Mammography – X-rays used to diagnose breast cancer

Mammography – X-rays used to diagnose breast cancer

Breast cancer is the most common form of cancer in women – in Germany, around one in ten will develop it during their lifetime. Mammography offers the possibility of detecting the tumour early, thus significantly improving the prognosis. Fortunately, a breast cancer diagnosis is no longer a death sentence. In most cases, even a gentle and breast-conserving therapy is possible.

The prerequisite, however, is that the tumour is discovered early. Regular self-examination and breast palpation by the gynaecologist are essential for this. In addition, mammography offers the best options. That is why, since 2005, every woman in Germany between the ages of 50 and 69 has the right to a mammography screening every two years.

principle of mammography

In mammography, the breast (“mammary”) is examined with the help of X-rays. X-ray images are taken in two planes. From these different perspectives, changes can be compared and better assessed. A particular type of X-ray is used, with which the soft tissue of the mammary gland can be shown particularly well. The images are then examined by a doctor, often with the help of a magnifying glass.

 

criticism of mammography

The difficulty in the assessment is that not every breast can be assessed equally well. In women who take hormones, in younger people or with larger breasts, the tissue is often very dense, and changes are difficult to assess. This can mean that very rarely, a deviation is overlooked or – more frequently – a finding is wrongly considered suspicious, leading to further investigations.

It is being discussed that exposure to radiation increases the risk of developing breast cancer – but this has not yet been proven. In addition, the burden as a result of technical developments 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 recovery.

When to do the mammography

There are several situations in which a mammogram is indicated:

  • Symptoms: If the woman or her gynaecologist discovers a suspicious lump or a hardening of the breast, feels an enlarged lymph node in the armpit, or if symptoms arise that lead to the suspicion of a tumour, mammography – in addition to the ultrasound examination – is the first instrument-based examination method. Most changes can be easily identified, localized and evaluated with it.
  • Increased risk of breast cancer: If a woman has had breast cancer in the family, has had breast cancer herself in the past, or has had early stages of cancer diagnosed, she is entitled to regular check-ups.
  • Cancer prevention :  Mammography is the only method that can detect the smallest calcifications (microcalcifications), which are a typical early sign of breast cancer. This is why it is the method of choice for cancer screening. A basic examination between the ages of 30 and 40 is recommended, during which the mammary tissue is assessed and any risk factors are identified. Between the ages of 50 and 69, screening examinations should be carried out at regular intervals, usually every two years.

 

Mammography process

A mammogram is usually performed in a radiology practice or the X-ray department of a hospital. No preparation is necessary for the patient. However, if possible, you should not use any body lotion, body powder or deodorant beforehand   – these can distort the absorption. For the same reason, metal parts must be placed in the examined region. The examination only takes a few minutes per breast.

In rare cases, if there are special findings, it may be necessary to additionally inject contrast medium into a mammary gland duct (galactography). Before the X-ray examination, a doctor feels the breasts, and in some cases again afterwards. During the examination, the breast is carefully 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 to reduce the radiation exposure and show the structures in the X-ray image more clearly and, therefore, to assess them better. The best time for an examination is, therefore, immediately after menstruation. This is when the mammary gland tissue – subject to hormonal fluctuations – is least sensitive. If cancer is suspected, mammography should, of course, be carried out immediately.

Further examinations if breast cancer is suspected

A change in the mammography can often only be better assessed with the help of an ultrasound examination (sonography). This allows benign tumors to be distinguished from malignant ones, and cysts to be distinguished from solid tissue changes. However, since it is impossible to detect microcalcifications with sonography, it is unsuitable as the sole preventive examination.

Another additional examination is magnetic resonance imaging with which tissue changes can be specified, and biopsy, in which changes are punctured under local anaesthesia and usually with sonographic control and tissue is removed for microscopic examination.

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