Evaluation of preventive technologies in Germany: Case studies of mammography, prostate cancer screening, and fetal ultrasound

Objective: In this article, three preventive strategies - mammography screening for breast cancer, PSA screening for prostate cancer, and routine ultrasound in normal pregnancy - are discussed in the context of German health care. Methods: Epidemiologic data and German studies evaluating different aspects of these preventive measures were identified and analyzed. Results: Only a few studies could be identified that investigate these preventive measures. Despite sufficient evidence, in part derived from a German study, there is not yet a mammography screening program. In contrast, ultrasound in pregnancy is offered routinely, although there are controversies regarding the benefit of this practice. PSA screening is not offered as part of the screening program for prostate cancer. However, PSA tests as well as mammographies are done in large numbers in German ambulatory care - a practice that could be considered wild or opportunistic screening. Conclusions: These case studies show that preventive programs and practices in Germany are not sufficiently based on sound evidence. The paucity of evaluation activities related to prevention in Germany is probably due to the low threshold to introduce new preventive programs into the German healthcare system in the past.