Mode of breast cancer detection: a study from the German part of the Maas-Rhine-EUREGIO

Cancer screening programmes differ throughout the European Union with regard to their content as well as their acceptance by the population. In Germany, mammography is not yet part of the recommended screening programme, although its routine use is recommended by several national and international institutions. We were interested in the present methods of breast cancer detection and the correlation to tumour stage, histology and prognosis. Patients with breast cancer, presenting in our department between January 1990 and December 1994 (1,050 cases), were asked whether the suspicious finding was first detected by themselves, their physician, or in routine mammography. Seventy-two per cent of tumours were detected by patients themselves, 12% by the physician at routine cancer screening or for other reasons, and 16% were found in mammography performed without clinical suspicion of cancer. Tumours found by physicians or by mammography were treated much sooner than those first recognized by the patient and, thus, were of lower T and N stages. Surgery could more often be breast-conserving in these cases. Of the T2 stages, as far as can be determined after the short follow-up, patients with tumours detected by screening showed a better survival rate. In spite of the introduction of cancer screening programmes most breast carcinomas are still detected by patients themselves. Therapy is often started after a great delay, so that the tumours are found to be at more advanced stages and show a worse prognosis than those detected by clinical examination or mammography.