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Germany forced to tackle high death rates from breast cancer

BMJ 2001; 323 doi: (Published 14 July 2001) Cite this as: BMJ 2001;323:70
  1. Annette Tuffs
  1. Heidelberg

    Germany's health minister, Ulla Schmidt, has come under pressure to introduce a special law on mammography that will provide every woman aged between 50 and 70 with a high quality mammogram every other year.

    Compared with the United Kingdom and the United States, Germany still has high mortality from breast cancer. Every year about 3500 women in Germany are estimated to die of breast cancer because of a lack of effective mammography screening.

    Screening programmes following European guidelines are already established in other countries, such as the United Kingdom and Sweden.

    The move towards a similar programme in Germany came after sufficiently high pressure had been applied by patients associations. Politicians of all parties quickly took up the issue and are, according to the German medical journal Deutsches Ärzteblatt, currently preparing drafts for a legal regulation, which has been demanded by radiologists and other cancer specialists for some time.

    The law might be passed before the recently established projects for a model on the introduction of quality assured mammography screening in the German towns of Wiesbaden and Bremen are finished and evaluated. Two further projects are planned. However, the federal health ministry denies that a special law is being prepared and points towards initiatives by doctors and health insurance schemes to introduce new quality assurance criteria.

    Currently, every year about 47 000 new cases of breast cancer are diagnosed in women in Germany, and about 18 000 women die of the disease. These numbers can only be estimated because cancer registration in Germany is incomplete. Mammography is mainly used and financed by health insurance schemes for diagnosing a suspicious lump in the breast.

    However, there is a large grey area of uncontrolled mammography for screening purposes. Neither technical devices nor the diagnoses are regularly checked, and there is no obligatory training or certification.

    Rolf Kreienberg, a gynaecologist from Ulm and the president of the German Cancer Society, has demanded the introduction of evidence based guidelines for the diagnosis and treatment of breast cancer, and these which are curently being prepared by the the society.

    Independent of the legal development, radiologists are intending to introduce certificates for participation in training courses to establish valid selection criteria for patients.

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