Application areas of mammography
1. if changes or lumps have been noticed during the self-examination or the examination by the doctor, they can be further examined by mammography 2 In Germany there is also the “mammography screening”. Women who have no risk factors should be mammographed routinely every two years between the ages of 50 and 69. Women with risk factors (e.g. breast cancer diagnosis in close relatives or with breast cancer in their own medical history) should also have mammograms performed earlier and annually (see breast cancer risk).
The success of mammography screening is controversially discussed. Proponents say that for women between 50 and 70 years of age, it leads to a reduction in breast cancer mortality of about 25% to 30% after 5 to 6 years. Critics point to new data evaluations and criticize that the figures of 25 % – 30 % refer to the relative risk reduction.
It has been shown that this relative risk reduction is often misunderstood by both patients and physicians, or the expected benefit for the participants is overestimated. In absolute terms, it means (absolute risk reduction): In relative terms, this is a reduction of 25 %.In other words, out of 1000 women who take part in serial mammography five times during 10 years, 999 women will not benefit because they do not die of breast cancer anyway (996 women) or because they die of breast cancer anyway (3 women). The absolute risk reduction is therefore only 0.
1%. However, one in 1000 women is saved by mammography screening.
- During 10 “screening years” 4 out of 1000 women die of breast cancer without mammography screening.
- During 10 “screening years” with mammography screening the number of deaths decreases from 4 to 3 per 1000 women
Digital Mammography
The principle of digital mammography is the same as that of “normal” mammography, the difference is in the images produced. Whereas in “normal” mammography, the familiar X-ray images are created according to a principle similar to that of a camera, in digital mammography the resulting images are not projected onto a foil, but are converted directly into a computer file. Advantages result from the digital post-processing of the images, which is thus made possible, and the possibility of producing three-dimensional images of the breast.
If one compares the resolution and contrast of the images produced by the various methods, the advantages of conventional mammography currently still outweigh the disadvantages, although microcalcifications (see breast cancer types) are easier to detect with the digital method. The radiation exposure is somewhat lower with digital mammography, but it causes high costs for the clinics due to the necessary purchase of new equipment, and the evaluation of the images must first be learned by the physician. Overall, however, digital mammography is on the rise.
Magnetic resonance mammography (MRI mammography or MRI of the breast) is a procedure in which strong magnetic fields are used to produce various sectional images that can later be combined to form a three-dimensional image of the breast. In magnetic resonance mammography, a contrast medium is injected into the body through a vein in the arm before the actual examination in the so-called “tube”. The patient must then lie in a prone position in the magnetic resonance tomograph (MRI) for 30 minutes, if possible without moving much.
For more information on the MRI of the breast, please see MRI of the breastMagnetic resonance mammography has the highest sensitivity and accuracy in detecting invasively growing breast tumors. In the case of dense glandular tissue, the combination of X-ray and magnetic resonance mammography offers the highest degree of diagnostic certainty for the exclusion of breast cancer. For experienced examiners, the sensitivity of the examination is approx.
90%, although there are also approx. 20% of “false malignant” findings. But even with this most complex method not every cancer can be found.
The quality of the examination varies greatly, which is why the insurance companies only reimburse the examination in a few selected clinics. Due to the great effort involved in the examination and the high costs, MRI mammography is not a routine examination and is not suitable as a screening method. Most health insurance companies only pay for the examination in special cases and on request.
MRI mammography is used as a supplement for findings that cannot be clarified by other examinations, especially in the case of non-palpable findings. It is also used in cases of residual suspicion after an inconspicuous cell/tissue sample (biopsy) and in cases of suspected multiple cancer foci in one breast. MRI mammography has been used with great success in some studies for the early detection of recurrences, i.e. when the cancer returns after treatment, or for the diagnosis of a second, still very small carcinoma in the other breast with existing breast cancer findings. As an alternative to digital mammography, magnetic resonance imaging can be used if a patient has very dense breast tissue or breast implants. Radiation-free magnetic resonance mammography can also be used instead of digital mammography in high-risk patients (for example in cases of particular family stress).