Mammography screening is a breast cancer screening program for asymptomatic women between the ages of 50 and 69. Mammography is an X-ray examination of the breast that is useful for early detection of breast cancer, because it can reveal very small, non-palpable tumors at an early stage. The goal of the program is to detect breast cancer so early that the tumor is still small and the lymph nodes are not yet affected. This gives women the chance of a favorable prognosis, gentler treatment and ultimately a cure for the disease.

The mammography screening program guarantees a high quality of the examination:

• Mammography is performed by specially trained professionals on strictly controlled digital equipment.

• So called screening units have been set up for the examination. These are centers that specialize in the early detection of breast cancer. The doctors and specialist staff must have special professional qualifications. Checks are carried out at regular intervals to determine whether the criteria for approval for mammography screening continue to be met. If the strict controls (recertification procedure) are passed, the authorization is extended.

• Each mammography image – usually 2 images of each breast – is independently reviewed by at least two specially trained specialists. As proof of their qualification, the physicians must evaluate at least 5000 mammography images per year and regularly demonstrate their professional ability in examinations.

In the event of a suspected case of breast cancer, the further necessary examinations are carried out within the screening program. The results and further procedure are discussed jointly by the physicians involved.

The program for the early detection of breast cancer is aimed at over ten million women between the ages of 50 and 69 nationwide. It is sponsored by the statutory health insurance funds and the National Association of Statutory Health Insurance Physicians (KBV).

The mammography program is an additional offer to the annual cancer screening by your gynecologist.

Participation in mammography screening is voluntary and free of charge for women with statutory health insurance. Women with private health insurance are also eligible. The extent to which your private health insurance will cover the costs of the mammography screening examination should be clarified with your insurance company prior to the examination.

Screening means that all people in an age group are offered a certain examination. The examination is intended to find those people who already carry a disease, such as breast cancer, without feeling anything about it.

The goal of mammography screening is to detect breast cancer as early as possible through mammography in order to be able to treat it better and more gently. The development of breast cancer cannot be prevented by this.

The mammography screening program is the first cancer screening program according to uniform European quality standards. It is implemented by physicians and radiological specialists in a total of 95 screening units.

Regular reviews of the screening units as well as comprehensive collection and evaluation of the examination results are intended to ensure that the high quality level of the program is maintained. Early breast cancer detection can only be successful if the quality of the program is particularly high.

The advantages of the mammography screening program at a glance:

• Certified screening units: The examinations take place in so called screening units. These are centers that specialize in mammography and have special approval for it. The centers must renew these approvals regularly every 30 months.
• High quality of the examination: Mammography is performed by specially trained medical-technical radiological specialists on strictly controlled, digital equipment.
• Double reporting of mammography images: Each mammogram is reviewed independently by at least two physicians. As proof of their qualification, they must assess at least 5,000 mammograms per year and regularly prove in examinations that they also assess mammograms correctly.
• Clarification in case of suspicion: In case of suspicion, further necessary examinations are performed within the screening program. The results are discussed jointly with the physicians involved.
• Transparent program results: The program is strictly controlled. The results from the screening are published regularly by the Cooperation Association for Mammography in “annual reports”.

Breast cancer is the most common cancer among women in Germany. In 2002, the Committee on Health of the Bundestag found that measures taken so far had serious shortcomings in diagnostics and treatment: At that time, there were neither controlled requirements for the professional qualifications of physicians who diagnosed mammograms, nor were results of the examinations documented and systematically evaluated.

It seemed particularly problematic that there were “many unnecessary operations”. There was a lack of binding guidelines for interdisciplinary cooperation between physicians and of clear control mechanisms for the performance of diagnostics.

Against this background, the Bundestag passed a cross-party resolution in 2002 to introduce the nationwide mammography screening program. Breast cancer screening will be significantly improved through optimal equipment supply, certification of qualified personnel, and institutionalized double diagnosis by two independent experts.

A nationwide invitation system is to ensure that the offer is taken up nationwide. In particular, a reduction in the number of unnecessary surgical interventions due to false-positive findings can be expected, according to the health committee’s recommended resolution.

When an uncontrolled division of a cell of the breast tissue occurs, cancer can grow, invade healthy tissue and form so-called metastases.

Breast cancer is very diverse: Some types of breast cancer develop slowly and have little tendency to metastasize, while others are very aggressive.

According to the Robert Koch Institute (2013), around 70,000 women are diagnosed with breast cancer in Germany every year. Approximately one in 11 women will develop the disease in the course of her life. The probability of developing breast cancer increases with age. About 17,500 women die of breast cancer each year.

One type of breast cancer is the so-called ductal carcinoma in situ (DCIS), which is particularly well detected with mammography. Studies to date assume that DCIS, a precancerous state, develops into a dangerous tumor in 30 to 50 percent of cases. Therefore, according to the current standard of care of the “S3 Guideline for Diagnosis, Therapy and Aftercare of Breast Cancer”, appropriate removal is also recommended for cells in precancerous state.

The risk of developing breast cancer increases with age. If your mother, daughter or sister is affected by breast cancer, your risk doubles; if you have two affected relatives, it quadruples.

However, other factors also have an influence on the risk of breast cancer, although not to the same extent as the “familial risk”: Heavy alcohol consumption, long-term use of medication for hormone therapy during menopause, and being overweight after menopause can have an unfavorable effect.

Regular exercise and sport, on the other hand, reduce the risk. Psychological factors such as inner attitude, enjoyment of life or stress do not play a role in the risk of breast cancer.

In order to detect breast cancer, physicians use various examination methods. In addition to the age of the woman, it must also be taken into account whether this is a pure screening examination of a healthy woman or whether a woman with complaints is visiting a doctor.

Quality-assured mammography screening at two-year intervals is suitable for the early detection of breast carcinoma in women between 50 and 69 years of age. Mammography is currently the only method generally recognized as effective for detecting precancerous breast lesions or early tumor stages.

Mammography: In mammography, the breast is x-rayed. X-rays are electromagnetic waves that are attenuated differently as they pass through the tissue. Mammography is not only used in screening of symptom-free women, but also in the clarification of suspicious findings.

Ultrasound: Ultrasound examinations use a transducer to send sound waves into the tissue. Depending on the tissue type, a certain amount of the sound is reflected by the tissue. The different gray values produce an image on which the different structures of the breast can be seen. Ultrasound consequently does not require X-rays, but it does have limitations. The typical calcifications in precancerous lesions and very small tumors can hardly be detected with this examination method. For this reason, ultrasound is not suitable as the sole measure for early detection of breast cancer – however, it is used to complement mammography in the clarification process.

Magnetic resonance imaging: In magnetic resonance imaging (MRI), the body is exposed to an artificially generated magnetic field. The different content of hydrogen atoms of the individual tissue types forms the contrast through which the organ structure becomes visible. MRI is a very sensitive method used to find small tumors. The problem is that false positive findings can occur, since benign changes can also absorb contrast agents and thus light up in the images.

Self-palping: “Lumps” found by self-palping are often benign. On the other hand, if the palpated tumor is malignant, it has often already “spread.” Studies have shown that self-palping does not prevent breast cancer deaths and unnecessarily also leads to more supposedly abnormal findings. Self-palping can therefore not be classified as an early detection measure.