[Assessment of mammography screening and its introduction in Germany in the Statutory Early Diagnosis Program]

Malmö, in the south of Sweden, has, over the past 15 years, achieved a reduction in the mortality rate of 10% as a result of adjuvant drug treatment (adjuvant chemo- and hormone therapy). The drop in the mortality rate by means of a quality assured early diagnosis programme, reduces the mortality rate for breast cancer by 34% so that in South Sweden these methods have reduced the death rate for breast cancer by a total of 44% although the incident rate has increased by 1.25%. It follows that a quality assured early diagnosis programme is by far the most effective method of reducing the mortality rate for breast cancer, whereby breast cancer constitutes the main cause of death from cancer in women. The effectiveness of early diagnosis is dependent on experience with these methods whereby the learning curve, even in the case of specialists, does not reach a maximum until there has been at least 6-8 years experience and a minimum of 8000 patients have been seen. A reduction in the mortality rate can only be achieved if a large number of the population takes part (in Sweden, 89% of women contacted) and only applies to the age group 40-70. In the case of younger women (40-50 years) the reduction in the death rate in Sweden lies at 30%. For cost-benefit reasons this age group has not yet been recommended for routine screening in Sweden, apart from in clinical studies. Screening is only effective with complete quality control of technical equipment and personnel as stipulated in the European guidelines for screening mammography (August 1997 edition, EU Commission (EUREF). The risks of radiation exposure, with a threshold value of 5 mGy per breast (X-ray in two planes), is so minimal that it is as yet not measurable. The induction of breast cancer through annual screening mammography is estimated theoretically at 4 indicated cases of breast cancer to 1 million female years. Theoretically these induced cases of breast cancer can be cured by early diagnosis. A reduction in the mortality rate of 34% is a tremendous advantage for women. Since breast cancer is the main cause of death in women between the ages of 38 and 51 and screening considerably cheaper than other preventive measures (cervical smear, dialysis in kidney disease, safety belts, medication to lower cholesterol levels) the introduction of quality assured screening is an essential priority towards improving the health of women in society today. It has been proved (Netherlands) that the cost of screening is far lower than the expense incurred in the treatment of women in the metastatic stage of their cancer illness before death.