Mammography: Information & Mammography Specialists

A mammogram is an X-ray examination of the female breast. It is considered the best method for the early detection of breast cancer (breast carcinoma).

This examination can detect even very small tumors at an early stage. These small lumps cannot be felt until later.

Small calcium deposits can also be detected with a mammogram. They are considered a sign that a “change” is taking place within the tissue. This may therefore be a precancerous stage of breast cancer.

For women between the ages of 50 and 69, there is a nationwide mammography screening program for breast cancer prevention. This program is aimed at women who do not actually have any risk factors for breast cancer. Every woman in this age group can undergo a free screening every two years—in addition to her annual cancer screening exam. She will receive an official invitation by mail.

Professional associations recommend having a mammogram as part of early detection starting at age 40 at the earliest. The cost of a bilateral mammogram ranges from 100 to 200 euros. Patients not enrolled in the mammography screening program may have to cover these costs themselves.

Women should always have a mammogram performed by an expert—that is, at a radiology practice. In addition to trained and experienced staff, these facilities have high-quality equipment that is regularly inspected. This ensures that patients are not exposed to excessive radiation.

The radiation exposure for a bilateral mammogram in two planes averages between 0.2 and 0.4 millisieverts. This value corresponds to about ten percent of the radiation exposure to which every German citizen is subjected annually due to natural environmental factors.

Radiologists—specialists in X-ray diagnostics—use digital mammography for early breast cancer screening. With this method, X-ray images are not developed on film but are stored electronically. This allows them to be viewed on a monitor and easily enlarged.

You should not use deodorant before a mammogram. Deodorant can cause a haze on the X-ray image.

During the mammogram, each breast is X-rayed once from above and once from an oblique-lateral position. This provides the doctor with a total of four images. If the doctor notices changes in the breast on one of the images that appear unclear, they may take additional images.

The layers of tissue should appear as thin as possible in the images. For this reason, two Plexiglas plates compress the breast. This may be slightly uncomfortable.

Performing a Mammogram © RFBSIP | AdobeStock

The breast is softer and less sensitive to pain between the end of a menstrual period and the next ovulation. Therefore, women who have not yet reached menopause should have their mammogram performed during the first half of their menstrual cycle.

During the mammogram, you should try not to move so that the image is as sharp as possible. However, the exposure time is only a few seconds.

A benign tumor appears on the X-ray as a dense, uniform structure with smooth borders.

Malignant tumors differ in that they often have what are known as “cancer feet”—that is, star-shaped projections. In addition, they have blurred borders.

However, mammography cannot always definitively determine whether a tumor is benign or malignant. To be certain, the doctor takes a tissue sample during a biopsy. To do this, the doctor uses a hollow needle under sterile conditions.

The tissue samples are then examined under a microscope in the laboratory.

There is no cause for concern that cancer cells could spread throughout the body as a result of the tissue removal.

Any calcium deposits are classified as microcalcifications or macrocalcifications based on their size. Macrocalcifications can reach sizes of up to 0.5 mm or more.

While macrocalcifications clearly represent a benign change, microcalcifications can indicate either a benign or a malignant change.

The doctor assesses whether the calcifications indicate a benign or malignant change based on the shape and distribution pattern of the particles. In the case of suspicious microcalcifications, further evaluation should be performed via a tissue biopsy.

Magnetic resonance imaging (MRI) can also be used instead of mammography for the early detection of breast cancer. This is an imaging technique that does not involve radiation exposure.

An MRI provides detailed images of tissue using a contrast agent and can thus reveal pathological changes. International studies have shown that this significantly more expensive procedure is also suitable for the early detection of breast cancer.

In Germany, however, magnetic resonance imaging is still controversial as a general method for the early detection of breast cancer. The method has both advantages and disadvantages when it comes to breast cancer screening.

In general, breast MRI can detect precancerous conditions such as

• DCIS (ductal carcinoma in situ) or
• precancerous lesions that remain undetectable on mammography, or
• benign tissue changes that should nevertheless be surgically removed, such as ADH (atypical ductal hyperplasia)

.

MRI also provides better results for young women with dense breast tissue and hereditary forms of breast cancer. On the other hand, microcalcifications in the breasts are less easily detected by MRI than by mammography.

Furthermore, an MRI exam costs at least €400 and takes considerably longer. A mammogram can be performed in two minutes, whereas an MRI takes about 30 minutes.

For widespread screening, the use of MRI therefore also poses a logistical challenge.

MRI scanner © digitale-fotografien | AdobeStock

Randomized controlled trials are studies in which patients are randomly assigned to two treatment groups. Such studies are considered the gold standard in medicine for answering specific research questions.

In such studies, experts were able to demonstrate that the breast cancer mortality rate could be reduced by 30 percent through the use of mammography for early cancer detection. There are also comparative studies between mammography and magnetic resonance imaging (MRI) from which meaningful applications for MRI can be derived:

• For early detection of breast cancer in high-risk patients (familial breast and ovarian cancer),
• when mammography results are difficult to interpret,
• in cases of histologically confirmed invasive lobular breast cancer.

An MRI can also be used to improve surgical planning when multifocal or multicentric breast cancer is suspected. This is the case when the breast cancer occurs in multiple foci or breast quadrants.

In summary, mammography is a study-proven screening method for the early detection of breast cancer.

However, due to the exposure to X-rays, the benefits and risks should always be carefully weighed on an individual basis with the treating physician.