Breast cancer is the most common form of cancer in women - in Germany, about one in ten suffers from it during their lifetime. Mammography offers the opportunity to detect the tumor at an early stage and thus significantly improve the prognosis. Fortunately, breast cancer diagnosis today is no longer a death sentence. Usually even a gentle and breast-conserving therapy is possible.
However, the prerequisite is that the tumor is detected early. Important for this is the regular self-examination and palpation of the chest by the gynecologist. In addition, mammography offers the best options. Therefore, since 2005, every woman between the ages of 50 and 69 in Germany has been entitled to a mammography screening every two years since 2005.
Principle of mammography
In mammography, X-rays are used to scan the breast ("mamma"). X-ray images are taken in two planes. From these different perspectives, changes can be compared and better assessed. A special type of x-ray is used to visualize the soft tissue of the mammary gland particularly well. The pictures are then examined by a doctor, often with the help of a magnifying glass.
Criticism of mammography
The difficulty in judging is that not every breast is equally good to judge. For example, in women taking hormones, younger or larger breasts often have very dense tissue and changes are difficult to assess. This can lead to a situation where a deviation is rarely overlooked or - more frequently - a finding is wrongly suspected and therefore requires further investigation.
It is being discussed that radiation exposure increases the risk of developing breast cancer - but this has not been proven so far. Moreover, as a result of technical developments, the burden is much lower than a few years ago. In contrast to the risk is the fact that breast cancer can be detected very early with the help of mammography and thus the chance of recovery increases significantly.
When the mammography is performed
There are several situations in which a mammogram is displayed:
- Symptoms: If the woman or her gynecologist detects a suspected nodule or hardening of the chest, feels an enlarged lymph node in the armpit, or if symptoms arise that suggest the suspicion of a tumor, mammography is the first method of examination in addition to ultrasound examination, Most changes can be easily identified, localized and evaluated.
- Increased breast cancer risk: If a woman has had breast cancer in her family, has had breast cancer in the past, or has been diagnosed with cancerous precursors, she is entitled to a periodic examination.
- Cancer screening: Mammography is the only method that can detect the smallest calcifications (microcalcifications) that are a typical early sign of breast cancer. That is why she is the method of choice for cancer screening. It is recommended to have a baseline examination between the ages of 30 and 40, during which the mammary gland tissue is assessed and any risk factors identified. Between the ages of 50 and 69, screening should then take place at regular, usually two-year intervals.
Course of mammography
A mammogram is usually performed in a radiology practice or the radiology department of a hospital. No preparation of the patient is necessary. However, she should not use any body lotion, body powder or deodorant before - they can falsify the intake. For the same reason, metal parts must be deposited in the investigated region. The examination only takes a few minutes per breast.
In rare cases, it may be necessary in special findings, in addition to inject contrast agent into a mammary gland duct (galactography). Before the X-ray examination, a doctor scans the breasts, in some cases again afterwards. During the examination, the breast is carefully flattened between two plates - the x-ray tube and the film table.
This is what most women find uncomfortable or even painful. However, it is necessary to reduce the radiation exposure and to make the structures in the X-ray image sharper and thus easier to assess. The best time for an examination is therefore directly after menstruation. Then the mammary tissue - which is subject to hormonal fluctuations - is the least sensitive. In case of suspected cancer, mammography should of course be performed immediately.
Further investigations in case of suspected breast cancer
A change in mammography can often only be better assessed with the help of an ultrasound examination (sonography). This makes it possible to distinguish benign from malignant tumors and cysts from solid tissue changes. Since sonography can not detect microcalcifications, it is not suitable as the sole preventive examination.
Another additional study is magnetic resonance imaging, which allows tissue changes to be specified, as well as biopsy, in which changes under local anesthesia and usually with sonographic control are punctured and tissue is taken for microscopic examination.