Breast cancer tests have always been the center of attention. Early diagnosis is the magic formula to be able to deal with the as promptly as possible breast cancer. It remains the most widespread neoplasm in our country. There are about 55,000 new diagnoses to Italy in Italy alone. This is about 30.3 percent of all cancers that affect women and 14.6 percent of all cancers diagnosed. Adhering to control screenings is essential. To answer all doubts, we asked for help from Dr. Pietro Panizza, head of the Breast Radiology Unit of the IRCCS San Raffaele Hospital in Milan.
Breast Cancer Tests: At What Age Do You Begin Checkups?
Secondary prevention, therefore that made with examinations, begins at the age of 40 with mammography. In fact, some screening programs start at 45-50 years old depending on the region of residence. It then goes on up to 69 years, even if some Regions manage to get up to 74 years.
What is meant by screening?
When I speak of screening I mean the one organized by the regional health system. The screening involves the invitation of the patient to undergo a mammogram by letter from the ASL. It is a free service, which is part of the Lea, which are the essential levels of assistance.
So the real secondary prevention is that which is done with mammography starting from 40-45 years. Then if there are family risk histories or even hereditary forms, which are still a small part, surveillance programs or personalized programs can be implemented.
Mammography lowers the risk of mortality significantly
For mammography there are certain results, found by numerous studies that demonstrate the effectiveness of this intervention. Mammography screening – from 45 to 49 every year, from 50 to 69-74 every two years – has been seen to reduce mortality in women who adhere to the invitation by up to 40 percent. This is a very good result.
Were there any delays due to Covid? How is the situation now?
Yes, because screening programs such as practices in all clinics were closed for about 4 months during the first wave. So there have been delays that are being made up for by increasing the number of exams in the daily sessions. We have not yet managed to get back to the ideal level, but we are working on this.
Delays can also have severe consequences, because we know that early detection is one of the main weapons against cancer, especially for aggressive ones.
Breast Cancer Tests: Why Are Women Under 40 Preferred to Undergo Ultrasound and Not Mammography?
Younger women have a higher sensitivity to radiation. As it is known, the ionizing radiations which are the X-rays that are used for mammography are contraindicated in young people. The udder is considered to be mature around the age of 35. So we try to absolutely avoid mammography before that age, unless there is an important suspicion.
The breasts can be adipose, glandular or mixed. Are there any differences in the diagnosis?
Absolutely yes. Fully adipose breasts are about 10 percent. Those totally glandular, that is, dense, are another 10 percent. So 80% is somewhere in between.
The predominantly adipose breast
The breast is composed of adipose tissue then fat and parenchymal tissue then glandular and fibrous tissue supporting the gland. Mammography is a fantastic exam in fatty breasts. Those consisting mainly of fat are transparent to X-rays, so we see them gray with mammography. The lump is white, what we doctors call radiopaque. Therefore, in the predominantly adipose breast we are able to identify the lump very easily.
Dense or glandular breasts
The big problem with the predominantly glandular breast is that it is completely radiopaque, which means we see it completely white. Then the gland is white, the nodule is white. This is why we often resort to ultrasound, which however is not included in the screening program. Screening requires that all women are examined only with mammography and that they are called back for any investigations only when there is a diagnostic doubt.
The role of magnetic resonance
Some countries have begun to do mammography and ultrasound for those with dense breasts. MRI is also being experimented with. There is a very recent study by the Dutch and another done in the United States that shows that MRI is absolutely the best test for evaluating dense breast. For the resonance, however, there are other problems, you have to do an intravenous injection with a contrast medium and therefore it is much more complicated.
Ultrasound is also needed, which is not included in the screening
In some countries like Canada and the United States there is a movement called “Are you dense? ” which has lobbied the various states and achieved a good result. When women are screened, the radiologist is obliged to report the presence of a dense breast and that the mammogram in that case has a capacity to identify a lesion that is very small. Then the examination must be completed with an ultrasound. I am convinced that a similar solution will soon be reached in Italy as well.
Breast cancer tests: does the presence of breast implants allow you to undergo mammography without problems?
Yes. As you know, in mammography you have to compress, squeeze the breast. The thickness must be made homogeneous. Otherwise the image is blurred and would not allow us to see the presence of lesions. The prosthesis should be guaranteed to withstand some type of compression. The technician proceeds with an adequate maneuver, which is able to push the prosthesis towards the muscle. With a kind of pinch, the part of the breast without the prosthesis must be brought forward. In this way we will have a more precise diagnostic mammogram, even if about 20% of accuracy is lost. It must be considered that the prosthesis is radiopaque, therefore it does not allow X-rays to pass. Therefore, the part of the breast covered by the prosthesis is not visible if we do not move it.
Anyone with a prosthesis should choose the mammogram-ultrasound combination
As for the ultrasound, however, there are no problems, because the prosthesis is behind the mammary gland. The same happens with resonance. The only examination that is partially invalidated but which is still fundamental, is the mammography. So those who have a prosthesis should do mammography and ultrasound.
For rough breast implants we speak of a rare tumor
It is a very rare case of lymphoma. So if a certain type of symptomatology appears, it is now faced. It can happen, even if very rarely, that there is an accumulation of fluids around the prosthesis. In these cases, this liquid is aspirated and examined by making dedicated evaluations. There is an ad hoc protocol of the Ministry of Health, so when there is a suspicion, we are required to respect this protocol and make all investigations to rule out lymphoma.
Who is most at risk of developing breast cancer?
- There is a percentage of women – which is about 10% – who have it an inherited genetic mutation, which we have known for 25 years now. These women have a risk that is much higher than that of the normal population. Those who have this mutation know that they must undergo periodic checks which include, for example, the annual use of magnetic resonance imaging. In many regions, all follow-up examinations are free.
- Then there is what is called family risk which affects roughly another 10-15%, which is related to family history. So if there are cases in the family and there are no characteristics that could suggest the genetic mutation, that is defined as a woman at risk for family history. It can be linked to environmental situations, food. Unfortunately, we do not yet know all the causes.
- Just over 70% is represented by tumors that we could define as occasional, in the sense that they are not linked to a specific risk.
- Returning to dense breasts, it was found that not only is it more difficult to diagnose cancer, but it is also a risk factor compared to the normal population.
- Obesity is also a risk factor.
The story that struck Angelina Jolie
The case of Angelina Jolie had caused a lot of discussion. She had her mother with ovarian cancer and her aunt on breast. Both had suffered a lot. The actress did a genetic test that confirmed the genetic mutation and she made the drastic choice to remove breasts and ovaries. Now the research has gone on. You can choose to join a surveillance program by doing MRI checks. The choice to resort to surgery also remains valid. Each patient has a unique history and the therapeutic option must take this into account.
Breast Cancer Tests: When Should A Man Worry?
Someone has mentioned a mammogram in males with the genetic mutation, but we are still a long way off, because it is something that still does not convince. Self the man feels a lump appear on the chest, must contact the general practitioner and then undergo tests, which are the same as for women, and therefore, depending on the case, mammography and ultrasound.
The goal of the research is zero mortality from breast cancer. Are you optimistic? Where are we at?
We are still quite far. Surely incredible progress has been made. There were some particularly aggressive cancers that were a kind of condemnation that now respond to new therapies in a fantastic way. There is the possibility of doing therapies even before surgery.
Even from a psychological point of view, women have the perception that the drug is working and that the tumor is slowly disappearing. So we are definitely on the right track. After all, this type of tumor is so frequent that it is being studied a lot, unlike what can happen, for example, with rare tumors.
Trust your sense of sense too
Breast cancer affects one in eight women in their lifetime. We are therefore talking about important numbers and it is the most frequent cancer in all age groups. So you must always be alert and when the woman feels something that does not convince her, she must contact the doctor. The advice is also to trust their sixth sense a lot. I have seen that many times women felt that something was wrong and even against the advice of some doctors they went ahead. They were right.