What is it?

Mammogram (mammography) allows to simultaneously visualize the entire volume of the breast (panoramic examination), to identify tumors at an early stage, when represented only by microcalcifications. In recent years we have moved from analogue mammography on film to digital mammography on computer, with a process similar to that of photography. It is the only examination that has proved effective in early diagnosis: the screening programs carried out over the past 30 years, based solely on mammography, have reduced mortality from breast cancer by up to 50%.

There are no limits related to the size of the organ: small breasts and male breast can be subjected to mammography without any difficulty. In the presence of implants it can and should still be performed, although some areas of the breast may not be assessable.

The limits of this technique are: the use of X-rays, with consequent risk, even if very low, of causing tumor and very dense breasts, that is, with a prevalent glandular and fibrotic component, which reduces the ability to identify any lesions. From the age of 40 the biological risk progressively approaches zero: some researchers have compared this risk to that of smoking 1 cigarette or to that of breathing for 2 days in a big city.

The average sensitivity of mammography, i.e. the ability to identify the tumor, is 80%, which means that it may not detect tumors in 20% of cases, therefore, 1 out of 5 tumors is not visible. This may depend on the quality of the mammogram, the doctor's ability to interpret it, the type of breast, the site and the type of tumor. Nevertheless, mammography is the only test that has been proved to reduce mortality from breast cancer. In the case of very dense breasts, when the sensitivity of mammography is lower, the examination is supplemented with ultrasound, which has good sensitivity in dense breasts and is often useful in supplementing mammography.

No reduction in breast cancer mortality has been demonstrated with any other examination, so to date mammography cannot be substituted by any other examination.

When is this exam indicated?

Mammography is performed either in cases of suspicious symptoms to find the cause of symptoms or for preventive purposes in asymptomatic women to reduce breast cancer mortality. Secondary prevention, or early detection, can begin with mammography at age 40. Several studies have shown that in the age group between 40 and 49 years, preventive mammography is effective if performed every 12 months, while over 50 years, in the absence of particular risks, mammography is effective if performed at least every 2 years.

How is it performed?

To perform the mammography the breast is gently compressed with a special flexible plate; the compression, if done progressively, causes mostly a slight discomfort, some women report pain, a few very strong pain. The compression does not cause any damage and the pain usually resolves in a few minutes. Compression is necessary to reduce the thickness of the breast, which allows for good quality images and reduced radiation dose.

How to prepare

Avoid smearing creams or talcum powder on your breasts before the mammography. Make sure you are not pregnant and, if in doubt, report it to the radiology specialist prior to undergoing the procedure. If you have implants, report this to the radiology specialist performing the examination.

Always bring mammograms, breast ultrasounds, breast MRIs or previously performed needle aspiration and needle biopsy resutls.



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