What is a Screening Mammogram?
Since our goal is disease prevention and early diagnosis, we talk about screenings a lot. This time, as we continue the topic of breast cancer prevention we will discuss what a screening mammogram is?
Diagnostic or Screening Mammogram?
So what is screening? According to Wikipedia, screening (“selection, sorting”) can mean – a system of primary examination of groups of clinically asymptomatic individuals in order to identify causes of disease. But in order to accurately capture the subtleties of this definition, we will take a couple of examples.
So, a 45-year-old patient comes to the doctor and complains of mammary gland pain. The doctor examines her, does not find any pathology, but gives her a referral for mammography. Here’s another situation: the patient comes to the doctor and complains of a chronic gastritis exacerbation. The doctor, in addition to giving recommendations for the gastritis treatment, recommends undergoing mammography. What does it have to do with screening?
Screening is done to detect serious diseases such as cancer and breast cancer (BC) in particular. Both patients have no breast cancer symptoms. Both were advised to undergo mammography. However, in the first case, the patient complained about breast pain, and in the second case, she didn’t. Therefore, in the first case, it will be a diagnostic mammogram. In the second case – screening mammogram.
Globally, there is no difference, both patients will undergo mammography. Another thing is important here. In the first case, the patient came with mammary gland complaints, which indicates the necessity of examination. In the second case, the doctor took the initiative and recommended a mammogram.
Unfortunately, while situations described in the first case are numerous, those described in the second case are few. Doctors often forget about this important examination method. Mammograms are scheduled only in those cases when patients have breast complaints. Therefore, we consider it expedient to inform healthy women to require mammography tests when visiting their doctors. In our further articles, we will return to the world recommendations on how often and to whom it is recommended to undergo screening mammography.
What is screening for?
But what is screening for? What does it give us and why is mammography screening performed all over the world?
Unfortunately, the incidence of breast cancer is constantly increasing. There are many reasons. We cannot influence the incidence rate. Long-term results of breast cancer treatment directly depend on the stage at which treatment started. The smaller the stage, the shorter, cheaper, and more effective the treatment. Therefore, the whole world is fighting to identify the early, if possible preclinical stages of breast cancer.
Thus, mammography is the main assistant in identifying breast cancer at its early stages. Let’s look at some examples again.
Breast cancer screening mammography
During self-examination (when women regularly check the condition of their glands), the average size of detected tumors is more than 2 cm. Rarely, only in cases where the tumor is actually located on the gland surface, subcutaneously, the patient has a chance to find this tumor measuring 1.2-1.5 cm. In all other cases, unfortunately, it is virtually impossible to identify a small tumor on your own. Therefore, self-examination, as a method for early detection of breast cancer, is not included in international recommendations for patients.
Furthermore, breast ultrasound is a favorite method for patients. But, alas, the method is not suitable for breast cancer screening. First, ultrasound can detect tumors in the mammary glands if the tumors are larger than 8 mm. Secondly, the incidence of breast cancer is higher in older age groups. Besides, the value of ultrasound as a diagnostic method decreases with age and with increased size of the gland. For this and other reasons, the ultrasound diagnostic method is not a screening method.
It should be noted however that ultrasound has many advantages. We will talk about it separately. But only mammography can be used as the main method of breast cancer screening1. During mammography, a tumor of 3 mm or more can be detected. It’s also possible to detect signs of non-invasive breast cancer in the form of microcalcification, as well as precancerous pathology. We wrote about the clinical forms of breast cancer separately.
For patients with breast cancer and those treated for breast cancer, routine annual MMGs are performed. It’s important for the early detection of relapses and contralateral cancers.
My wish to everyone is that all examinations would only be screenings confirming that we are healthy.
Written by Y. Timovskaya, Ph.D., doctor oncologist of the highest category, Member of ESMO.