Tag: women's health

Breast Cancer and Prevention, the Fear of Screening and How to overcome it

When choosing a healthy living routine, the goal is to stay healthy and live long. However, alongside meals with light and fresh foods, simple exercises to keep fit without excessive physical exertion, and extra attention to hydration, we need to remember that there is also another routine at the heart of healthy living. That of diagnostic examinations, which it is right to undergo at a cadence suggested by the family doctor. And to participate without fear or dread in the routine of cancer screenings. 

Mammography screening: no fear because it saves lives

This is not the case for everyone, but there are many who flee checkups and examinations because of the enormous worry of “having something.” The main fear is that of discovering a malignant tumor; mammography, among the female population, is among the most feared exams along with Pap smears, ultrasound and CT scans. The invitation to come to a specialized center for national mammography screening, which is free of charge and every two years, is often left unheeded by those who are in the target range between 50 and 69 years old. The risk of this fear? For those who avoid the exams is to overlook serious, and less serious, symptoms to the point of making them more difficult to treat or even incurable. Dr. Anna Abate of San Gerardo in Monza, who works in the Breast Unit and specializes in mammography screening, explained it well to us in this interview:

“Unfortunately, most women, do not have a clear understanding of the value and purpose of screening […] a valuable modality of diagnosis because it allows detection of lesions that are not yet clinically detectable. Most women still do not understand that the possible presence of a lesion that is not clinically palpable ensures the possibility of early intervention. […] But prevention must be done in another spirit: not as a condemnation but as an opportunity to detect lesions that are still very small with a low surgical, therapeutic, and therefore psychological impact and a better prognosis.”

Mammography: don’t be influenced by environment and experience

Why does fear block so many women and how do we overcome it? The first piece of advice is to start with a necessary distinction: fear dwells in our minds, while danger is present and concrete in reality. The fear of the results of cancer screening, such as mammography, is in the head, but the danger of cancer is well present with its burden of complexity and treatment. In fact, breast cancer continues to be the most frequently diagnosed cancer in women. But thanks to screening and increased awareness, it’s possible to dignosticate it at an early stage.

So what happens when the fear of screening is triggered? Psychologist and neuroscientist Lisa Feldman Barrett, in her book “How Emotions are Made,” explains that we don’t simply react to external stimuli, but we help create our emotions depending on our surroundings and our past experiences. So the idea of having a screening test for breast cancer, in a specialized center, with a doctor and mammographer invokes in many an extreme: if I do this test then I will find cancer and my life is in danger. It is called prediction: our brain is constructing a negative situation even when, in reality, that situation does not exist. And this happens based on memories of similar situations already experienced, such as, for example, someone’s account of an experience that has left trauma. In the case of mammography screening, the prediction is the testimony of women who have recounted discovering cancer this way.

But if we rationalize this, the reality leads us to an entirely different conclusion: an examination is being done to prevent a potential life-threatening disease, and therefore, even if there is an alteration or abnormality, action can be taken in time to increase survival. In the case of crippling fear, one must get out of one’s head and look at what is really there: doing prevention allows for healthy living and intervention. By its nature, mammography screening is a test that targets healthy people and is not invasive at all.

These directions are not a substitute for consultation and discussion with your physician, but are reported for informational and educational purposes only.

Self-Examination, the first Breast Cancer Prevention Exam

A few simple gestures can make all the difference in breast cancer prevention.

At a typical time in the daily routine, just a few minutes and proper self-examination can keep potential changes and irregularities in check. Here’s how.

Although breast cancer in its early stages generally causes no discomfort, women can feel changes in their breasts through this periodic self-examination. This should be done between days 7 and 14 of the cycle, when the breasts are less likely to be swollen and sore. For women who no longer menstruate, the advice is to choose a day that is easy to remember, such as the first or last day of the month.

Special attention should be paid to the following abnormalities:

  • Changes in breast size or shape
  • Difference in size between the two breasts that has appeared recently
  • Retractions, folds or swelling of the breasts
  • Skin abnormalities, such as redness, inflammation or “orange peel” skin
  • Hardening or presence of lumps in breast tissue
  • Nodules or swellings in the axillary cavity
  • Retraction or redness of the nipples or discharge of fluid
  • Pain in the breast area

Self-examination is not a substitute for a medical examination or mammogram for early detection of breast cancer. Prevention programs are available in all regions that invite all women aged 50 and older to have mammography screening every two years.

If you notice changes or irregularities in your breasts, do not be alarmed; they may be benign lesions. See a specialist who will direct you to the appropriate tests.

Self-palpation performed once a month facilitates early detection and increases the likelihood of cure. However, this does not mean that every lump that is palpated automatically corresponds to breast cancer; even cysts can be the cause of a mutation. However, every palpable lump should be examined by a specialist.

What Mammography is, What it is for and How it is performed

It is often said that ‘better safe than sorry’!

Adhering to a screening is the first and most important step for a possible early diagnosis: it is essential to talk to your family doctor or a specialist and have the tests done. If there are family risk factors, the recommendation is always to seek advice from your doctor.

Mammography is not usually a painful examination and is therefore performed without hospitalisation, anaesthesia or sedation of the patient. One should not be afraid to have it done and the advice is always to go to specialised centres.

Mammography, what it consists of and who performs it

Mammography is an X-ray examination of the breast, using a low dose of ionising radiation for a few seconds. It allows early detection of breast tumours, as it is able to detect lumps, even small ones, that are not yet perceptible to the touch. Mammography is performed by a specialist doctor in senology on an outpatient basis, so there is no need for admission or day hospital.

No preparation is needed in the hours or the day before the examination, and you can eat and drink. The advice is to wear comfortable clothes and not to apply creams or deodorants to the skin in the area affected by the examination, as they may alter the image available to the doctor for the examination. If you have had previous examinations, starting with the screening mammogram, you should bring them with you and inform your doctor.

Practical information for breast screening

The time of an examination is about 15 minutes, not including the phases of acceptance and interview with the doctor. The examination involves positioning the breast on a plane (detector) and compressing it with a plate (compressor) to ensure immobility during the examination and to obtain sharp, quality images. A total of 4 projections are performed: viewing the breast both from above and from the side.

The actual duration of the examination on the machine is only a few seconds per projection. Greater accuracy in diagnosis is achieved by the evaluation of the mammogram performed separately by 2 radiologist doctors. If the result is positive, you are invited for a second mammography, an ultrasound scan and a clinical examination to confirm or not the actual presence of a tumour.

Mammography, tomosynthesis and ultrasound: how they work

The traditional digital mammogram acquires a single image of the compressed breast. Traditional mammography allows for two-dimensional images of the breast. In newer systems, a three-dimensional acquisition is added to this so-called “traditional” examination, which, by breaking down the breast into thin layers, allows even the most minute structures to be appreciated.

Ultrasound, on the other hand, is a diagnostic examination that scans the breasts and axillary cords using a probe that emits ultrasound and allows for the detection of any palpable breast lumps or any changes in the axillary lymph nodes.

In practical terms, breast ultrasound is also used as a second-level examination to complement or supplement an initial diagnosis of mammography, particularly in breasts with particularly dense tissue. Or if the screening mammogram finding presents the need to deepen tissue: this second step should not be frightening, but is precisely a preventive practice to further investigate what may be cancerous lesions still in an early stage. Again, it is good to rely on a specialized center or breast unit that has all the machinery to immediately perform an ultrasound to support a mammogram examination.

When and Who should have Mammography Screening

Breast cancer is an enemy that can be tackled by anticipating it with healthy lifestyles and without letting your guard down thanks to screening. Mammography is crucial in the prevention of breast cancer, which is the most common cancer disease in the female population. Thanks to early diagnosis and effective treatment, the survival of women with breast cancer has improved, with mortality significantly reduced and estimated 5-year survival increasing.

10 useful tips before mammography screening

Screening for breast cancer is aimed at women between the ages of 45 and 74 (https://healthcare-quality.jrc.ec.europa.eu/ecibc/european-breast-cancer-guidelines/screening-ages-and-frequencies) and involves having a mammogram every two or three years, depending on the age group. *

So here is a list of some good practices to keep in mind when we want to join the screening programme:

  • Respect the timing of mammography screening according to age and any family predispositions
  • Always talk to the family doctor or a specialist first to get all the information about the examination and the centres where it can be carried out
  • Anxiety and fear are often uncomfortable companions on this journey of prevention. However, if the examination requires further investigation, early screening and early diagnosis are the allies that can make the difference in the course of treatment.
  • Do not procrastinate: therefore write down on your calendar the day and time when you want to have the screening examination in order to have a high probability of booking the examination without procrastination
  • On the day of the examination, do not apply deodorants or creams to your skin, as these may alter the image of the mammogram
  • Try to relax; discomfort has been shown to increase a negative psychological state
  • The doctor is a trustworthy person with whom you can talk and share your anxieties and fears.
  • In the case of breast implants, let them know when you book: the centre will be able to tell you if they can perform the examination or refer you to another specialised centre
  • Always go to centres that have the latest generation of equipment, which is more reliable and emits less radiation
  • Carefully keep your screening records and reports to bring with you to each subsequent medical check-up as the information may be crucial for comparison

*This information is based on European guidelines, check with your doctor the screening programmes are in your country.

How is breast cancer screening done?

Mammography, from a technical point of view, is a radiological examination of the breast that allows early detection of tumours in that part of the body because it is able to detect lumps, even small ones, that are not yet perceptible to the touch. So monthly breast self-examination is a good practice, but it cannot replace mammography screening for women covered by this programme.

It is precisely these organised screening programmes that require the examination to be performed by visualising the breast both top-down and sideways. Greater accuracy in diagnosis is achieved by the evaluation of mammography performed separately by two radiologist physicians.

A positive mammogram is not the same as a definite diagnosis of breast cancer, although it does indicate an increased likelihood of being affected by the disease.

This is why, in the event of a suspicion, the first examination is followed by further diagnostic tests that, again within organised screening programmes, consist of a second mammogram, an ultrasound scan and a clinical examination. These examinations may also be followed by a biopsy to assess the characteristics of any cancer cells. Only upon completion of this pathway is a definite medical response obtained and a course of treatment promptly initiated.