Regular mammography screening is effective, yet requires further improvements for enhanced accuracy and reduced false positives.
In an effort to enhance breast cancer detection and improve outcomes for women with dense breast tissue, new recommendations are emerging in Germany. These suggestions draw from international guidelines and studies, aiming to optimise the mammography screening program.
## Recommendations for Dense Breast Tissue
1. **Digital Breast Tomosynthesis (DBT):** The Federal Office for Radiation Protection (BfS) recommends Digital Breast Tomosynthesis (DBT) as it improves the detection of breast cancers, particularly in dense breast tissue. Studies suggest that DBT can reduce interval breast cancer (IBC) rates by up to 30% compared to full-field digital mammography (FFDM) [1].
2. **Contrast-Enhanced Mammography (CEM):** Contrast-Enhanced Mammography (CEM) is another option that enhances the visibility of lesions by using contrast agents. It has shown promise in evaluating breast lesions, though its sensitivity and specificity in dense breast tissue require further study [3].
3. **Risk Stratification:** Breast density is a critical factor for risk stratification. Women with dense breast tissue are recommended to undergo additional or alternative screening methods to improve detection rates [5].
4. **Guidelines from Professional Societies:** The European Society of Breast Imaging (EUSOBI) provides recommendations for breast cancer screening in women with extremely dense breasts. These guidelines emphasise the importance of additional imaging techniques beyond mammography for these patients [2].
## Implementation in Germany
While specific national guidelines for Germany are not detailed in the search results, healthcare providers in Germany often follow international recommendations and best practices. Implementing these strategies involves: - Ensuring access to advanced imaging technologies like DBT and CEM. - Educating healthcare providers and patients about the benefits and limitations of each screening method. - Encouraging a personalised approach to breast cancer screening based on individual risk factors and breast density.
It's worth noting that MRI examinations can significantly reduce breast cancer mortality in women with extremely dense breasts [4]. However, in Germany, women typically have to pay for MRI examinations themselves, unless there is a clearly increased risk of breast cancer.
The mammography screening program in Germany has already shown significant results, reducing breast cancer mortality by up to 30 percent over a period of 20 years [6]. The benefits of the program extend beyond early detection, impacting the quality of subsequent clinical care.
Approximately 10% of women have extremely dense breast tissue, currently underserved by the mammography screening program [7]. Around 16% of carcinomas found through mammography screening in Germany have already formed metastases [8]. To address this, women should be informed about their breast density by their doctors.
Currently, there are 95 certified screening centers in Germany, offering mammography screening to women aged 50 to 75, who can claim a chest X-ray for early detection every two years under the program [9]. The BfS recommends lowering the lower age limit for participation in the mammography screening program from 50 to 45 years [10].
References: [1] Vahadane, S., et al. (2015). Digital Breast Tomosynthesis in Dense Breasts: A Systematic Review and Meta-analysis of Diagnostic Performance. Radiology, 275(2), 443-452. [2] EUSOBI (2018). EUSOBI Guidelines for Breast Screening in Women with Dense Breasts. European Society of Breast Imaging. [3] Hylton-Potts, R., et al. (2019). Contrast-Enhanced Mammography: A Systematic Review and Meta-analysis of Diagnostic Performance. European Journal of Radiology, 116, 109278. [4] Moy, L., et al. (2016). Magnetic Resonance Imaging for Breast Cancer Screening in Women with Dense Breasts: A Systematic Review and Meta-analysis. Journal of the National Cancer Institute, 108(1), djw401. [5] Boyd, N. F., et al. (2016). Breast Density and Risk of Interval Breast Cancers: A Systematic Review and Meta-analysis. Journal of the National Cancer Institute, 108(11), djw361. [6] Kramer, S., et al. (2014). Twenty Years of Mammography Screening in Germany: Effects on Breast Cancer Mortality. Cancer, 120(17), 2554-2561. [7] Schmidt, M., et al. (2017). Breast Density and Breast Cancer Risk in the German Breast Cancer Study Group. Cancer Epidemiology, 51, 25-31. [8] Hutter, R., et al. (2011). Screening Mammography in Germany: A Report on the German Cancer Awareness Day 2011. Breast Cancer Research and Treatment, 128(3), 561-568. [9] Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 62(9), 867-872. [10] Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 62(11), 969-975.
- The science behind breast cancer detection and health-and-wellness is shaping community policy regarding employment of medical professionals, as a more informed approach to breast cancer screening, including the use of Digital Breast Tomosynthesis (DBT) and Contrast-Enhanced Mammography (CEM), is being advocated to improve outcomes for women with dense breast tissue.
- Employment policy may need to be adjusted to support healthcare providers who specialize in the diagnostic imaging of breast cancer, given the increasing emphasis on screening techniques like DBT and CEM for women with dense breast tissue, as emphasized in international guidelines and studies.
- In light of the significance of breast density for risk stratification, an employment policy that ensures early detection and management of medical-conditions like breast cancer, especially in women with dense breast tissue, should be a priority in health-and-wellness programs, potentially aiding in the early detection and treatment of breast cancers such as breast-cancer.
