Secondary Prevention

It has been shown that suitable early detection measures can significantly reduce the mortality for many types of cancer, particularly cervical and breast cancer. In the case of breast cancer, a high-quality screening program is currently the most effective measure that can be proposed to reduce mortality. Early detection programs can also reduce deaths due to melanomas of the skin. Finally, various possibility are being recognized for the effective early detection of colorectal cancer.

Regarding the higher mortality rates for cervical cancer in the former GDR, it should be determined how differences in the effectiveness of early detection programs contribute to the disparity between east and west. In this case the stage may already be set for a rapid improvement in mortality rates as health care practices in eastern Germany are raised to the level of western standards.

Long-term epidemiologic studies in various countries have shown that a high-quality mammographic screening program can reduce breast cancer mortality by 25-30% in women 50-70 years of age. Effective screening mammography requires strict adherence to the quality standards that have been identified in studies and recently issued as guidelines by the European Union. It must be determined whether a consensus exists in Germany for offering such a program to women. If so, pilot projects should be initiated without delay.

Finally, screening for the early detection of melanoma is available as an effective measure for reducing the mortality of this disease. Current projects should be continued or expanded.

Several approaches are available for colorectal cancer screening. It appears that mortality can be reduced somewhat by performing occult blood tests as part of the screening process. Perhaps a significant reduction in mortality could be achieved by applying endoscopic techniques, but the acceptance of this invasive method would probably be low. Pilot projects should be designed to test the feasibility of the various approaches and their effectiveness in reducing the mortality of colorectal cancer.