Complementing mammography with ultrasound: Discover up to 45 percent more tumors
Mammography is one of the most important methods for the early detection of breast cancer. According to experts, over 17,000 carcinomas could be discovered in one year. However, experts are now reporting that up to 45 percent more tumors can be diagnosed if ultrasound diagnostics are used in addition to the X-ray examination.
Cancer with the highest death rate
Breast cancer is the cancer with the highest death rate among women in Germany. Nationwide, around 17,000 die of it every year and around 70,000 fall ill each year. According to the German Society for Senology (DGS), around 80 percent of women who are ill can now be successfully treated. A lot depends on an early diagnosis. Since 2002 women in this country have had the opportunity to take part in the mammography screening free of charge. With this special X-ray examination, numerous breast cancers are recognized at an early stage. However, if additional ultrasound examinations are carried out, significantly more tumors can be diagnosed.
Breast cancers are often not clearly identified on X-ray examination
In Germany, women aged 50 to 69 can participate in the breast cancer screening program free of charge. However, only about every second goes to mammography screening.
Women are often afraid of the examination. It is also known that the investigation does not offer a guarantee.
The problem is that the X-ray examination of the breast - the most common diagnostic procedure in this country - can often not clearly identify a large part of the so-called breast cancer.
However, if ultrasound diagnostics are used in addition, up to 45 percent more invasive carcinomas can be detected, reports the German Society for Ultrasound in Medicine (DEGUM).
The experts are therefore demanding that ultrasound breast examinations should already be used as standard in routine examinations for the early detection of cancer.
Little is known about the added value of sonography
"The high added value of sonography for early cancer detection is far too little known," says DEGUM expert Professor Dr. med. B. Joachim Hackelöer, who held professorships for gynecology and obstetrics at universities in Hamburg and Marburg.
For example, the medical service of the Central Association of Health Insurance Funds (MDS) recently classified the benefits of this examination as unclear in an assessment process for several individual health services (IGeL services).
Against this background, Hackelöer believes that there is an urgent need for clarification.
But why is breast ultrasound so useful? "The female breast consists of a mammary gland tissue. Connective tissue and fat envelop this glandular tissue, ”explains Hackelöer.
"The ultrasound examination of the breast shows the glandular and connective tissue with bright echoes, while carcinomas are often shown with dark echoes."
According to the information, an echo contrast is created, which enables the diagnosis to be made effectively. In contrast, the X-ray examination of the breast - the so-called mammography - does not show such a clear contrast between the tumor and the rest of the glandular and connective tissue.
Here the carcinomas are shown in light or white and can therefore be masked or hidden by the rest of the glandular and connective tissue. This is particularly often the case for women with dense tissue - i.e. a high proportion of milk gland tissue.
Women with dense breast tissue
According to DEGUM, these women should therefore also be urgently examined using ultrasound - and there are numerous: According to the latest data, almost half of women over 50 have dense breast tissue.
“The problem is that breast density is currently not being systematically recorded and communicated in the German mammography screening program. However, women with extremely dense glandular tissue have a higher risk of developing breast cancer, ”says Professor Dr. Alexander Mundinger, chief physician of the breast center section, imaging and minimally invasive breast diagnostics at the Niels-Stensen clinics at the Franziskus Hospital Harderberg in Georgsmarienhütte.
At the same time, the risk of masking breast cancer is highest in these patients. "But they are only recommended and funded for an early x-ray examination every two years in Germany to detect breast cancer. That has to change urgently. ”
So that more breast cancer tumors can be discovered earlier in the future, DEGUM experts are calling for a new concept: “In Germany, we urgently need a risk-adapted, optimized screening program. Here, mammography should be supplemented by ultrasound diagnostics of the breast, ”said Hackelöer.
"In addition, the early detection must be carried out very individually." According to the experts, it would be ideal if the ultrasound and the X-ray examination - depending on the degree of breast density - were used in a standardized manner once a year for women over the age of 40.
If possible, these examinations should be carried out by DEGUM-certified gynecologists and radiologists. According to the ultrasound experts, the DEGUM concept should already be integrated into the screening training of the budding doctors - this is the best way to ensure high quality in sonography. (ad)