If a cancer has already metastasized, the chances of recovery—and usually the treatment options as well—decrease. The earlier cancer is diagnosed and treated, the better the prognosis. That is why cancer screening (early detection) plays a very important role.
Statutory health insurance plans offer various screening programs. Taking advantage of these programs can actually save your life.
However, many types of cancer cannot be detected in their early stages. Statutory cancer screening therefore primarily focuses on the early detection of
Depending on your age and gender, various cancer screening tests are recommended.
Regardless of the cancer screening programs mandated by law, everyone should have regular
by examining and palpating them. Specialists can provide information on the best way to do this and what to look for.
Specific Cancer Screening for Women
Cancer screening is usually performed by a gynecologist.
Cancer screening for the reproductive organs
For women aged 20 and older, cancer screening of the reproductive organs includes
- a medical history interview with questions about symptoms, abnormal bleeding, and vaginal discharge,
- an examination of the cervix,
- the collection of tissue samples from the cervix and the uterine cervix (Pap test), and
- a cytological examination (Pap test) as well as
- a gynecological pelvic exam, and
- a final consultation.
Breast Cancer Screening
Generally, starting at age 30, breast cancer screening (mammography) includes
- a medical history interview with questions about changes and symptoms in the breast,
- an examination and palpation of the breast and lymph nodes
- instructions on how to perform a breast self-exam.
Starting at age 50, a mammogram of both breasts is also performed as part of the mammography screening program. This is done every two years until the end of the 70th year of life.
Specific Cancer Screening for Men
Starting at age 45, statutory screening includes cancer screening of the genital organs, which involves
- inspection and palpation of the external genitalia, as well as
- a digital rectal exam of the prostate and lymph nodes
are the main focus.
Cancer Screening for Both Genders
Skin Cancer Screening
Skin cancer screening is performed every two years starting at age 35. It consists of
- a medical history interview with questions about changes and symptoms affecting the skin, as well as
- an examination of the entire skin surface, including the scalp and all skin folds, particularly
- the armpits,
- groin,
- the gluteal cleft,
- the spaces between the fingers and toes,
- the area under the breasts, and
- belly button.
Cancer screening for the rectum and the rest of the colon
Cancer screening for the rectum and the rest of the colon includes
- a fecal occult blood test starting at age 50 (annually until age 54) and
- starting at age 55, two colonoscopies performed ten years apart, or
- a repeat fecal occult blood test every two years.
During skin cancer screening, the doctor checks for suspicious moles, among other things © Pixel-Shot | AdobeStock
Overview of Cancer Screening
Cancer screening tests recommended for women
Sorted by age, statutory health insurance plans recommend the following cancer screening tests for women:
- Starting at age 20: annual gynecological exam with a targeted medical history review regarding menstrual irregularities and vaginal discharge, followed by a Pap smear and cytological examination
- Ages 30 and up: Annual breast exam with
- medical history regarding symptoms and changes,
- palpation of the breasts and regional lymph nodes, and
- instructions on self-examination
- From age 35: skin examination every two years
- Ages 50 to 54: Annual colon and rectal examination, including digital rectal exam and fecal occult blood test
- Ages 50 to 69: Mammography screening every two years; invitation to a mammogram from certified screening centers.
- Ages 55 and older: colonoscopy twice at ten-year intervals, or, alternatively, continued fecal occult blood testing every two years.
Recommended cancer screening tests for men
Sorted by age, statutory health insurance providers recommend the following cancer screening tests for men:
- Cancer screening for men aged 35 and older: skin examination every two years
- Cancer screening for men aged 45 and older: Annual prostate and genital examination, including a medical history review of changes and symptoms, and palpation of the prostate and lymph nodes
- Cancer screening for men aged 50 to 54: annual colon and rectal examination, including digital rectal exam and fecal occult blood test
- Cancer screening for men aged 55 and older: colonoscopy twice at ten-year intervals, or, alternatively, a fecal occult blood test every two years.
The term “Cancer Screening Plus” refers to expanded cancer screening examinations. These are usually not covered by statutory health insurance plans.
Depending on the doctor’s office or medical facility, these consist of service packages tailored to individual needs. They usually include the screenings covered by health insurance as well as supplementary or alternative procedures. The doctor bills patients directly for these as Individual Health Services (IGeL).
Some of these additional screenings can be quite expensive and are not always appropriate for the individual patient. It comes down to weighing potential cancer risk factors against the increased costs. You should discuss with your doctor whether the additional screenings would be beneficial in your specific case.
If, for example, the patient is at increased risk, some of these examinations may well be appropriate. An increased risk exists, for instance, in cases of a family history of cancer or frequent exposure to carcinogenic substances.
General Expanded Cancer Screening
For the early detection of tumors in the abdominal cavity, the “Cancer Screening Plus” program includes an abdominal ultrasound. Most often,
are examined in greater detail.
For the early detection of skin cancer, a skin examination using a special magnifying device (dermatoscope) is offered. This examination is called a reflected-light examination.
A test for blood in the urine is intended to provide indications of bladder or kidney cancer.
A general blood test, including liver and kidney function tests as well as lipid profile, is also available.
Testing the blood for specific tumor markers can also provide indications of cancer. For example, a bladder tumor screening test (NMP 22) is intended to aid in the early detection of bladder cancer.
An ultrasound examination of the abdomen, such as of the kidneys, can provide indications of cancer © LIGHTFIELD STUDIOS | AdobeStock
Advanced Cancer Screening for Women
For women, various ultrasound examinations (Sono-Check) are also part of advanced cancer screening. Examples include
- transvaginal ultrasound (vaginal ultrasound) for the early detection of endometrial cancer (endometrial carcinoma) and ovarian cancer (ovarian carcinoma), and
- breast ultrasound (mammasonography).
In addition, a laboratory test for chlamydia
- to ensure fertility and
- to protect against premature birth, miscarriage, and myocardial infarction (heart attack)
is also offered.
A test for human papillomavirus (HPV test) is also available. A positive HPV test may indicate an increased risk of cervical cancer.
Occasionally, testing for the following tumor markers is also offered for early cancer detection:
- SCC or Cyfra 21-1 for the early detection of cervical cancer
- Cyfra 21-1 or beta-hCG for the early detection of uterine cancer
- Beta-HCG, AFP [alpha-fetoprotein], CA 125, or inhibin B for the early detection of ovarian cancer
- CA 15-3 or CEA for the early detection of breast cancer.
Expanded Cancer Screening for Men
For men, advanced cancer screening often includes
- a transrectal ultrasound (TRUS) of the prostate, as well as
- a blood test using a PSA test for the early detection of prostate cancer.
An ultrasound examination of the testicles can provide additional assurance in the early detection of testicular cancer. The measurement of certain tumor markers in the blood (e.g., beta-hCG, AFP) serves the same purpose.
Examinations for the early detection of breast cancer
Physical examination of the breast and lymph nodes
The statutory cancer screening program includes an annual physical examination of the breasts and armpits. Lymph nodes are located in the armpits. For this, the patient raises her arms above her head. The doctor can then palpate the breasts and armpits.
In addition, women are instructed on how to perform a self-examination of their breasts once a month.
Mammography
A mammogram is a specialized X-ray examination of the breast. It helps detect small breast tumors that are not yet palpable or otherwise detectable.
Breast cancer is highly treatable in its early stages. Therefore, early diagnosis is particularly important for breast cancer.
During a mammogram, the breast is gently compressed between two radiolucent Plexiglas plates. Some women find this procedure uncomfortable or even painful. For this reason, it may be advisable to schedule this early-detection exam during the first half of the menstrual cycle. At that time, the breast is generally less sensitive to pressure.
A mammogram is an X-ray examination and therefore involves a certain amount of radiation exposure. However, thanks to improved X-ray technology, this exposure is kept to a minimum.
Performing a mammogram for cancer screening © RFBSIP | AdobeStock
Breast Ultrasound
Breast ultrasound (sonography) is less accurate than mammography. Ultrasound is better at visualizing dense, glandular breast tissue than mammography. For this reason, the exam is more suitable for younger women.
Sonography is very effective at distinguishing benign cysts from breast lumps.
Screening for colorectal cancer
Fecal occult blood test
Colonic tumors often bleed. One method for the early detection of colorectal cancer is therefore to test the stool for blood.
Often, the amounts of blood are so small that they are not visible to the naked eye. To detect this, a fecal occult blood test is performed. This test detects hidden blood—that is, blood in the stool that is not visible to the naked eye.
For the fecal occult blood test, stool samples are applied to test strips and examined in the laboratory for traces of blood.
Colonoscopy
During a colonoscopy, a colonoscope is used to examine the interior
- the rectum,
- the large intestine, and
- the final section of the small intestine
. During the procedure, an optical instrument attached to a flexible tube is inserted through the anus into the intestine. The doctor can then examine the intestinal lining for any abnormalities.
A colonoscopy can detect early stages of colorectal cancer and polyps (benign growths).
Virtual colonoscopy
In virtual colonoscopy, the colon is examined without inserting any instruments into the bowel.
Instead, cross-sectional images of the colon are taken from the outside using computed tomography (CT) or magnetic resonance imaging (MRI). The computer then assembles these cross-sectional images into three-dimensional images. This allows the doctor to examine the inside of the colon.
Virtual colonoscopy appears to be equivalent to conventional colonoscopy in terms of the diagnostic value of its images.
Screening for Cervical Cancer
Genital examination
The gynecologist palpates the lower abdomen and thoroughly examines
- the labia,
- vagina, and
- the cervix.
The uterus and ovaries can be palpated externally through the abdominal wall. If any abnormalities are suspected, the area around the uterus can also be palpated through the anus.
The cervix is examined through the vagina using a vaginal speculum. The doctor dilates the vagina with the speculum. Then he examines the tissues in the area of the inner vagina and the cervix. To do this, the doctor uses a colposcope (a special magnifying device).
Pap Test for Early Cancer Detection
The Pap test is a cytological examination of the uterus. To perform it, the gynecologist takes a smear—that is, a sample of cellular material—from the cervical os and the cervix. To do this, they use a spatula, a small brush, or a cotton swab.
In the laboratory, the sample is examined under a microscope for cellular changes.
HPV Test
The HPV test can detect an infection with human papillomaviruses (HPV). These viruses are the main cause of cervical cancer.
For this test, a tissue sample is taken from the cervix and analyzed using molecular biology techniques to detect the presence of HPV genetic material.
The best way to prevent cervical cancer is through HPV vaccination. It immunizes women against these dangerous viruses. However, the vaccine is only recommended for young girls.
Screening for Skin Cancer
Skin Cancer Screening
During skin cancer screening, the doctor asks the patient if they have noticed any changes in their skin.
In addition, during a visual examination of the skin, the doctor looks for any abnormalities. This could include, for example, an excessive number of moles.
If skin cancer or a precancerous condition is suspected, a thorough evaluation using a dermatoscope by a dermatologist is required.
Reflected-light examination (reflected-light microscopy, dermatoscopy)
During a reflected light examination, skin changes are examined using a so-called reflected light microscope. A reflected light loupe is a magnifying glass equipped with a halogen lamp.
Under high magnification, the doctor can also inspect deeper layers of the skin and assess them with relative certainty. In most cases, a general practitioner or dermatologist performs the reflected light examination.
Tests for the Early Detection of Prostate Cancer
Digital rectal examination of the prostate for early cancer detection
During the digital rectal examination, the doctor inserts a finger into the rectum. This allows him to feel for small irregularities on the surface of the prostate.
However, this method cannot detect tumors located deeper within the prostate.
Transrectal ultrasound of the prostate
During a transrectal ultrasound (TRUS) of the prostate, an ultrasound probe is inserted into the rectum. This allows the doctor to examine the prostate.
However, this ultrasound examination is often recommended only in combination with a digital rectal exam or a PSA test.
