Mammography (assessment tests)

Content

Introduction

Mammography is an X-ray examination carried out to identify the possible presence of breast lumps due to a tumor disease. Breast cancer is the first cancer for frequency and mortality among female neoplasms but, thanks to the progress achieved both in the recognition of the disease in the initial stages (early diagnosis) and in its treatment, the chances of recovery are now much increased.

Mammography is used as a test for early detection ( screening) tumor nodules still not identifiable on palpation.

It can also be prescribed by the doctor outside of screening programs when lumps or other signs are detected on palpation of the breast which, in his opinion, require an investigation to ascertain (diagnose) their nature.

Thanks to the organized screening programs, carried out with mammography, the discovery of this tumor in the early stages is now more and more frequent. This facilitates the rapid initiation of care and improves the probability of survival.

Breast cancer screening, according to the indications of the Italian Ministry of Health, is aimed at women between the ages of 50 and 69 and requires the examination to be performed every two years. in fact, most breast cancers and, according to the experts of the International Agency for Research on Cancer (IARC), participation in the screening organized every two years, can reduce the mortality caused by this disease by 35%.

Sometimes, doctors suggest more frequent or closer checks for the presence of risk factors such as, for example, cases of breast or ovarian cancer in the family that increase the likelihood of breast cancer even in old age. younger.

Although this is a consolidated activity, which has demonstrated its effectiveness in reducing mortality from this cancer, today there is debate on the risk of the so-called overdiagnosis linked to screening mammogram. Basically, it discusses the undesirable effects of the detection and treatment of tumors that could have no influence on the quality or life expectancy of the woman under examination. For example, in the event that the tumor identified by mammography had a growth very slow or in the event that the woman dies from other causes independent of breast cancer, the possible risks associated with her treatment could outweigh the benefits of having discovered it at an early stage. However, today we do not have tools that allow us to predict which Tumor lesions are set to rapidly become invasive cancer and which will remain silent for years Available research suggests that this risk is less than the benefits of having a mammogram every two years between the ages of 50 and 69.

The test

All women can undergo mammography to check for the possible appearance of potentially dangerous formations and there are no conditions that limit the execution of the examination, except for pregnancy.

In case of breast implants it is necessary to inform the operator before carrying out the exam.

No preparation is required, anesthesia is not necessary and there are no consequences that require the presence of a companion.Some studies suggest that in women not yet in menopause, the test is more effective if performed in the first two weeks after the start of the menstrual flow.

The examination involves a brief compression of the breast (breast) between two plates of a special radiographic equipment that allows to expose the compressed tissues to a modest amount of X-rays. Two radiographs are taken for each breast, from different angles. compression, some women find the exam painful, but the discomfort lasts only a few minutes. The execution time of a mammogram is in fact 5-10 minutes and, once the exam is finished, everyone's normal life can be resumed immediately. the days.

The radiological equipment used ensures that the X-ray dose delivered is kept as low as possible and the risk associated with radiation exposure is negligible compared to the advantages of early tumor diagnosis (read the Hoax). Like any exam, mammography also has limitations and can determine either false positives (abnormal results in healthy people) or false negatives (normal results in sick people). The presence of a lesion may not be detected, for example, due to difficulty in interpreting the characteristics of the breast tissue, through the X-ray images, in some particularly dense breasts or if the lesion is so small that it is not yet detectable. It is therefore very important that all women pay attention to any breast changes in the time interval between two mammography exams, performing self-examination, to report them promptly to their doctor.

Results

Mammography produces digital, black and white images of breast tissue that can be viewed on a computer screen. It is the radiologist's task to evaluate these images, carefully verifying the possible presence of suspicious formations.

For the purposes of interpreting the results, it is important for the radiologist to have a previously performed mammogram that allows them to compare the images and identify changes in the areas observed. For this reason it is useful to always carry the previous mammography exam with you.

In screening programs, the results are evaluated separately by two radiologists to ensure greater reliability of the diagnosis. If the mammogram is normal, a letter is sent home with the result of the examination inviting the woman to repeat the screening test after 2 years up to 69 years of age. If the mammogram shows reading problems, and / or "dubious" images, the woman is asked to undergo further diagnostic tests which may include an additional mammogram, performed with magnification, and an ultrasound. The latter examination, in general, is not recommended as a screening test but may be useful in particular cases, especially in younger women, or to investigate the nature of a lump allowing, for example, to detect its liquid or solid nature.

In some cases, mammography and ultrasound may be followed by a biopsy, an investigation that consists in taking a small amount (sample) of tissue from the suspected area, to assess the presence, or not, of any cancer cells.

Only at the end of this process is it possible to confirm the diagnostic suspicion and, in case of positive, proceed with the treatment which, in most cases, involves surgery and, in cases selected on the basis of the characteristics of the woman and the tumor removed, integrated therapies such as chemotherapy.

In-depth link

Italian Association for Cancer Research (AIRC). Breast cancer screening

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