We have gathered the questions we hear most often and answered them based on our experience, current guidelines and international literature. If your question is not covered here, get in touch — we will be glad to answer it.
Preventive mammographic screening should begin at age 40 and be performed every year until 65. From 65 to 75 the screening continues every 2 years.
At age 35 a first, baseline mammogram can be performed — preferably digital, due to its lower radiation and better performance in dense young breasts. From age 30 it is useful for women to be studied with ultrasound, especially before pregnancy or the placement of silicone implants.
Digital mammography carries up to 30–40% less radiation than conventional film mammography. It detects smaller lesions and smaller calcifications that accompany early breast cancer.
The DMIST study confirmed its advantages, recommending it as a priority for all women near menopause and those under 50.
Yes. Digital mammography using a full-field detector (full field panel) made of selenium or silicon makes the most of the technique’s advantages.
Its most recent evolution, Tomosynthesis, is even more precise: by scanning the breast in one-millimeter slices, it enables the detection of small suspicious lesions that often hide in dense areas.
The latest development concerns the creation of Synthetic images from Tomosynthesis, which reduces both examination time and radiation by 40%, since only tomosynthesis is used to generate the images.
The key safeguard is that the breast imager reading the mammograms is experienced — which is ensured when they report at least 4,000 mammograms per year.
In screening, a double reading by a second radiologist and the use of a computer-aided detection (CAD) system increase the detection rate of cancer — even early cancer — by 20%. Using a mammography unit with Tomosynthesis increases the sensitivity of the examination, especially in difficult and high-risk dense breasts.
Usually a mammogram is not painful, provided the examination is performed by an experienced technologist and on the 7th–12th day of the cycle, when the breast is in a resting phase. Avoiding coffee, which has a hormonal effect, in the last days before the examination helps significantly.
The use of a special pad called MammoPad, now also used at our Center, reduces discomfort by 50%. In addition, on our new Hologic 3Dimensions unit, the curved compression paddle and the shorter compression time reduce pain and discomfort by 50%.
High-resolution Tomosynthesis today enables the detection of smaller breast cancers compared with its original form, as well as the creation of better Synthetic images that reduce the total radiation of the examination by at least 40%.
By scanning the breast in 1-millimeter slices, cancers are revealed that would otherwise be detectable only with a complementary ultrasound.
Finally, the use of contrast agent in mammography significantly changes the picture for detecting small cancers, even in difficult dense breasts, and for the same indications it can replace a Contrast-Enhanced MRI mammogram, which also uses a contrast agent.
Today, risk assessment is essential and is performed using a program built into the mammography unit. The program determines the probability that, over the next 2 years, the woman being examined will develop cancer, taking into account her age, breast density, and the findings detected on the mammographic examination.
There are 4 risk categories: low, average, moderate, and high.
The risk calculation allows us to correctly plan the mammographic screening schedule a woman should follow —annual, every eighteen months, or every two years— and determines whether it should be supplemented with other preventive techniques, such as ultrasound or MRI. Women with moderate or high risk benefit in particular, as they need more frequent screening and additional complementary examinations, especially those with dense breasts.
High-resolution ultrasound is often used to clarify mammographic findings, when the breast imager judges it necessary. It is also used as a supplement in high-risk women with dense breasts, categories 3 and 4 on the BI-RADS system, with a negative mammogram.
It is also used as an alternative to mammography in younger women, under 40. In women under 35, as well as in women who are pregnant or breastfeeding, ultrasound is considered the examination of choice in the case of a palpable finding.
It is an ultrasound technique that allows us to distinguish a benign nodule from lesions suspicious for malignancy, by measuring their elasticity qualitatively but now also quantitatively, with the latest development — shear-wave elastography. Cancers show increased stiffness (>70 kPa) and wave speed (>2 cm/sec).
With elastography, unnecessary biopsies can be avoided in benign lesions that can simply be monitored. The method is applied with equally encouraging results in the characterization of thyroid nodules.
There is also three-dimensional breast elastography, which maps the elasticity of the entire breast and is used mainly in monitoring women with breast cancer, to assess their response to the chemotherapy administered to them.
The elastography used today at our Center, in both its strain and shear-wave forms, is further advanced.
The study of the micro-vascularization of a lesion, available on the ultra-fast Aixplorer ultrasound, adds further information for detecting a cancer. Finally, the use of contrast agents in breast ultrasound too can help characterize lesions and select those that need further biopsy.
They are small lesions that are not palpable and are usually detected on preventive mammographic screening or on automated screening ultrasound.
Their biopsy is performed either surgically, with localization via a guide wire, or percutaneously with a mammotome under mammography guidance, or with ultrasound when they are visible sonographically. Non-palpable lesions visible only on MRI mammography are localized only on it, unless the lesions are also detectable with ultrasound.
The new osteoporosis machines allow not only the measurement of bone mineral density (BMD) in various regions of the body, but also the detection of silent fractures of the spine, which are a serious prognostic indicator for a new, more severe fracture.
They also allow the detection of calcifications in the abdominal aorta — a prognostic factor for cardiovascular events — the measurement of bone density with 30% less radiation and in 10 seconds, as well as a three-dimensional (3D) study that assesses the mechanical strength of the bone.
Finally, they automatically calculate the FRAX score in a single examination, helping the decision on whether or not to administer treatment, by accurately estimating the risk of an osteoporotic fracture.
Osteoporosis machines (DEXA), beyond measuring bone density, record bone density across the entire skeleton and, at the same time, the body’s content of muscle mass and fat.
Regional measurements of the above are available and, specifically for fat, a separate assessment is now made of subcutaneous and visceral fat (which lies within the abdomen). The measurement of visceral fat is a prognostic factor for metabolic and cardiovascular disease.