threat of secondary illnesses. „But such knowledge must be accessible to the citizens“, says Lauterbach. After all, the collection of data is also paid by the taxpayer. „The registers can only be used by doctors and experts. That's unacceptable. "Show that the citizens „to be considered stupid“.

The federal states have already announced that they will not provide any funds for the project. Against the will of the countries, the law in the Bundesrat would fail. So most likely the health insurance companies are sitting on the costs. (Sb)

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