Imaging Studies for the Early Detection of Breast Cancer: Imaging Is Not Sufficient

Abstract

Recently, quality assured mammography screening has been implemented in Germany, which is based on the guidelines of international experts but has important structural differences. Imaging is not the only factor that contributes to successful early detection of breast cancer. Women’s confidence is undermined by diverging articles in the press, political campaigns, and different methods such as digital mammography, magnetic resonance tomography, or ultrasonography. The result of all this is that participation rates are still low. How might the situation in Germany be improved? Early detection (screening) programs cannot be merely transferred from other countries to Germany. The treatment and often the diagnosis of breast cancer in Germany are in the hands of gynecologists, who are not integrated into mammography screening projects. The gynecologists are not informed about the results of the mammograms which is an unnecessary loss of information and confidence in the system. In Germany, screening units have not been affiliated to certified breast cancer centers in the same way as in other countries. Information programs for women have not been conducted to a sufficient degree. Providing information and by doing so eliminating fears—this is an essential improvement for early detection programs. Known risk groups should be screened differently, not only by means of mammography. The radiation density (>50%) affecting the breast is currently the biggest risk factor. Physical examination by trained personnel is not being undertaken either. How else is it possible that in breast cancer centers, women whose tumors are easily palpable are operated on an almost daily basis? About half of all women (younger than 50 and older than 69) are not included in mammography screening. We are in the position of being able to conduct controlled randomized studies of the validity of breast cancer screening. An initial, promising contribution has been made in Schleswig-Holstein. What has been lacking thus far is only the will to jointly succeed.