Photo by Ana Garcia De La Blanca
Each year a staggering amount of women avoid being screened for breast cancer because they are afraid that the radiation itself will cause the disease.
The Centre for Microdose Mammography in Tegel is painfully aware of this fact and is one of the few practices in Berlin that prides itself on employing an innovative Swedish low-dose mammography technique that reduces radiation by 80 percent and produces exceptionally detailed x-ray images.
Dr. Ehler is one of five doctors who work in a close-knit team. She performed the one-hour breast-screening process for us: a mammography followed by a patient-doctor consultation, a physical examination (palpation) of the breast, and a final ultrasound.
What are the regulations in Germany regarding compulsory breast examinations?
If the patient has a healthy family history and no prior symptoms, screening is compulsory from the age of 50 and once every two years thereafter.
The average age for breast cancer is 63, but a lot of younger women come in if they feel pain or are anxious.
Are many women scared to have these check-ups?
Lots of patients don’t come in because they don’t see the point. Some 18,000 women die of breast cancer a year, and they think, “Well that’s that. I’ll die anyway.” Then they say, “It’s radiation.” They call it Bestrahlung, but actually they should call it ‘radiation exposure’.
When I fly to, say, Thailand, I don’t say I just got “radiated”. You can’t get rid of this fear in the women, so as radiologists we really have to fight and say that with radiation you can prevent cancer if you recognise it early. And with a technology that reduces radiation so dramatically.
Low-dose mammography sounds great, but does health insurance pay for it?
Only private insurance. But many people, especially among the younger ones, are happy to pay €98 to receive the treatment with the lowest radiation.
There are types of cancers that can only be detected with a mammography, and others are better detected by an ultrasound. If only an ultrasound is done, there are calcifications that can’t be seen. The methods have to complement each other, as they display different results.
Are there a lot of young women coming in?
Yes, and they obviously stick in my mind more. For check-ups, the youngest are born in the 1970s. There was one patient who was born in 1974, and she came in with pain on one side and definitely had breast cancer. Then there are those who come because they’re burdened by their family history.
Do you see a lot of fake breasts?
Strangely enough there aren’t so many here. But I used to work in Cologne and, there, we had a huge number of patients who had implants.
Can you remember the first time you had a breast in your hand?
It must’ve been in 1990. I was in Israel doing a traineeship in a gynaecology practice, learning about births and breasts. In Germany they’re not so keen on letting trainees get close. It was a great experience, and I examined a lot of breasts there.
What’s the worst tumour you’ve ever seen?
Tumours that grow out, that smell and are ulcerous – it’s terrible. These patients most likely live alone and ignore it. So many patients claim, “I injured myself and it’s not healing.” Then on the other hand, there are hysterical patients who are constantly getting check-ups.
What’s the amount of before you can say the cancer is gone?
That’s almost a philosophical question. You can see it statistically, like after x amount of years if there’s no reoccurrence, then the chances of a reoccurrence is close to none.
The philosophical way of seeing it is that once you’ve got active cancerous cells, you’ll always have cancer and you have to take care of that. It stays in your blood, you remain a cancer patient and we can’t let the patients forget that.
There are programmes that give these patients the strength to say they have breast cancer and stay positive about life.
Zentrum für Microdosismammographie, Berliner Str. 25, U-Bhf Borsigwerke, Tel 030 4373 1803