EN
Between “a lump has been found” and “we know what it is” lie a few days, and they are the hardest days in the whole story. German breast diagnostics is built so that this gap is as short as possible and ends in certainty rather than in a referral for yet another test. Here is what it consists of and what has changed in it over the past two years.
Screening: the age limits have moved
Germany runs a national mammography screening programme — examination of women without complaints, paid for by the statutory health insurers. For many years it covered ages 50 to 69. From 1 July 2024 the upper limit was raised to 75: about 2.5 million more women became entitled to a free mammogram every two years. At first they had to book themselves; since January 2025 women aged 70 to 75 receive personal invitations by post, like the other participants in the programme.
The lower limit remains unchanged for now, but here too things are moving: in March 2026 an amendment to the federal ordinance came into force recognising the balance of benefit and risk as acceptable for ages 45 to 49. The decision on whether to include this group in the programme is to be taken by the Federal Joint Committee (G-BA) in the autumn of 2026. So as things stand, screening means 50 to 75 years of age, every two years, with a likely extension downwards in the foreseeable future.
The design of the programme matters more than the equipment: the images in it are read independently by two doctors, a third is brought in where they disagree, and the centres themselves are regularly audited on image quality and on the number of cancers detected. This is what a patient rarely sees, and it is exactly what distinguishes the programme from “simply having a mammogram”.
If there is a complaint or a finding
Here the logic is different: not screening but a targeted examination. The standard set is digital mammography, often with tomosynthesis (a series of images from different angles from which a layered picture of the breast is built; this helps where the tissue is dense and everything merges on an ordinary image), plus high-resolution ultrasound. In young women with dense tissue ultrasound is often more informative than X-ray, so it is done first.
Contrast MRI of the breast is not used for everyone but where indicated: hereditary risk, an unclear picture on the studies already done, assessment of extent before surgery, monitoring during drug treatment.
Findings are reported on the international BI-RADS scale — from “normal” to “high probability of malignancy”. The category determines the next step: a follow-up in six months, routine surveillance, or a biopsy. The convenience of this is that it removes ambiguity: the figure in a report means the same thing in any country.
Why a biopsy, and why it need not be feared
No image gives a final answer — only tissue does. That is why in Germany a suspicious lesion is virtually always sampled with a needle first, rather than operated on straight away.
Most often a core needle biopsy is done under ultrasound guidance: under local anaesthetic, several cores of tissue are taken through a puncture. If the lesion is visible only on mammography — microcalcifications, for instance — a vacuum-assisted biopsy is used under X-ray or tomosynthesis guidance: the tissue is drawn in by negative pressure, which yields more material from an exact point. Both procedures are outpatient, take less than an hour and need no stitches. A substantial proportion of such findings turn out on examination to be benign, and the biopsy closes the question rather than opening it.
If a tumour is confirmed, its biological properties are determined from the same material: hormone receptors, HER2 status, the index of cell division activity. All further tactics depend on this — which is why in Germany treatment is not begun until the pathology report is complete. The case is then discussed by the multidisciplinary board of the breast centre: gynaecologist, oncologist, radiologist, radiation oncologist, pathologist, plastic surgeon, psycho-oncologist.
Hereditary risk and a second opinion
If there have been cases of breast or ovarian cancer in the family, particularly at a young age, a separate consultation at a centre for familial breast and ovarian cancer makes sense: there the indications for genetic testing are assessed and, where the risk is confirmed, an intensive surveillance programme is offered — with an earlier start, annual MRI and more frequent examinations. This is a separate pathway, not the same as ordinary screening.
And one more thing: an opinion on the images and on the biopsy slides can be obtained without travelling. For a second opinion you need a disc with the studies, the medical records and the pathology material — blocks or slides. Review of the material by another pathologist sometimes refines both the diagnosis and the subtype of the tumour, and with it the plan.
This material is for information only and does not replace a consultation with a doctor. Which examinations are needed and how they are to be interpreted can be determined only after an examination at the clinic in person.