Cancer mammography screening offers no guarantee

Experts argue about the pros and cons of the screening program

07/29/2014

Should women undergo a mammogram for the early detection of breast cancer, or better not? The investigation, which is carried out on special X-ray equipment, was for years considered the ultimate in breast cancer screening. But now there is a controversial discussion about the pros and cons of the Screening Program for Early Detection, which targets all women between the ages of 50 and 69: while some continue to believe that screening can save lives, others fear that In the end, it could actually harm women.

German Cancer Aid recommends mammography as a useful measure for early detection
Mammography - yes or no? This question has been the subject of controversial discussions for a long time. In June 2002, the German Bundestag unanimously decided to introduce a quality-assured mammography screening program for women aged between 50 and 69 in Germany - based on the „European Guidelines for the Quality Assurance of Mammography Screening. "According to the German Cancer Aid put the chest X-ray examination „According to all data currently available, [...] for women between the ages of 50 and 69, a sensible measure for breast cancer screening“ and is therefore recommended in addition to regular sampling. But experts continue to doubt the benefits of screening - a difficult situation for women, because they often do not know in the end whether they should opt for or against the investigation. „Many women are currently insecure“, said Gabriele Plettner of the German Cancer Aid to the news agency „dpa“. Therefore, neutral and factual information about the screening is needed first and foremost, so that women can get a comprehensive picture of the advantages and disadvantages.

Less advertising, more information
For this purpose, the Federal Joint Committee (G-BA) is now planning to have the invitation and the leaflet on mammography screening revised by the Institute for Quality and Efficiency in Health Care (IQWiG). The main aim is to promote the screening less, but instead leave it to each woman to weigh up the pros and cons of the method. An obviously important step, because the level of knowledge about the screening in this country seems rather low for most women. For example, the current health monitor of the Barmer GEK and the Bertelsmann Foundation had shown that 30 percent of the almost 2000 women surveyed assumed that mammography could protect against breast cancer.

„Contents must be adapted to the current medical knowledge“
Accordingly, the subcommittee on method evaluation had already decided at the end of May 2014 that IQWiG should be commissioned with the revision. „The G-BA regularly reviews the impact of its decisions and must provide reasonable evidence that it no longer complies with the general state of medical knowledge. It has been shown that the contents of the Mammography Screening Guidelines must be adapted to current medical knowledge“, so Dr. Harald Deisler, non-partisan member of the G-BA and chairman of the relevant subcommittee.

Decrease of the complete breast can be prevented by early detection
However, the revision of the leaflet does not help ignoring the fact that experts have long been controversial about the advantages and disadvantages of the method. As an advantage is often stated that by regular X-ray examinations under the highest quality criteria breast cancer can be detected at an earlier stage than by the usual sampling or by mammograms, which are not subject to quality control. If the cancer were discovered early, this in turn would mean that often the decrease of the complete breast could be prevented. In addition, the chances of recovery would improve overall, because according to the Cooperation Community mammography studies have shown that the mortality rate for the women invited for screening by about 20 percent lower than those who were not invited. „With around 1000 participants, the regular use of quality-assured mammography saves 5 lives - and not 1 life or no life, as is repeatedly claimed“, says Prof. Sylvia Heywang-Köbrunner, Director of the Mammographie Reference Center Munich.

Mammography can put women in unnecessary fear
Of course, a screening method, of course, can not guarantee that every cancer is detected and cured early. Instead, an aggressive tumor can be fatal despite detection by mammography, and there is also the possibility that a cancer develops between the two-year checks and is eventually (late) discovered. In addition to the wise experts but also repeatedly on the disadvantages of screening mammography, for example, suspected cases, which turn out to be unfounded, lead to unnecessary worries in the affected women. In addition, it is problematic for the German Cancer Aid that some tumors are not detected in mammography at all, moreover „Tumors are also found and treated that would never have been conspicuous and therefore would not cause any problems“, so the cancer aid in a booklet on the subject.

220 million euros a year
The costs of screening are also an important issue for critics, so the question is asked again and again: „How much money should early detection costs?“. Since the costs are fully covered by the statutory health insurance, they pay 220 million euros annually - which is equivalent to 80 € per examined woman every two years means: „For me, the question is not whether we lower breast cancer mortality by screening, but how much“, said Tatjana Heinen-Kammerer, Managing Director of the Mammography Cooperation Association „dpa“.

Transfer of study results from abroad is not easily possible
But this is exactly where other numbers are published time and again to strengthen either the pros or the contra position in the discussion about breast cancer screening. According to the Robert Koch Institute, 2000 lives saved per year can be assumed here in Germany - but so far there are no reliable data, as the screening program was only gradually introduced nationwide between 2005 and 2009 for the legally insured. Also, a transfer of study results from abroad could be problematic, because the screening methods would, for example, vary greatly from country to country, so Tatjana Heinen-Kammerer on. Accordingly, according to the director of the Cancer Information Service, Susanne Weg-Remers, women should not be confused by the current interpretations of the study from abroad: „It makes sense to wait and see what comes out of the German mammography program in about five years“, so the expert. (No)