When to have a mammogram

Breast cancer is one of the three types of cancer for which rapid diagnosis is possible, along with cervical and colon cancer. Mammography is the test that allows for its diagnosis in a simple and quick manner. Statistically, it is found that if performed between the ages of 50 and 69, mammographic examination can significantly reduce mortality from this type of disease.

It is precisely in this age group that the majority of breast tumors occur. According to experts from the International Agency for Research on Cancer (IARC), adherence to screening in this age group can reduce mortality from this disease by 40%. For this reason, the Ministry of Health promotes plans for the execution of this diagnostic examination every two years.

Data on mortality reduction are reduced for the preceding age group, from 40 to 49 years, and for those over 70 years. However, in some Italian regions, screening protocols have been activated that include checks for the 45-49 age group. Since there is no definitive evidence of the ability to reduce mortality associated with screening performed with mammography in this case, each individual case must be evaluated, and it is the doctor who determines the appropriate frequency for conducting the examination.

Mammographic examination is the main examination used for screening, but not the only one. Another useful examination for this purpose is ultrasound, which although not the most suitable examination for early diagnosis itself, serves to complement the verdict of mammography when it is not sufficiently clear and further diagnostic investigation is necessary.

Breast ultrasound may be useful in some particular cases, especially in younger women or to further investigate the nature of a nodule; however, it is not generally recommended as a screening test in place of or in addition to mammography.

In some cases, screening for the diagnosis of breast cancer is initiated at an earlier age, using different modalities. We are talking about women who have a genetic mutation in the BRCA1 and BRCA2 genes, a mutation that predisposes them to an increased risk of developing breast cancer. These are fairly rare cases (approximately 5% of all breast cancer cases) but it is necessary to initiate screening around the age of 25, using mammography as well as magnetic resonance imaging for this purpose. Early screening is also recommended for another category of women, those who have already had a previous diagnosis of a tumor that required radiation to the chest in the age group of 10 to 30 years.

To perform mammography, the patient is asked to place both breasts (one at a time) on the machine’s support. Using a specific command, the radiology technician compresses the breast to ensure the most comprehensive view possible for the instrument. At this point, it is sufficient for the patient to remain still for a few seconds so that the mammography machine can capture the necessary information to provide all the images required for the specialists.

Usually, two X-ray images are taken for each breast, with two different inclinations, to obtain the most complete view possible.

The peculiarity of the instrument we use at the MiniHospital “Sandro Pertini” for mammography is that, in addition to performing standard mammographic exams, it can also be used for tomosynthesis exams. Similar to CT scans, the machine uses data collected from the passage of X-rays in the area of interest to reconstruct a three-dimensional image of the various types of tissue. Tomosynthesis mammography allows for a more detailed study of the breast and consequently enables more accurate diagnoses.

To perform mammography with tomosynthesis, the procedure is identical to that of traditional mammographic examination; however, in this case, the machine rotates around the patient’s breast to acquire the data.

Performing mammography with tomosynthesis results in emitting a higher amount of radiation compared to traditional mammography. Therefore, it is prescribed exclusively to patients who actually need it based on their particular clinical situation. In this regard, the doctor plays a fundamental role; with their experience, they can decide which examination is most appropriate.