Detecting breast cancer in the early stages increases the chances of recovery, so standard imaging studies, including ultrasound or mammography, are recommended for screening. We explain when each is recommended below.

Almost every medical specialty has conditions where regular screening tests can make a huge difference and even save lives. And this is because the purpose of screening tests is to detect the disease or certain changes that indicate the development of pathology, before the appearance of symptoms.

And in the case of breast cancer, screening is vitally important in its own way, so experts strongly recommend it. “Early detection increases the number of cases of breast cancer with nodes less than 2 cm and without metastases in the lymph nodes. This increases the chances of a complete cure and reduces mortality from breast cancer by 30-40%,” said Smartliving.ro University Professor Dr. Florian Fitzal, primary care physician at the Wiener Privatklinik Hospital in Vienna.

According to the latest GLOBOCAN statistics, 12,085 new cases of breast cancer and 3,918 deaths from the disease were registered in Romania in 2020.

Breast cancer screening can take many forms, from self-examination at home to clinical examinations. Regarding the latter, to avoid confusion, it is necessary to consider certain aspects related to the differences between breast ultrasound and mammography, methods of imaging research and breast cancer screening, which help the doctor to evaluate changes in breast tissue. to be known

Mammography, up to 40 years

Ultrasound examination is an imaging study that uses sound waves to create an image inside the body, which facilitates the identification of abnormalities or changes in breast tissue (abscesses, mastitis), visualization of solid and cystic tumor changes or axillary lymph nodes. This is the main research method used in young women under the age of 40, whose breasts have a fibro-glandular structure. If this structure persists even after 40 years, ultrasound is also used as an additional method of examination when mammography shows unusual results and they need to be investigated. Ultrasound can also guide the biopsy.

Because ultrasound does not use radiation, it is a safe examination method for women who are advised to avoid X-rays or any other radiation-based imaging methods, including pregnant women.

Mammography and special cases

Mammography, on the other hand, uses X-rays to detect changes in breast tissue, such as nodules, calcifications, or other abnormalities, which may indicate the presence of cancer (sometimes as long as three years before a tumor becomes visible) or other abnormalities. This method of research imaging is used in the case of women over 50 years of age and those who – family history or other risk factors – have an increased risk of developing breast cancer.

It is necessary to emphasize the fact that, despite the importance of early detection of breast cancer, mammography can either not detect breast cancer or, on the contrary, give a false positive result. For this reason, additional examinations (for example, ultrasound of the mammary glands) are also performed after mammography, especially if an abnormality is detected.

Differences between ultrasound and mammography

As I have already said, both ultrasound and mammography are screening methods for breast pathology. The first criterion that should be taken into account when choosing one or another is, as you can see, age. But he is not the only one. Then, in many cases, both types of examination are recommended for the accuracy of the diagnosis, because there are noticeable differences between them, apart from the fact that one uses ultrasound and the other uses X-ray.

Ultrasound and mammography produce different types of images. While ultrasound usually cannot detect microcalcifications (tiny calcium deposits that can often be one of the first signs of breast cancer), mammography can detect them. Also, if mammography is purely a screening test, ultrasound can be used not only as a follow-up tool, but the images obtained with it guide the needle to the area of ​​interest to take tissue samples for biopsy.

The choice of the most suitable method of examination is made by the doctor, taking into account other aspects besides age, when he recommends mammography before the age of 40, only if the woman has a family history of breast cancer or significant risk factors. Then weight and breast size are criteria to consider as they can affect the quality of the images. For example, in women with dense breast tissue, a mammogram may not detect cancer, and an ultrasound may also be needed. On the other hand, women who are overweight, obese, or have large breasts may be better off with mammography, which in this case provides more accurate images than ultrasound.

Since when and how often are these tests recommended?

What is the ideal age to start breast cancer screening? This topic was intensively debated for years until an agreement was reached. But because breast cancer risk has been found to increase after age 40, the American College of Obstetricians and Gynecologists has recommended regular mammograms starting at that age. According to the American Cancer Society, women should be able to start annual screenings between the ages of 40 and 44 and have regular mammograms starting at age 45.

In Romania, for breast screening, mammography is recommended every two years, after 40 years and annually after 50 years. However, a woman and her doctor must weigh the benefits and risks of screening and how often to be screened. Women at higher risk of breast cancer may need more frequent mammograms than women at average or low risk.

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