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Mammographic screening: the importance of prevention

Breast cancer screening is the primary tool for early diagnosis of breast cancer. Screening refers to checking for the presence of a disease when symptoms are not yet present, allowing the identification of a condition in its early stages and therefore providing greater chances of recovery.

Together with cervical and colon cancer screening, breast cancer is the only type of cancer that can be diagnosed early.

The importance of prevention becomes evident when looking at the most recent data: breast cancer is the most common type of cancer in terms of incidence among women. It is estimated that in 2018, in Italy, it affected approximately 53,000 women (compared to 48,000 in 2015). While the incidence is increasing, the last few years have seen a decrease in the mortality rate by almost 1% each year, a decline attributed to the progressive spread of breast cancer screening activities.

The test that allows for early diagnosis is mammography, which is why it is called breast cancer screening mammography. When performed in the age group of 50 to 69 years, this type of examination can significantly reduce mortality from breast cancer. The reduction in mortality rate is less significant in women in both the older age group (over 70) and the younger age group (from 40 to 49 years).

What mammography is

mammography is a radiographic examination. Through the emission of low-dose radiation (non-harmful), it provides valuable information on microcalcifications and small nodules (not visible with ultrasound) or early-stage neoplasms. It is useful for women who, with advancing age, have a breast characterized by involutional changes, meaning a reduction in glandular tissue and the presence of a significant amount of fatty tissue. When the mammography report is not sufficiently clear, the primary diagnostic follow-up examination is represented by ultrasound.

What Breast ultrasond is

breast ultrasound  It is defined as a second-stage examination used for breast evaluation. It is recommended for women over 40 years of age who undergo a preventive mammography examination as a preliminary examination for breast cancer. Breast ultrasound is performed only if the mammogram report shows an area of ​​different density, requiring further ultrasound investigation.

Breast cancer screening follows different guidelines for women with specific conditions. For women with a genetic mutation in the BRCA1 and BRCA2 genes, which predisposes them to a higher risk of developing breast cancer, breast screening should start at the age of 25.

Mammography screening in cases of genetic mutations

According to the most recent data, a percentage ranging from 5 to 7% of breast cancers is linked to genetic risk factors, with the most common being mutations in the BRCA1 or BRCA2 genes.

For women without breast cancer but with a significant family history of the disease, as well as those carrying mutations in the BRCA1 and BRCA2 genes, the latest recommendations include a contrast-enhanced magnetic resonance imaging (MRI) every 12 months, combined as needed with mammography  or breast ultrasound.

This type of breast cancer screening, aimed at those with higher risk factors, is usually initiated from the age of 25. Alternatively, once it’s determined at what age family members developed breast cancer, breast screening starts 10 years before the age of onset of the tumor.

Breast cancer screening for women who have undergone chest radiation therapy

Breast cancer screening for women who have undergone chest radiation therap

Familial history of breast cancer is not the only case where screening activity should be initiated early. Women aged between 10 and 30 who have undergone chest radiation therapy to treat carcinoma also have a higher risk of developing breast cancer, due to the radiation exposure.

For these individuals, a specific mammographic screening program is recommended starting from the age of 25 or at least 8 years after radiation therapy. This approach involves undergoing contrast-enhanced magnetic resonance imaging annually, along with bilateral mammography or tomosynthesis with 2D reconstructions.

What if a positive result

In case of a positive result from breast cancer screening, the woman is invited to undergo a second mammogram, a breast ultrasound, and a clinical examination to confirm the actual presence of a tumor. Only after confirmation, the treatment proceeds, which in almost all cases involves surgical intervention.

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