Early-1	Early detection
	a. Early breast cancer detection is a cross-sectoral task. There should be a quality-assured, interdisciplinary combination of clinical examination, instrument-based diagnosis, surgical exploration and pathomorphological evaluation.
GCP	(Albert US et al. 2008)
	b. The care chain requires complex and quality-assured medical documentation to unify the whole quality management process.
GCP	(Albert US et al. 2008)
	c. Cancer registries are as important as they are necessary for the evaluation and quality assurance of early breast cancer detection. All patients diagnosed with breast cancer should therefore be reported to a cancer registry including the relevant details on primary findings and primary therapy. Cancer registries contribute to evaluation and quality assurance through population-related and regionally based analyses of tumor stages and long-term follow-up (recurrences and survival). When an early detection program is instituted or adapted, baseline data should be available for the preceding period.
GCP	(Albert US et al. 2008)
	d. Examinations for early detection can cause physical and mental stress. This situation must be urgently addressed by careful information and an effective communication strategy.
GCP	(Albert US et al. 2008)
Grade of recommendation A	e. In the context of early breast cancer detection, information should not just be confined to preformulated texts, but necessitates an informational discussion with the doctor that takes account of the womanʼs preferences, needs, worries and anxieties and allows joint decision-making for informed consent. In the case of mammography screening, information and explanations should be provided to the woman in the first place in writing, with the additional mention of the possibility of a consultation with the doctor in the invitation letter.
	(Albert US et al. 2008)
	f. Health outcome and quality of life should be recorded and evaluated in the long term with particular regard to any false-positive and false-negative findings in the diagnostic chain.
GCP	(Albert US et al. 2008)
	g. Women should be offered the possibility of discussing their medical history and possible risk factors as part of the statutory early cancer screening.
GCP	(Albert US et al. 2008)
Grade of recommendation A	h. The main population-related risk factor for the development of breast cancer is advanced age.
Level of evidence 2a	(Albert US et al. 2008)
Grade of recommendation B	i. Next to the BRCA1/2 mutation, high mammographic density (ARC3 and 4) is the greatest individual risk factor, so that the limited sensitivity of mammography in this context should be enhanced by an additional ultrasound scan.
Level of evidence 3b	(Albert US et al. 2008)
j. Women aged 70 years and over can be invited to participate in early detection measures, with due regard to the individual risk profile, health status and life expectancy.
GCP	(Albert US et al. 2008)
	k. Women with a BRCA1 or BRCA2 gene mutation, or with a high risk defined as a heterozygous risk > 20 % or a permanent lifelong risk of developing the disease > 30 %, should seek advice in specialist centers for hereditary breast and ovarian cancer and be counseled about an individual early detection strategy.
GCP	(Albert US et al. 2008)
Grade of recommendation A	l. Quality-assured mammographic screening at 2-year intervals in women aged between 50 and 70 years old is suited for detecting breast cancer early. At present, it is the only method generally recognized to be effective in detecting early stages of breast cancer or early tumor stages.
Level of evidence 1a	(Albert US et al. 2008)
Grade of recommendation A	m. Self-examination of the breasts, even with regular application and training, is not sufficient as a method on its own for reducing breast cancer mortality.
Level of evidence 1a	(Albert US et al. 2008)
	n. Women should be encouraged through qualified information to familiarize themselves with the normal changes of their own body. These include the appearance and feel of the breast so that the woman can identify any abnormalities herself.
GCP	(Albert US et al. 2008)
	o. The clinical breast examination, in other words palpation, breast inspection and evaluation of lymphatic flow, should be offered annually as part of the statutory early screening tests for women aged 30 years and over.
GCP	(Albert US et al. 2008)
	p. Ultrasound on its own is not suitable as a method of early detection.
GCP	(Albert US et al. 2008)
B	q. CE-MRI should be utilized as a supplementary method in the presence of a familial increased risk (BRCA1 or BRCA2 mutation carriers, or with a high risk defined as a heterozygous risk > 20 % or a permanent lifelong risk of developing the disease > 30 %).
Level of evidence 2a	(Albert US et al. 2008)