Breast Cancer Prevention: Mammography

Breast cancer is the most common malignancy among Italian women. In 2021, the disease caused about 12,500 deaths. That number rises to about 55,700 in estimates for 2022, up 0.5 percent from 2020 (source: Cancer Numbers 2022, AIOM).

But there is good news. Survival rates for breast cancer are high, especially when the cancer is detected before it spreads. Also, according to AIOM estimates, net survival at 5 years after diagnosis was 88 percent in 2021. Thus, the overall odds of surviving breast cancer continue to increase, but prevention and early detection are crucial.

Mammography is a key examination in breast screening. All women should have a mammogram at some point in their lives. The question is: when?

When Should You Have a Mammogram?

Prevention and timely diagnosis of breast cancer to increase the likelihood of effective treatment is only possible with regular breast screenings. Following general guidelines, all women should start having mammograms from the age of 40.

The frequency of examinations can vary and should be individually assessed by health professionals, taking into account factors such as family history and individual risks. Generally, mammograms are recommended every one to two years, depending on medical indications.

What is Mammography?

Mammography is a radiologic examination used primarily to detect breast cancer at an early stage and to detect any abnormalities or suspicious lesions. During the exam, the patient is asked to place her breast on a special platform while the machine applies gentle pressure to compress the breast tissue. This process may cause some discomfort, but it is essential to obtain clear and detailed images. The duration of the examination is usually short, taking about 20 minutes.

Mammography is a very effective diagnostic tool in that it can detect breast tumors that may be too small to be detected by self-examination or other methods. In addition, it can identify lumps or lesions that might be indicative of malignant formations, allowing early diagnosis and more effective management of the disease.

If a suspicious lump or mass is felt during breast self-examination, it is essential to consult immediately with a trusted physician, who will be able to assess the situation, prescribe the appropriate diagnostic tests, including mammography, and provide guidance on the next steps to follow for accurate diagnosis and appropriate treatment.

This preventive approach can help detect any problems early, increasing the chances of effective treatment and improving survival prospects.

European Guidelines

These are the European Commission's recommendations for screening for breast cancer prevention in asymptomatic women with an average risk of breast cancer occurrence (source: Screening ages and frequencies).

• Women between 40 and 44 years of age: screening mammography is generally not routinely recommended for this age group.
• Women between 45 and 54 years of age: a screening mammogram is generally recommended every 2 or 3 years. This interval was identified to balance the importance of timely diagnosis with the need to minimize false positives and over-diagnosis.
• Women aged 50 to 69 years: guidelines suggest having a screening mammogram every 2 years. This interval has been shown to be effective in early detection of breast cancer in this age group.
• Women between 70 and 74 years of age: guidelines suggest having a screening mammogram every 3 years. Continuing screening beyond age 74 may be considered depending on the woman's overall health and individual wishes.

What You Need to Know

Mammography may not provide a clear image for women who have dense breasts, making it difficult to detect cancers with this type of exam. If there is dense breast tissue, your doctor may recommend additional investigations, such as magnetic resonance imaging (MRI) or ultrasound, which provide better visibility of the breast tissue and help detect any cancerous formations.

Like any screening test, mammography has a percentage risk of false positives. This means that the scan might detect an area that looks like cancer but turns out to be a benign formation. This can generate anxiety and prompt further investigation, such as biopsy or other diagnostic tests. However, it is important to note that the false-positive rate is low and the benefits of early detection outweigh the potential risks. It is always advisable to discuss the benefits and limitations of mammography as a screening exam with your referring physician. Your physician can help assess your individual risk, provide clear information, and help you make informed decisions about the frequency of screening and other possible diagnostic investigations.

In any case, to prevent breast cancer and other diseases, it is important to:

• Maintain a healthy lifestyle. This includes eating a balanced diet rich in fruits, vegetables, whole grains, and limiting consumption of foods high in saturated fat, sugar, and salt. Regular exercise is equally important, as it helps maintain an adequate body weight.
• Observe yourself and practice self-examination. Closely monitoring the appearance of your breasts and practicing self-palpation regularly are important practices to detect any changes or abnormalities. Paying attention to the presence of lumps, changes in the appearance of the skin, breasts, or nipples is essential to promptly report any suspicious signs to your doctor.
• Undergoing screening programs periodically according to your age and individual risk factors is crucial to detect breast cancer early. Your doctor can provide guidance on the most appropriate time and frequency for screening examinations, which may include mammograms, MRIs, or ultrasound scans.

Attention to prevention and early detection of breast cancer is an important step in protecting one's health and increasing the likelihood of effective treatment and a better prognosis. Continuing to monitor your breast health and following your doctor's instructions will help preserve your long-term well-being, health, and quality of life.