Screening Methods in Breast Cancer

The high prevalence of breast cancer, its increasing frequency, the possibility of treating it in its early stages, and the ability to diagnose it at an early stage under current conditions all increase the importance of screening methods for breast cancer.

The choice of screening method is based on the patient's age, breast tissue structure, and physical examination findings.

CLINICAL BREAST EXAMINATION

Breast examination should be performed by a specialist doctor. Generally, it should be done every 1-3 years until the age of 40 and annually after 40 years of age. The frequency of the examination is determined by the doctor based on risk factors and any findings detected during the examination.

MAMMOGRAPHY

Mammography is the most important imaging method used for early diagnosis.

Mammography is a special breast X-ray film taken with a low dose of X-rays. It is used to detect formations, especially cancer markers, that cannot be detected through physical examination, as well as to view the details and internal structure of breasts in women with fibrocystic breast conditions.

No medication is used during the mammography. No injections are given. The breast is gently compressed between two plates. The purpose of compression is to prevent breast movement, improve image quality, reduce the amount of X-rays needed by decreasing the breast thickness, and allow overlapping formations in the breast to separate to avoid erroneous results.

With the new generation digital mammography, the amount of X-rays has been significantly reduced.

Mammography is performed in both horizontal and vertical directions.

No preparation is needed before a mammogram. The images do not change depending on the menstrual cycle, but mammography can be more comfortable when performed outside the menstrual period for sensitivity reasons.

During the examination, the upper body is exposed. It is recommended not to apply deodorant, talcum powder, or lotion to the breast and underarm areas to avoid affecting the images.

BIRADS (Breast Imaging Reporting and Data System)

BIRADS is a reporting technique used to show the course of action based on the mammogram result.

• BIRADS 0: An unclear finding in the mammogram that requires further investigation.
• BIRADS 1: Normal mammogram result.
• BIRADS 2: A finding that is 100% benign.
• BIRADS 3: Likely benign, follow-up in 6 months is recommended.
• BIRADS 4: The result requires biopsy for confirmation, as there is a high likelihood of cancer.

BREAST ULTRASONOGRAPHY

Breast ultrasonography is an effective method for women with dense breast tissue. It is useful for young women and those at familial risk when the mammogram is normal but a lump is palpable. It is also effective for detecting formations that might not be visible in mammography due to tissue overlap.

Ultrasonography does not involve radiation. It is the preferred method for women under 40 with a palpable lump.

Mild pain may be felt during breast ultrasound, particularly during sensitive periods. If there are signs of infection (pain, swelling, redness) in the breast, ultrasonography is preferred.

If suspicious findings are found during mammography or clinical breast examination, ultrasonography is used for further evaluation.

MAGNETIC RESONANCE IMAGING (MRI)

Magnetic Resonance Imaging (MRI) uses powerful magnetic fields and radio waves to create images. It does not involve radiation. MRI is used to detect formations and abnormalities not found in the body's natural structure. It is especially effective for imaging soft tissues.

MRI detects 20-25% of focal areas that are not visible through mammography, ultrasonography, or physical examination. MRI is especially useful in planning surgical treatment for dense fibrocystic breasts. It can also guide decisions when recurrence of cancer is suspected.

When cancer is detected in one breast, MRI is often used to search for similar formations in the same or the other breast.

MRI is typically not used as the first step in screening. In some cases, it is used to support ultrasound, and in high-risk patients, it is requested in addition to mammography. MRI is not affected by breast density or structure.

MRI is also used for post-treatment monitoring and to assess the effectiveness of chemotherapy in advanced breast cancer cases.

BREAST BIOPSY

When a suspicious lesion is detected in the breast through imaging techniques, a biopsy is performed to determine whether it is cancer or another type of formation. Biopsy involves the collection of tissue samples from the lesion using various tools and devices, often under the guidance of radiology.

The lesion may be better visualized in mammography, ultrasonography, or MRI. The biopsy is performed using the method that provides the best visualization. Sometimes, a surgical method may be used for the biopsy.

The sample is analyzed in a pathology lab to determine if it is cancerous. The goal of the biopsy is to obtain enough tissue for the pathologist to evaluate.

There are different biopsy techniques, and the radiologist determines the appropriate method based on the amount of tissue needed, breast structure, and the characteristics of the lesion.

During the biopsy, the upper body is undressed. The area to be biopsied is numbed using a local anesthesia technique. The goal is to ensure that no pain is felt during the procedure. After the procedure, you may experience pain during the day or the following day. Pain relievers can be used as recommended by your doctor. After the biopsy, the area will be closed, and it needs to be monitored for bleeding.