What is mammography?
Mammography is an image examination ( X-ray ) performed in the breast region, which allows the detection of nodules, breast asymmetries, microcalcifications, among other changes and injuries that are not yet noticeable and palpable.
The test is performed using a mammograph , a device that compresses the breasts, in order to obtain a detailed image of the region.
Its main focus is to diagnose whether breast cancer is present . Therefore, women who show the first signs of the disease should have a mammogram immediately. In addition, the test is indicated from the age of 35 and on young people who are at high risk of contracting the disease.
In Brazil, mammography is available free of charge by the Unified Health System (SUS) to all women over 40 years of age.
The diagnosis of breast cancer can be made through these two tests. However, breast ultrasound is complementary to mammography, not always necessary.
Ultrasound is an examination that converts sounds into images, by moving a device over the patient’s breasts. Mammography, on the other hand, is an X-ray, in which the breasts are compressed to visualize possible nodules.
The indication of each one of them will depend on the patient’s physique: women over the age of 40 must undergo mammography and younger women, in addition to mammography, must undergo ultrasound, as they have greater density in breast tissue.
There are 2 types of devices to perform this exam: digital and conventional. The two are by X-ray and the difference is in the way in which the image is captured.
In digital mammography, the X-ray transmits the image immediately to the computer screen, allowing the radiologist to store and retrieve the images electronically. In addition, it is possible to make adjustments, enlarge and enhance the images, which ensures greater visibility and ease to detect the presence of any foreign body in the breast region.
The image obtained from the breast is stored on a film, which must be processed after exposure. If there is a problem with the film, the images will have to be redone. In addition, women with larger breasts have greater difficulty in detecting the presence of malignant nodules by this type of examination.
It is recommended to do the first mammogram at 35 years of age , and after 40, the exam must be performed annually. However, in the case of women who are at high risk for breast cancer, that is, who have one or more first-degree relatives diagnosed with the disease, it is necessary to perform the examination before this period.
Mammography in men
Although rare, male breast cancer exists and it is extremely important that men do self-examination. In the face of any changes, it is necessary to have a mammogram to be able to determine an early diagnosis of the disease, thus increasing the chances of cure. Often the test is even more accurate in men than in women, as they have less dense and smaller breasts.
Under no circumstances should mammography be performed on children. If there are breast lumps, the ideal is to inform the pediatrician. He will investigate such conditions with a mastologist.
This test is also contraindicated in pregnant women.
The exam is done on an outpatient basis. The patient is positioned upright, next to the equipment that will press the breasts, in order to spread the breast tissue as much as possible and to reduce the radiation doses necessary to obtain the images.
The breasts will be compressed one by one, horizontally and vertically. During the procedure, the patient must remain immobile, even holding her breath for a few seconds, to obtain a good image.
Why is the breast compressed?
Breast compression is necessary so that all breast tissue can be viewed more clearly and down to the smallest detail, in order to find minor abnormalities and allow the use of a smaller dose of X-rays. In addition, by compressing them, the movement of the breasts is minimized during the examination.
Although uncomfortable, each mammographic view is very fast, lasting only a few seconds. When completed, the technologist will ask the patient to wait a few minutes before confirming that all the images worked. The whole process takes around 20 to 30 minutes.
Depending on the sensitivity that each woman has, the process can be more uncomfortable and painful. The ideal is to schedule mammography not so close to the period of menstruation, because the level of sensitivity of the breasts will be lower.
Inform the technologist if there is pain as the compression increases. It may relieve the pressure a little, but remember that the greater the compression, the better the results.
Some pre-exam tips can make it easier to take the test. Are they:
- Avoid using creams, deodorants or perfumes before taking the exam, as these can impair the capture of images.
- If you have already had this exam or any other in the breast region, take the results. The comparison with previous exams can facilitate the discovery of any foreign body in the region.
- Avoid scheduling the exam just before or just after menstruation, as during this period there is a greater density of glandular tissue in the breasts, in addition to being more sensitive, which makes testing difficult and makes it more uncomfortable.
- Notify the doctor about limitations. The less uncomfortable the exam, the higher the quality of the images. Therefore, during mammography, try to make your body as relaxed as possible.
- Notify the professional who will do the test about the presence of silicone prostheses.
The mammogram will be interpreted by a radiologist (professional specialized in monitoring and analyzing radiological exams), who will send the results to the patient’s referral doctor.
It is quite likely that the doctor will classify the test result within the world standard Breast Imaging Reporting and Data System (BI-RARDS). This method is able to categorize breast lesions in different groups. Are they:
- Category 0: the image cannot be seen correctly, requiring further exams to compare results;
- Category 1: breasts with a symmetrical appearance, with no sign of lesions with carcinogenic potential
- Category 2: breasts with benign lesions, with no indication of cancer.
- Category 3: lesion found, with a high chance of being benign. In that case, additional tests will be requested to exclude the possibility of cancer.
- Category 4: lesions found with a 20 to 35% chance of being cancer. A biopsy of the suspect tissue is likely to be necessary.
- Category 5: anomaly with a 95% chance of being malignant. Biopsy will also be required in these situations.
- Category 6: indicates the presence of a breast tumor already confirmed by biopsy.
The interpretation of the exam can be difficult and the result is not always accurate , as the resolution of the image can easily be compromised by the presence of numerous factors, such as dust, sweat or any other fluid in the breast region. In addition, patient characteristics such as age and density of the breasts can interfere with the effectiveness of the exam.
Silicone implants, for example, make visualization precarious. This is because they are not transparent to X-ray exams, making it difficult to read the results, especially if they are placed over the muscle and not below, as is the case with most women.
There are also more aggressive types of cancer that are not detectable through mammography, generating the false negative. In contrast, the false positive can arise when the result is abnormal and there is no cancer.
Mammography is available from SUS and some health plans. In private clinics, the average price varies between 50 to 120 reais the value may change according to the city or region of the country.
The Unified Health System (SUS) ensures the availability of the mammography exam free of charge for women of all ages in Brazil. However, women in the age group between 50 and 69 years old have priority for the preventive exam by the World Health Organization (WHO), based on studies that affirm a greater occurrence of the disease and greater efficiency of the exam.
Depending on the result of the mammogram, additional tests may be ordered from the patient. Abnormalities are common and some of them need to be evaluated separately and with more caution.
Such tests are also great for long-term monitoring and to see if the treatment is being effective. Are they:
Ultrasonography is a complement to mammography, in which it uses penetrating sound waves that do not affect or damage the breast tissue. It is indicated for patients with denser breasts.
It consists of a magnet that, together with a computer, transmits magnetic energy and radio waves through the breast tissue, creating very detailed images of the region inside the breasts, in which they distinguish what is normal tissue and what is diseased tissue.
It is the only procedure that really defines whether or not cancer is present. The test consists of removing fluids from the suspicious area, where they are examined with a microscope and tested for the presence of cancer cells.
If the cancer is diagnosed, there are two tests that the patient will be asked to assist in the prognosis: the hormone receptor test and the HER2 / neu test. These tests will give you information about which cancer treatments are most effective in each situation.
Myth: Young people do not need to take the exam
Truth: Breast cancer is more common in older women, but it can happen in younger women as well, especially if there is a family history. From the age of 40 the exam must be performed annually, but it is very important to be up to date with your body always.
Myth: If there is no family history, there is no risk of breast cancer
Truth: If someone in the family has had breast cancer, the chances of the patient actually having the disease increase. However, among all women who have the disease, 85% have no family history. So it is important not to miss the exam because of that.
Myth: Radiation is dangerous
Truth: The use of X-rays in mammography is used to obtain a good image of breast tissues and its risk is minimal when compared to the benefits that the exam offers.
Myth: Altered test result means cancer
Truth: Many women fail to get tested for fear of what they will find, but it is important to be aware that if there is actually cancer, it will only worsen treatment conditions and chances of cure. In addition, 80% of the nodules found are benign.
Myth: People who do not have breast lumps do not need to be tested
Truth: Even if the patient does not feel these nodules, they can still exist. Small tumors are common and early diagnosis increases the chances of a cure by 95%.
Myth: Having a healthy life excludes the risks of breast cancer
Truth: Physical exercise and healthy eating help to reduce the chances of developing the disease, but do not eliminate it entirely. The annual examination after the patient turns 40 is essential.
Myth: Mammography doesn’t work on very dense breasts
Truth: Although it is not as effective, because the images are not very clear in very dense breasts, the exam is not necessary. Ultrasound and magnetic resonance imaging are complementary exams that are highly recommended in these cases.
Self-examination is essential for the woman to know her breasts in detail, thus facilitating the perception of any abnormality there. It’s easy, fast and useful. And the sooner you discover the possibility of cancer, the greater the chances of a cure.
To perform the self-examination, the woman must be without clothes from the waist up, in front of a mirror, carefully observing if there is any type of deformation in the breasts.
With one arm up, the hand placed should make circular movements in one of the breasts, from the outside to the inside, in order to find spaces or small lumps. This procedure should be done on both breasts, up to the armpits.
Self-examination should preferably be performed in the period immediately after menstruation. In the case of women who do not menstruate, the ideal is to choose a fixed date to do it monthly.
Self-examination only identifies cancer when the disease already exists. Therefore, it is important to have a mammogram every year to identify the problem in advance.
It is also worth mentioning that when detecting signs of abnormalities, the patient should not panic, as they may be just benign functional changes.
Mammography is an indispensable examination in women’s lives. Although it is a little uncomfortable, it is quick and easy. The sooner the cancer is discovered, the greater the chances of a cure.
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