Women will in future be able to take part in mammography screening for the early detection of breast cancer from the age of 45. The Federal Joint Committee (GBA) has lowered the lower age limit for the early detection programme, as reported by, among others, Der Spiegel on Thursday, 15 October, and tagesschau.de on Wednesday, 14 October. Until now, the health insurers have covered the costs of the breast X-ray examination only for women aged 50 to 75. Younger women had to bear the costs themselves.
The decision is now being reviewed by the legal supervision department at the Federal Ministry of Health. If there is no objection, the new rule will take effect on 1 August 2027. From then on, women aged 45 and over will presumably be able to register directly with their responsible central office for an examination appointment. They will then probably receive personal invitations from January 2028, as Der Spiegel and t-online.de report. The GBA is the highest decision-making body of the joint self-administration of doctors, psychotherapists, hospitals and health insurers and determines which services are reimbursed by statutory health insurance.
2.5 million additional women
According to the GBA, around 14.5 million women aged 50 to 75 are currently able to take part in mammography screening. With the opening up to younger women from the age of 45, a further 2.5 million women are to benefit from the insurance-funded service, as t-online.de reports, citing the Federal Joint Committee. “Early detection only works well if signs of disease are reliably detected and there is as rarely as possible a ‘false alarm’,” said committee member Bernhard van Treeck, according to t-online.de. “In this spirit, we hope we have made a good decision.”
With the new rule, Germany is implementing an EU directive that recommends screening from the age of 45, as the Tagesspiegel writes. Every year, around 18,000 women die of breast cancer in Germany. According to the Centre for Cancer Registry Data, a new tumour in the breast tissue is diagnosed in around 75,000 women each year. One in six affected women develops the disease before the age of 50, while after the age of 70 the malignant neoplasm affects just under two in five women. Among women under 45, breast carcinomas are by far the most common cancer.
Benefits and risks of the X-ray examination
Mammography screening is intended to detect tumours at an early stage, before they are palpable or have spread to lymph nodes. A study by the Federal Office for Radiation Protection, which extended over several years, concludes that screening reduces the mortality risk for participating women by 20 to 30 per cent, as tagesschau.de reports. A meta-analysis by the Federal Office for Radiation Protection found, according to the Tagesspiegel, that in women under 50 the breast cancer mortality rate can be reduced by 18 per cent through mammography. In women over 70, the risk reduction was around 28 per cent.
Nevertheless, the X-ray examination is not without risks. Achim Wöckel, director of the women’s clinic and head of the breast centre at Würzburg University Hospital, told the Science Media Center, according to the Tagesspiegel: “The radiation exposure of a mammography is overall to be classified as low.” During the examination, radiation exposure of about 0.2 to 0.4 millisieverts occurs. “This exposure is significantly lower than the annual natural radiation exposure and corresponds to a natural exposure of several weeks,” said Wöckel.
An evaluation by the Institute for Quality and Efficiency in Health Care (IQWiG) from 2022 showed, according to the Tagesspiegel: of 10,000 women aged 45 to 49, up to 340 per screening round received a biopsy, although the suspicion of breast cancer was subsequently not confirmed. According to an estimate by the Federal Office for Radiation Protection, about 14 per cent of tumours detected through screening could be overdiagnoses. The prevention researcher Hajo Zeeb nevertheless remains confident: the higher breast density of younger women does make radiological analysis more difficult “to a certain extent”, but digital mammography remains the method of choice. The centres have “a great deal of experience with this methodology”.
Women from the age of 30 can have a manual examination of the breast and armpits once a year, as the Tagesspiegel further reports. This is part of the routine examination at the gynaecologist’s. Compared with manual palpation, X-raying has the advantage that even the smallest tissue changes and tumours that are not palpable can be detected.
