Pink October: everything you should know about mammography – 10/19/2023 – Balance

More than half of the women who sought SUS (Unified Health System) to treat breast cancer in the last three years sought care late. When they received the diagnosis, they already had the disease in advanced or metastatic stages, according to data from the Ministry of Health, available on the Cancer Radar platform.

The faster cancer is detected, however, the greater the chances of treatment and cure. In 2015, Inca (National Cancer Institute) established guidelines for the early detection of breast cancer. Among them is the indication of screening (examination in women who have no symptoms) carried out with mammography — an imaging screening procedure on breast tissue that can detect nodules that are not yet palpable.

It is common to find mammography efforts in the month of October, chosen for the breast cancer prevention campaign. In Bahia, the state government provides mobile units that offer the exam; in São Paulo, they are called “mammography carts” by management; and in Rio de Janeiro, “mobile mammograms”.

However, there are still doubts about carrying out the exam. In some places, for example, mammography is offered to women between 40 and 69 years old, while in others, from 50 years old. Some of the mobile units also do not serve women who have already had breast surgery.

Therefore, the Sheet sought out gynecologists, mastologists and oncologists to answer the main questions about the procedure.

Recommended age for mammogram

Screening with mammography is recommended for women between 40 and 69 years old, who are at higher risk of breast cancer, according to doctor Felipe Zerwes, president of the Mastology Commission at Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations). Exceptions to the rule, according to him, are patients at increased risk for cancer due to family history.

“What is recommended are healthy lifestyle habits, monthly self-examination and physical examination with a health professional periodically”, he states. In the SUS, however, exams are authorized for women between 50 and 69 years old, he explains.

Age difference between SUS and private network for mammography

The SUS follows the Inca guidelines, in which screening mammography is recommended for patients over 50 years old on a biennial basis, that is, once every two years.

“When we perform mammograms on patients under 50 years of age, there is the possibility, due to denser breasts, of finding what we call false negatives, in which the exam does not detect the lesion, and also false positives, which suggests an injury that may be nothing. Inca’s assessment is the one that would be most cost effective,” says Zerwes.

On the other hand, this is not the recommendation of scientific societies, such as Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations), Brazilian College of Radiology, Brazilian Society of Mastology and Brazilian Society of Clinical Oncology, which suggest 40 years as the ideal age. to start taking the screening exam, as well as annually.

“This way we can diagnose breast cancer in young women and in a shorter period of time, with greater chances of cure”, says Vanessa Donatelli, breast specialist at the São Camilo Hospital Network in São Paulo.

Is mammography radiation harmful?

The exam, which is an x-ray, has low radiation. Therefore, there is no reason to worry, according to experts. “The radiation emitted during mammography does not cause any harm to the woman. Quite the contrary, it gives the chance to make an early diagnosis of breast cancer and cure it”, says Donatelli.

There are techniques and equipment that can be used to protect the patient from radiation, if she is very worried, says oncologist Juliana Martins Pimenta, from Beneficência Portuguesa in São Paulo. But, according to her, the benefit of having a mammogram is much greater than any risk linked to the exam.

“We do not associate having a mammogram with a greater risk of developing cancer and this does not contraindicate the examination in any way. Mammography has allowed the early detection of breast cancer and, therefore, it has been a few years since We have reduced mortality.”

Can people with silicone have a mammogram?

Anyone with a silicone prosthesis can also take the exam.

“Some additional images may be necessary, but this does not prevent the examination from being carried out and also allows, with current mammography techniques, a very adequate assessment of the breast tissue. Ultrasound can be used for complementation. It is common for us to do this combination , to help detect any suspicious nodules and an MRI can also be requested if there is any doubt”, says Pimenta.

During the exam, the person in charge can also perform a maneuver, a “posterior removal” of the silicone implant in the patient’s breast before it is placed in the mammogram, says Donatelli.

Should those with dense breasts be concerned?

In women with dense breasts, the breasts have little fat (adipose tissue) and many glands (glandular tissue). They need to pay more attention to nodules, according to Zerwes.

“They have a slight increased risk of breast cancer and normally mammography has to be complemented by breast ultrasound. In special cases, if there is any doubt, [deve ser complementada] by breast magnetic resonance imaging”, says the doctor.

Can pregnant women have a mammogram?

Experts do not recommend carrying out the exam on pregnant women because of the radiation, which can be harmful to the formation of the fetus. Inca, however, states that mammography can be done with a lead apron to protect the abdomen, although calculations of radiation exposure to the uterus, according to the institution, suggest that there is virtually no radiation that reaches the fetus if the equipment is used. adequate.

Breastfeeding women, on the other hand, can undergo the exam, says Donatelli. According to Inca’s recommendation, screening is usually avoided during breastfeeding because breast density is significantly increased during this period, reducing the sensitivity of the method for detecting cancer.

Do men also have mammograms?

Men can also get breast cancer, although cases are rare. They should pay attention to breast cancer when they have a family history of the disease, according to Zerwes, but there is no formal recommendation for testing men — even in patients with a mutation that increases the risk of the disease.

“A man must sometimes spare his breast, but if he does not have a family history, the probability of having cancer is very low. Any change, sign or symptom, such as a lump, pain or secretion, in turn, You have to look for a health service, because you could have breast cancer”, says the doctor.

For trans men who have not undergone mastectomy, there has been a screening option in the SUS since 2022 and the recommendations are the same as those made to women.

In 2022, 4,239,253 mammograms were performed on women in the SUS. In men, 8,719 mammograms were performed, including for diagnostic and screening purposes.

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