Breast cancer screening is a type of radiography examination method used to detect various changes in women's breasts. Mammography allows detection of onsetting tumour diseases and various benign tumours in breasts. This disease may be life-threatening to women; that is why preventive screenings are performed with all women from 45 to 69 years of age.
Women at particularly high risk of developing breast cancer represent a specific category for the mammography examination. These are mainly women who have previously had breast cancer, and those with a strong family history of breast and ovarian cancer in their immediate relatives, i.e. parents, children or siblings. The category also includes women with a confirm BRCA mutation (who bear genes BRCA 1 or BRCA 2). It is up to the diagnosing physician to evaluate the risk level; the breast screening is performed more frequently and in lower age than usual.
Mammography is the process of using low-energy X-rays to detect various changes in the human breast which may sometimes manifest even an onsetting tumour in the breast. Breast cancer screening plays a major role in breast cancer prevention. Early detection of early stages of diseases is vital for starting a successful treatment.
Mammography uses specific X-ray devices called mammograms to create images of the breast. Mammograms use doses of low-energy ionizing radiation to create images. It is mainly used in breast screening detecting breast carcinoma. Mammography allows for early detection of a tumour in its very early stage of development, when the tumour is so small to be palpable under the skin and it has not manifested any symptoms yet. If detected at this stage, it tends to be fully treatable.
Mammography is a preventive examination falling into the category of secondary prevention. It cannot prevent the tumour from occurring, but it may prevent the disease from spreading when detected early.
In the Czech Republic, general mammographic screening has been in practice since 2002 and it decreased breast carcinoma mortality by up to 30%.
In the Czech Republic, mammography is a treatment paid for by insurance companies in women from 45 to 69 years of age; they are to undertake it once in two years. All they have to do is bring an application for the screening issued by their general practitioner or gynaecologist. Women of 40 or more may also choose to get examined earlier or upon their own request. Once a year at maximum. If the woman pays for the examination herself, the price ranges from CZK 400-700.
Women with proven genetic disposition for cancer and women with a strong family history of breast and ovarian cancer in their immediate relatives, i.e. parents, children or siblings are also a specific group.
Another reason that may lead women to undergo mammography may be a lump they feel in their breast, if the woman is over 30 years old. In women under 30, ultrasound screening is preferred. Young mammary glands are denser and therefore less readable for mammograms. However, even women under 30 may be sent for the mammography screening, if the ultrasound screening proves inconclusive.
How Does a Mammograph Work?
The screening is very similar to X-ray screening, but there are several differences. The patient needs to position her breast correctly in order to minimize the dose of radiation received and to make the images as clear as possible. The mammograph has two boards in between the breast is inserted and pressed slightly. This pressing occurs gradually and should not be painful at all. Mammography screening and X-ray screening also differ in the range of radiation applied. The so-called low-energy radiation has lower energy and longer wavelength than radiation used for X-ray imaging of bones.
Mammography has its modifications; ductography and galactography. This screening method is applied in patients with abnormal milk duct secretion, if the secretion occurs on one side only and especially with secretion featuring blood. Such milky bilateral secretion is usually a symptom of a hormonal problem.
Mammography is performed in specialized wards called mammocentres. They provide experienced staff and equipment necessary for the screening. It is very suitable to frequent the same mammocentre; the doctors there will have access to all your previous screening images allowing them to evaluate potential changes that may have occurred since your last screening.
The screening itself requires no special preparation beforehand. It is more suitable for the screening to take place in the first half of the menstrual cycles, especially if your breasts get tenderer during menstruation; the right timing will prevent unpleasantness.
Before the actual screening, you remove your top, place the breast to be screened on the screening mat, between the pad and the compression pad. The screening worker provides the breast is positioned correctly and gently and gradually compresses it. The breast will be compressed between the pads with force 70-150 N. The compression is carried out by specialized trained workers and it should not be painful, although it may sometimes be unpleasant. However, certain extent of compression is necessary in order to obtain a quality image. The screening worker turns the mammogram on, creates an image and releases the breast. In total, the screening yields 4 images - one horizontal and one diagonal image for each breast.
The breast compression is necessary to make quality images that are well readable and easy to evaluate. The screening itself does not take more than 5 minutes. The doctor then examines and evaluates the images. This mammography screening allows detection of even the tiniest tumours that are not palpable in breast examination by the doctor or in breast self-examination. The X-ray screening is capable of imaging the breast with higher portion of cutaneous tissue - it is usual in older women. Younger women tend to have higher portions of connective tissue and glands, making the ultrasound screening method more suitable for them.
If the doctor discovers a tumour they consider risky, they apply for a follow-up mammography in 3-6 months. Most frequently, it is a cyst or a small benign tumour node of cutaneous or connective origin. Another possibility is that the doctor discovers a tumour node that could be potentially malignant and consequently they have to perform more tests to learn about its character. In such cases, a core-out biopsy is recommended. After numbing the area, a thin needle (2 mm in diameter) is inserted into the tumour node, some tissue is collected for the purposes of a histology examination and the doctor examines the inside of the breast using the ultrasound screening in order to insert the needle carefully and correctly. This procedure is usually out-patient; the patient may go home right after and the results will be available within several days.
Breast cancer is the most frequent malignant breast disease in women. Malignant tumour originates from cells of the mammary gland, and in the initial stages, women usually do not observe any symptoms. Larger tumours can be felt as a painless lump in the breast and later can manifest as palpable enlarged lymph nodes in the armpit. Cancer may manifest through changes in the shape of the breast, changes in nipples, indentures in breasts, breast pain, hardening and redness of the breast. Risk of breast cancer increases after women reach 40 years of age; there are also other risk factors such as history of breast cancer in the family, beginning menopause after the age of 55, the age of first pregnancy after 35 years of age, malignant disease and poor lifestyle. Protective factors against breast cancer are: pregnancy before 20 years of age, vitamin A, physical activity, breastfeeding, intake of beta-carotene and omega-3 fatty acids.
The actual treatment of breast cancer depends on the extent and clinical stage, either with surgical treatment, radiation therapy, chemotherapy, hormonal therapy and immunotherapy. To increase chances of recovery, it is necessary to detect breast cancer as early as possible, which is allowed by the mammography examination.
The aim of the preventive mammography is early detection of breast cancer and reduction of mortality from this disease. Breast self-examination and regular gynaecological examinations are an essential part of prevention.
Preventive mammography leads to early detection of breast cancer and reduce mortality from this disease.
Breast Cancer - Myths
The number of breast cancer patients is fairly high; the threat of the disease also gives ground to many myths about breast carcinoma. Breast cancer became a boogeyman for women in advanced western-world countries.
What are the most notorious myths about breast cancer?
- Wearing underwired bras may increase the risk of breast cancer.
No research has ever confirmed this assumption; doctors deny this myth, but some alternative healers point out that wires push on lymph glands in the lower section of the breast and lead to toxins being gathered in the tissue.
- Using deodorants and antiperspirants in your armpits may lead to breast cancer.
No research has ever confirmed the link between using deodorants and antiperspirants in armpits and occurrence of cancer. Human body is able to easily break down substances in these products.
- Only women with history in breast cancer in their family are at risk of getting breast cancer.
Up to 70% of diagnosed breast cancer patients have no family history of breast cancer.
- The smaller the breasts the lower the risk of malignant tumour.
There is no link between breast size and risk of tumour occurrence.
- You may cause breast cancer by bumping into your breast.
Cancer never originates from injury.
- Frequent flying increases the risk of breast cancer because the body is exposed to radiation more frequently.
It has never been proven that flying increases the risk of breast cancer.
- Cysts in breasts are heralds of cancer.
They are not. It is not even recommended to operate them; their content is removed with a needle and it is necessary to check up on them regularly. There is a very small chance that a papilloma may originate from the cyst's epithelium. However, it is nonsense to say that a cyst is just a first step to breast cancer.