Breast cancer is the most common form of cancer in women – in Germany, about one in ten will develop it during their lifetime. Mammography offers the opportunity to detect the tumor early and thus significantly improve the prognosis. Fortunately, a breast cancer diagnosis today no longer means a death sentence. In most cases, a gentle and breast-preserving therapy is even possible. However, the prerequisite is that the tumor is detected at an early stage. Regular self-examination and breast palpation by the gynecologist are important for this. In addition, mammography offers the best possibilities. Therefore, since 2005, every woman in Germany between the ages of 50 and 69 is entitled to mammography screening every 2 years.
Principle of mammography
Mammography uses X-rays to screen the breast (“mamma”). X-ray images are taken in two planes. From these different angles, changes can be compared and better evaluated. A special type of X-ray is used, which allows the soft tissues of the mammary gland to be visualized particularly well. The images are then examined by a physician, often with the aid of a magnifying glass.
Criticism of mammography
The difficulty with assessment is that not every breast can be assessed equally well. For example, in women taking hormones, those who are younger, or those with larger breasts, the tissue is often very dense and changes are difficult to assess. As a result, it is very rare for an abnormality to be missed or, more often, for a finding to be wrongly considered suspicious and therefore prompt further investigation. It is discussed that radiation exposure increases the risk of developing breast cancer – however, this has not yet been proven. Moreover, as a result of technical developments, the exposure is much lower than it was a few years ago. The risk is offset by the fact that breast cancer can be detected very early with the help of mammography, which significantly increases the chances of cure.
When mammography is performed
There are several situations in which mammography is indicated:
- Symptoms: If the woman or her gynecologist discovers a suspicious lump or hardening of the breast, palpates an enlarged lymph node in the armpit, or if complaints arise that raise suspicion of a tumor, mammography – along with ultrasound examination – is the first method of examination using equipment. Most changes can be well detected, localized and evaluated with it.
- Increased risk of breast cancer: if a woman has a family history of breast cancer, has a history of breast cancer herself or has been diagnosed with precancerous lesions, she is entitled to an examination at regular intervals.
- Cancer screening: mammography is the only method that can detect the smallest calcifications (microcalcifications), which are a typical early sign of breast cancer. Therefore, it is the method of choice for cancer screening. A baseline examination is recommended between the ages of 30 and 40, during which the mammary gland tissue is assessed and any risk factors are detected. Between the ages of 50 and 69, screening examinations should then be performed at regular, usually two-year intervals.
Procedure of mammography
A mammogram is usually performed in a radiology office or the X-ray department of a hospital. No preparations by the patient are necessary. However, she should avoid using body lotion, body powder, or deodorant beforehand, if possible – these can distort the image. For the same reason, metal parts must be removed from the examined region. The examination takes only a few minutes per breast. In rare cases, it may be necessary to additionally inject contrast medium into a mammary gland duct (galactography) in the case of special findings. Before the X-ray examination, a doctor palpates the breasts, and in some cases again afterwards. During the examination, the breast is gently pressed flat between two plates – the X-ray tube and the film table. Most women find this uncomfortable or even painful. However, it is necessary in order to reduce the radiation exposure and to image the structures in the X-ray image more sharply and thus to be able to assess them better.The most favorable time for an examination is therefore directly after menstruation. This is when the mammary gland tissue – which is subject to hormonal fluctuations – is least sensitive. If cancer is suspected, mammography should of course be performed immediately.
Further examinations if breast cancer is suspected
A change in the mammogram can often only be better assessed with the help of an ultrasound examination (sonography). This can be used to distinguish benign from malignant tumors and cysts from solid tissue changes. However, since sonography cannot detect microcalcifications, it is not suitable as the sole screening examination. Another additional examination is magnetic resonance imaging, which can be used to specify tissue changes, and biopsy, in which changes are punctured under local anesthesia and usually with sonographic control, and tissue is removed for microscopic examination.
