Breast Cancer Awareness: Researchers Argue About Mammography Study - With magnetic resonance examinations you can feel on obviously better tumors in breast cancer risk than with the classical x-ray examination, the mammography. This is the result of a study on several hundred women, which was conducted at four German university hospitals. Recently, several German scientists published the EVA study in the "Journal of Clinical Oncology". Mirror ONLINE and other media reported.
Christiane Kuhl, Professor at the University of Bonn and first author of the study, then demanded a revision of medical guidelines. "Hereditary stressed women should undergo 30 an annual magnetic resonance investigation", said Kuhl on mirror ONLINE. Annually approximately 57,000 women develop breast cancer, an estimated 5 to 10 percent of cases are due to inherited (see info box on the left). Depending on the frequency of breast cancer cases in the family women have a high or moderate risk of hereditary. Kuhls according to perform the magnetic resonance examination, called also breast MRI, especially in young women with moderate risk of breast cancer, because these is a mammography without benefits.
According to the current guidelines but, women with a familial risk of breast cancer get a breast MRI only in combination with a mammography. This is unnecessary, is cooling: an MRI is done, is the benefit of mammography in these women equal to zero. "So that can and should be avoided the mammography in these young women," quoted Kuhl in the press release of the University Clinic in Bonn, which was released to the study.
The benefits of mammography screening is controversial
But it's not just that the mammography according Kuhls useless in these women is. Mammography is an x-ray and charged the body with radiation, which can cause mutations in the genome. Young women know the basis of their family tree, they are at increased risk should, very early - make annual screening - with 25 or 30. Thus accumulates in them at a significant radiation exposure.
Unlike women who undergo the normal mammography screening. Current breast cancer screening is recommended for all women aged between 50 and 69 years. The mammography screening was set up several years ago at great expense; one thousand specially trained doctors perform it. You must undergo regular quality control and training. Something you want to ensure a high success rate in cancer detection.
With their demands, Kuhl has attracted the displeasure of the "cooperation community mammography" is. This joint sponsorship of statutory health insurance funds and Federal Association of Statutory Health Insurance Physicians was founded in 2003, the mammography screening of the German Federal Government decided nationwide in Germany to implement, coordinate and evaluate.
So, the cooperation community responded with a press release on the study: "It is well known that MRI is not suitable for the General breast cancer screening," it says. "One of the big disadvantages of MRI is a too high rate of eye-catching findings turned out in further clarification as harmless." The study here came to a different conclusion: the number of false alarms on the nuclear spin was even lower than with mammography.
"The cooperation community responds extremely allergic, if something is published, which also only indirectly critical represents mammography", suspected Kuhl. "Probably out of fear of falling attendance."
Are still relatively low, with only 1.45 million of the approximately ten Million eligible women between 50 and 69 are currently participating in the mass screening. Perhaps because of the benefits of mammography screening is questioned repeatedly by experts. In a meta-scientists came to the conclusion that very few women benefit from the mass screening: Danish researchers found that of 2,000 women who make regular mammograms for ten years, only one woman is preserved in addition before the breast cancer death. This success, however, is paid for with numerous false alarms: In 200 women mistakenly suspected cancer is detected, ten even get a cancer treatment, although they are perfectly healthy.
Co-authors flinch
At the request of mirror ONLINE the cooperation community mammography explained the reasons for the press release: "The clarification was necessary became, after numerous media representatives on the basis of misleading publications on the EVA study in the community of cooperation had turned and had asked for the implications of the study for the early detection program." The EVA study refers expressly only to women with an increased risk of breast cancer.
Also Kuhl says: "Our results have nothing to do with the General mammography screening and refer only to women with an increased risk of breast cancer." It urged the General screening.
But now some co authors of the study of Kuhls rowing back: in a comment to the press release of the University of Bonn they distance themselves from Kartal statements.
"Against the above background, scientists of the site Münster in accordance with other renowned scientists for not allowed to delete the X-ray mammography from the early diagnosis of familial breast cancer in General involved in the study, listed below hold it," says the commentary.
Author of the paper is Walter Heindel of the University Hospital of Münster, which was involved in addition to the University hospitals of Bonn, Munich, and Ulm in the study. Reasons for writing: "As a co-author who became study I on the informed planned press release in advance, nor I gave my consent to the contents of this press release", Heindel communicated on request. MIRROR ONLINE a correspondence between him and Kuhl exists however, stating that he gave his approval of press release one day after its publication.
The withdrawal could be politically motivated: the University Hospital Münster is one of the nationwide training and reference centers for the German mammography screening program. The head: Walter Heindel. In a written statement that no pressure was exerted on Heindel mirror ONLINE of declared Heindel and mammography, cooperation society.
A screening mammography is better remunerated as a normal
So Heindel and the other signatories of the commentary, which the mammography screening could generally be brought into disrepute, have worried: "In summary is to point out that the contentious discussion is alone on a relatively small group of women with explicitly higher cancer risk at the early detection diagnostic imaging age regularly begins from the 25th."
This "small group" is after all up to 10 percent of all breast cancers - so around some 5,000 women per year. And these are only the cases where breast cancer has broken out. How many women wear a genetic breast cancer burden in itself, no one knows.
The iron defense of mammography screening program is financially motivated, because it is too much money. "Important here is that a mammography examination within the screening program will be compensated higher as a mammography, which is done by a gynecologist or radiologist due to a suspected diagnosis," says Annette Kruse Kalpesh, who runs a consulting firm for physicians. "For a mammography within the screening program, the doctor can settle 61, 25 euro in the statutory health insurance." He gets even 102 euro for privately insured.
Only a thousand doctors share the cake
When a woman on the basis of a suspicion of breast cancer but receives a mammography, will be paid differently. Then, the gynecologist or radiologist receives only 52.50 euros by the statutory health insurance. First of all, that sounds like not so much less. But the crucial difference is that this so-called curative mammography - other than preventive because of screening - within a fixed budget per quarter will be paid. Kruse Kalpesh estimates: "gynecologist, the mammograms receive a so-called 'Radiology of part of quality supplement' in height of 3.90 euros per patient." In other words: in 1000 patients per quarter, the obstetricians and Gynecologists has a budget of 3900 euro for mammography. For it he can perform a mammography of both breasts at 74 women." Any other patient is a losing proposition for him.
Not so with mammography screening - because it is billed extra budgetary, without capping. This means that the more women are screened, the more deserving of the doctor. Furthermore, the investigation is uncomplicated: "When mammography screening is an anonymous screening without physician contact and clinical examination," says Kruse Keirath. "Depending on the center are carried out per unit of between eight and ten tests per hour." A medical consultation is required only if something is found in mammography. Unlike with curative mammography, because here the woman was indeed examined for suspected. A call is therefore common.
A lucrative market has evolved the relatively few doctors share. Ten million women between 50 and 69 years of age are entitled to a mammography screening. In 2007, 1.45 million women took part according to figures of the community of cooperation of mammography. Approximately €89 million, which share the thousand certified doctors - or 89,000 euros per doctor, are every two years.
And the market is growing, because it tries to better to increase the participation rate by written invitations. On the other hand, the demographic development will help to ensure that the proportion of older women will increase anyway. It's worthwhile to purchase a mammography X-ray unit with a value of 80,000 euros.(source: spiegel.de - Breast Cancer Awareness: Researchers Argue About Mammography Study)
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