Cancer Screening (Early Detection of Cancer)

What is Cancer Check-Up?

Cancer screening or early detection is the term used to describe examinations that detect cancer before it causes symptoms (pain, bleeding, dysfunction) or spreads throughout the body (metastases). Early detection is ideal for precancerous lesions, such as benign tumors that have a high risk of degeneration but are not cancer yet. The aim is using this information to start early treatment of the disease with better results. Cancer screening is used for early detection and does not reduce the probability of developing cancer.

Legitimate Guaranteed Cancer Screening in Germany

Cancer Screening for Women

Cervical cancer screening is recommended once a year for women as of the age of 20 years. The internal and external genital organs are examined, and a "PAP" smear of the cervical mucus is taken. This smear developed by the Greek doctor George Papanicolaou significantly improved early detection. The frequency of this disease has not decreased significantly in recent decades, but only half as many women die from it today compared to 40 years ago. Currently, there are efforts to have the PAP test for women over the age of 35 years carried out only every three years. A smear test for HPV viruses is supposed to be added.

As of the age of 30, women are entitled to have palpation in their breasts and armpits carried out once a year. Breast cancer screening is essential because breast cancer accounts for one-third of all cancers in women and is, therefore, the most common cancer. Women are entitled to mammography between the ages of 50 and 69, and earlier if there is a family history of cancer. This involves taking an X-ray of the breast and identifying conspicuous structures that are not palpable.

Cancer screening for men

As of the age of 45, men are advised to have their prostate examined once a year. Prostate cancer is the most common cancer in men (28% of all cancers). The examination is performed through the anus, and the doctor can feel enlargements of the prostate gland through the intestines. The doctor also examines the genitals and examines the inguinal lymph nodes.

Cancer Screening for Men and Women

As of the age of 35, men and women can have a skin cancer screening carried out by a dermatologist every other year. The doctor examines the entire skin (including areas that are rarely exposed to the sun) for abnormalities, especially moles.

Colon cancer screening is carried out using two methods. As of the age of 50, patients can have stool samples examined once a year for the smallest amounts of blood that are not visible to the naked eye (occult blood). If the test is positive, a colonoscopy is recommended. Colonoscopies are also recommended every ten years as of the age of 55 as a precautionary examination. In a colonoscopy, the entire colon is examined with a camera tube that is inserted through the anus. Polyps, small tumors in the intestine, can often be discovered and removed during the examination. Every other person in Western Europe develops a polyp in the large intestine in the course of their life. Polyps themselves are not dangerous but often grow into cancer over a long period of about 10-15 years.

IGeL Services (Individual Health Services) for Cancer Screening

Beyond the legally guaranteed measures for cancer prevention, doctors from various fields offer so-called IGeL services. These are not covered by health insurance and must be paid by the patient. Frequently offered individual health services for cancer prevention are ultrasound examinations of the breast and ovaries in women and PSA value determination for early detection of prostate cancer in men. Some doctors also offer skin cancer screening as IGeL. The difference to the health insurance service is that the dermatologist does not just check the skin for abnormalities with the naked eye, but uses a dermatoscope for the examination. Another possibility for individual cancer screening is the full-body MRI, in which the whole body is imaged without radiation. Even the smallest tumors can be detected in this examination.

Why is Individual Health Services not Covered by Health Insurance?

Health insurance companies are legally obliged to work economically. This is why statutory health insurance companies only cover the costs of services that have been statistically proven to have a benefit in reducing cancer mortality for a large number of patients. Before a service is included in the catalog of statutory cancer prevention, it must be proven that this service measurably reduces cancer mortality.

What Are the Costs for Cancer Screening?

The legally guaranteed cancer screening examinations are covered by the health insurance companies and are therefore free of charge for the patient. The costs for individual health services are regulated by the medical fee schedule (GOÄ). In order to avoid unpleasant surprises when you receive your bill, patients should request a transparent cost estimate.

Benefits and risks of cancer screening

The advantage of some screening tests is controversial, as their performance can also have harmful effects. For example, mammography (for breast cancer screening) uses X-rays, which themselves have a harmful effect on tissue and are have a small chance of triggering the development of cancer in a healthy person.

Therefore, it is advisable to only carry out mammography in patients for whom the benefits outweigh the risks. Men and young women are rarely affected by breast cancer. Mammography would do them more harm than good.

An essential examination for skin cancer is done by observation and is therefore harmless. It can be carried out in anyone without having concerns. In general, a high-risk test is only recommended if the benefits are also great.

The sensitivity of a test, which means the accuracy of the results of a screening method, is another risk. A test can be a false negative, which means that existing cancer is not detected by a method, or false positive when a test value falsely indicates cancer even though there is none. This can be very stressful for the patient if he has to undergo further examinations. In those cases, the patient is confronted with fears even though they are unfounded.

Screening is only considered useful if cancer you are testing for is treatable. If the patient is already seriously ill or very old, cancer screening is not beneficial. If cancer were be found, it would be of no significance for the patient’s health if he already has a low life expectancy or if the cancer therapy would be too stressful to survive. The patient would not benefit from the test result, but the diagnosis would still be emotionally very stressful. Ignoring a cancer disease can protect the quality of these patients’ lives.

Not every diagnosed cancer necessarily leads to complaints during the patient's lifetime (e.g., breast cancer, prostate cancer). It is, therefore, possible that in rare cases, people with a diagnosed cancer may take on a stressful and harmful treatment without necessity. This problem associated with screening is known as "overdiagnosis."

Sources :

• www.cancer.org/cancer/cervical-cancer/about/key-statistics.html
• www.krebsinformationsdienst.de/vorbeugung/frueherkennung/frueherkennung.php
• www.tk.de/centaurus/servlet/contentblob/141708/Datei/681/Broschuere-Frueherkennung-von-Gebaermutterhalskrebs.pdf .
• emedicine.medscape.com/article/773832-overview
• www.verbraucherzentrale.de/kosten-von-igel-leistungen--informieren-spart-geld
• Heiner Greten – Innere Medizin 12th edition
• Thieme – Duale Reihe – Innere Medizin 2009