Early detection of cancer: what examinations are there?

Cancer screening serves to detect cancer at a stage when it has not yet caused symptoms – such as pain, bleeding, or palpable lumps. Examinations for early detection thus aim at discovering a previously unnoticed malignant tumor at a very early point in time. A cancer can therefore be treated earlier and often more successfully too. As a result of this, the prospects of healing can be increased. Furthermore, less invasive therapies are sometimes possible. 

Cancer screenings are examinations used to detect the preliminary stages of a cancer – such as initial changes in tissue. Such examinations are so far only possible with a few types of cancer, for example bowel cancer or cervical cancer. Removing benign intestinal polyps during a colonoscopy can thus help prevent the development of malignant bowel cancer.

In Germany, various early detection screenings for certain cancers were introduced as early as 1971 for all people with statutory health insurance. Since then, the offered preventive and early detection measures have been developed further based on current scientific knowledge.

So since 2009, there as been a nationwide mammography screening program in Germany for the early detection of breast cancer. Women aged 50 to 69 are invited to get a mammogram (x-ray of the breast) every two years. From July 2024, this will be extended to include women up to the age of 75.

Meanwhile, the statutory health insurance funds also invite people personally and in writing to get bowel cancer and cervical cancer screening at regular intervals. Along with the invitations, insured people are given comprehensive and balanced information about the benefits and risks of the particular examination at the same time. The invitations are used to provide customized information to insured people. But the examination can also be claimed without a prior invitation as soon as the appropriate age has been reached.

Currently, the health insurance funds bear the costs of the following examinations for the early detection of cancer and cancer screening: 

• cervical cancer screening
• breast cancer screening
• melanoma and non-melanoma skin cancer screening
• prostate cancer screening
• bowel cancer screening

Cervical cancer screening

• annual examination of the external and internal genitalia from the age of 20 years
• annual cervical smear for women aged 20 to 34 years
• cervical smear and human papillomavirus (HPV) test for women aged 35 years and up, every three years, provided the examination does not give any indications of cell changes and/or an HPV infection

Early detection of breast cancer

• annual breast exam and instructions on self-examination for women aged 30 years and up
• mammography of both breasts for women aged 50 to 69 years, every two years

Skin cancer screening

• complete physical examination of the skin for women and men aged 35 years and up, every two years for the early detection of malignant melanomas and non-melanoma skin cancer

Early detection of prostate cancer

• annual prostate exam for men aged 45 years and up

Bowel cancer screening

• annual fecal occult blood examination with an immunological stool test for men and women aged 50 to 54 years
• initial colonoscopy in women aged 55 years and up, and in men aged 50 years and up. If this is normal, it can be repeated after ten years. If changes such as intestinal polyps are found, the time to the next examination is reduced.
• if no colonoscopy is claimed, examination for fecal occult blood with an immunological stool test for women and men aged 55 and up every two years only

Assessment of the offered tests in terms of their benefits and risks depends on the type of cancer and examination method. 

The German Federal Joint Committee (Gemeinsamer Bundesausschuss, or G-BA) decides which early cancer detection examinations are included in the benefits catalog of the statutory health insurance funds. This decision-making body of our health system also determines who has a claim to these examinations, at what age and in which time intervals. 

Both statutory and private health insurance funds bear the costs of examinations regulated by law as a rule. Those with insurance can freely decide whether they would like to make use of the examinations or not. Participation is thus voluntary.

There are also examinations and tests that are offered in medical practices, but are not part of the statutory early detection program. The costs are not borne by the statutory health insurance funds. So these examinations have to be paid for privately if they are made use of. They are also called individual health services (in German: individuelle Gesundheitsleistungen, abbreviated to “IGeL”). Examples are the ultrasound examination of the ovaries and prostate or determination of some values from the blood or other bodily fluids in the laboratory. Individual health services are often medical measures for which there is no sufficient proof of their benefits or which have not yet undergone a benefit assessment.

As a general rule, participation in examinations for the early detection of cancer is voluntary. There is no time pressure, so it is possible to calmly learn about the advantages and drawbacks of early cancer detection examinations.

Advantages of early cancer detection

Thanks to participation in an examination for early detection, a cancer can be prevented (in the best case) or discovered at a very early stage. An early start to treatment increases the prospect of healing and decreases mortality. Furthermore, patients in an early tumor stage can often be treated with therapies that have fewer side effects. However, how big the advantages of early detection screening actually are depend on the type of cancer being examined. So for example, the benefit of particular examinations for early detection of breast cancer, bowel cancer and cervical cancer is scientifically proven and widely recognized by experts. This is a reason why personal invitations to these examinations and information are sent to the people entitled to claim them.

Drawbacks of early cancer detection

Along with the aforementioned advantages, examinations for the early detection of cancer can also be associated with drawbacks and stresses and strains.

• While an early diagnosis does increase the chances of healing, it does not provide any guarantee of this.
• A cancer may have developed so quickly that it will cause sudden symptoms between two exam appointments. 
• The examination itself can have risks such as complications during the colonoscopy.

Also, no method is 100% reliable. It may thus transpire that healthy people are inadvertently diagnosed as sick and sick people as healthy.

• It is quite common for a suspicious test result to be exposed as a false alarm (“false positive” result). Such false positive results involve irksome and unnecessary follow-up tests, for instance taking a tissue sample (biopsy).
• If a tumor is not discovered by a test, this is called a “false negative” test result. Those affected wrongly think that they are safe.

Overdiagnosis and overtherapy – what does that mean?

Thanks to early detection screening, slowly growing tumors can also be discovered. They do not cause symptoms and usually do not reduce life expectancy or limit the quality of life of those affected. The discovery of such a tumor as a result of early detection screening is called overdiagnosis. Its treatment – with all the associated complications and risks – is regarded as overtherapy. Unfortunately, it is not possible, as a rule, to predict with the currently available examination methods whether a tumor will grow slowly or aggressively in a patient.

If you would like to know which examinations for cancer screening and early detection you are entitled to, you can for instance get in touch with your family doctor.

Furthermore, there are websites that offer comprehensive information about these topics. These include:

IQWiG: health information on screening

Federal Ministry of Health (Bundesgesundheitsministerium): early detection of cancer for men and women

Cancer Information Service (Krebsinformationsdienst): screening and early detection of cancer

German Cancer Aid Foundation (Stiftung Deutsche Krebshilfe): early detection of cancer

German Agency for Quality in Medicine (ÄZQ): early detection

Mammography Board (Kooperationsgemeinschaft Mammographie): information about the Mammography Screening Program

Medical Service of the Central Association of Health Insurance Funds (Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V.): IGeL Monitor

If you need personalized information, you can also make direct contact with Cancer Information Service doctors by dialing the freephone number (0800) 420 30 40 or sending an email to krebsinformationsdienst@dkfz.de.