Dr. Andrea Gartenbach: New Methods of Cancer Prevention

Cancer ranks second overall among causes of death in Germany. In the European Union in 2022, it was the leading cause of death among women under 65 and the second most common among men. In every decade of life, it is one of the most common causes of premature mortality. The timing of the diagnosis dramatically affects the chances of cure.

For example, breast cancer has a cure rate of over 90 percent in stage I, but in advanced stages it drops to well below 30 percent. Lung cancer, if detected early, is successfully treated in about 60 percent of cases, while in the late stage, fewer than ten percent of those affected survive. For pancreatic cancer, the five-year survival rate with early diagnosis is around 38 percent, but in late stages it is only about three percent.

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Despite modern therapies, the chances of cure with later cancer diagnoses have not yet improved significantly. Therefore, a well-thought-out and individually tailored early detection strategy is essential.

Cancer: What statutory prevention provides

The existing statutory early detection programs are clearly structured, evidence-based, and free of charge for all insured persons. However, they only cover selected types of cancer. For cervical cancer, there is an annual examination starting at age 20, and from age 35, it is combined with an HPV test every three years. HPV stands for human papillomaviruses, which can cause cervical cancer.

Breast cancer is checked annually by palpation starting at age 30, and additionally by mammography every two years between ages 50 and 75. Skin cancer is examined every two years from age 35 through a skin check. Colon cancer screening begins at age 50 with an annual FIT test, which detects blood in the stool, or a colonoscopy after ten years with an inconspicuous finding).

Cancer prevention and early detection for women and men

Detect cancer early, even before it causes symptoms. Which preventive check-ups are recommended and when? What does the insurance cover? A guide.

Prostate cancer is detected annually by a palpation examination starting at age 45, with a PSA test done based on individual decision.

These prevention programs are important and helpful, but they by no means cover all types of cancer. For example, there are no regular insurance screenings for pancreas, ovaries, liver, or esophagus, because these types of cancer occur less frequently or currently no broadly validated early detection methods exist.

Moreover, no single test reliably detects every stage of a tumor. For example, colon cancer: the FIT test detects blood but does not necessarily discover tissue changes that occur without bleeding.

That's why modern, additional diagnostic methods are indispensable to the standard methods. The most sensible strategy is "stacking": combining several tests to add strengths and compensate for weaknesses, such as combining an imaging method like MRI with a liquid biopsy.

Why medical supervision is indispensable in cancer

Cancer screening is not a single isolated test but a medical process. An abnormal finding must be placed in the context of individual risk factors. Medical supervision ensures that no unnecessary interventions occur, important examinations are not missed, and every decision is made with awareness of the opportunities and risks.

Modern technologies can close these gaps

An example from my practice: A patient, 62 years old, a former heavy smoker, wanted to realistically assess his lung cancer risk. Given his history, we decided to perform an annual low-dose CT of the lung. This is a low-radiation computed tomography that can make fine tissue changes in the lung visible.

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In addition, we conducted a liquid biopsy. The first CT already showed a small shadow in the right upper lobe. The complementary liquid biopsy was inconspicuous. In the following months, the finding remained stable, so we assumed a benign change. For the patient, this meant not only medical safety but also the assurance that we would detect changes early and avoid unnecessary interventions.

What diagnostic methods are currently available to us?

1. MCED tests (Multi Cancer Early Detection) and liquid biopsy: Blood tests that detect cell-free tumor DNA or characteristic methylation patterns. Tumor cells release tiny DNA fragments into the blood, often measurable long before symptoms appear.
2. Low-dose CT of the lungs: Low-radiation computed tomography for early detection in high-risk individuals, such as long-term smokers.
3. Multiparametric MRIs: Radiation-free high-resolution diagnostics that combine multiple tissue parameters, particularly valuable in prostate or breast cancer.
4. Whole-body MRI: Radiation-free imaging of the entire body, suitable for increased overall risk, provides comprehensive overview but can also produce incidental findings.
5. Urine biomarkers: Established for follow-up in bladder cancer, useful as an addition for high-risk patients.
6. Stool DNA tests: Possible in addition to the FIT test, standard in some countries.

In summary: Early detection is a building block system. We rely on the stacking principle: Multiple procedures are combined to add strengths and minimize weaknesses of individual methods. It is crucial to consider sensitivity (how well a test actually identifies the sick) and specificity (how well it does not falsely classify healthy individuals as sick) in the context of individual risk. A positive test result must always be associated with a clear strategy: Screening is only meaningful if treatment is desired and possible in the event of a serious case.

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Early detection is no guarantee of a cure, but it offers great opportunities. Here, attack is the best defense. And: Not every detected tumor is life-threatening. Some grow so slowly that they would never cause symptoms. Tests with high sensitivity can lead to false alarms, which are psychologically and medically burdensome. However, smart prior consideration can greatly reduce these false alarms.

Four questions help make the right decisions in advance:

1. What is my personal risk, depending on age, genetics, lifestyle, and pre-existing conditions?
2. Which test suits me, classical or innovative, and what is its significance and limitations?
3. What does a positive result mean for me, am I ready for further diagnostics or treatment? Screening makes sense if there is a clear, accepted procedure in the positive case, from confirmation through staging to therapy.
4. Who accompanies me, assesses findings and coordinates the next steps?

Today we have more opportunities than ever to detect cancer at a curable stage. Those who use established programs, adapt diagnostics to their individual risk profile, combine suitable methods and have them properly classified by a competent doctor, significantly improve their chances of many healthy years of life.

In longevity medicine, this means not only preventing diseases but strategically shaping health: proactive, forward-looking, and scientifically based. As a doctor of preventive and personalized medicine, I see my task as developing an individual, highly precise health management for each patient. The goal: To ensure long-term health!

Dr. Andrea Gartenbach: Precision medicine is the key to a healthy and happy life.

Dr. Andrea Gartenbach is a specialist in Internal and Functional Medicine, an expert in longevity, and a former competitive athlete. In her current column for Premium Medical Circle, she explains why she believes in precision medicine and how it works.