Mammography
and Martina Feichter, medical editor and biologistValeria Dahm is a freelance writer in the medical department. She studied medicine at the Technical University of Munich. It is particularly important to her to give the curious reader an insight into the exciting subject area of medicine and at the same time to maintain the content.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
Mammography is an X-ray examination of the breast (lat. Mamma). They can help diagnose changes in breast tissue (such as lumps) that could be breast cancer. In addition, women in Germany and Switzerland are aged between 50 and 69. Age, in Austria between the ages of 45-69 routinely invited to mammography (mammography screening). Read here how the examination works, when it makes sense to have a mammography and what risks it entails.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. D05C50
What is mammography?
Mammography is an X-ray examination of the breast for the early detection of breast cancer (breast cancer) or its precursors. These include small calcium deposits (microcalcifications), lumps, thickenings, asymmetries or other disorders in the tissue architecture of the breast.
In analog mammography, the classic X-ray image is created on an exposed film sheet. The newer digital mammography allows an electronic storage of the image on a computer so that certain areas can be enlarged and reworked if necessary. Even a three-dimensional picture of the breast can be made. This can help the doctor better assess some areas of tissue.
Mammography: when does it make sense?
When a mammography makes sense is still being discussed critically by many experts. It is important to weigh the benefits of the examination - its high hit rate in the detection of breast cancer - against the risks and disadvantages (see below). The current situation in Germany is as follows:
For women under 50 years of age (Germany and Switzerland) or. Under 45 years of age (Austria), mammography is usually only performed if there is a specific suspicion of breast cancer - for example because a suspicious lump in the breast can be felt. In women with an increased risk of breast cancer, however, it can make sense to repeatedly X-ray the breast in a rotational manner (see below).
Mammography is routinely recommended for women over 45 (Austria) or over 50 (Germany and Switzerland). Breast cancer occurs particularly often in this phase of life. For this reason, women in this age group are invited to have a mammography every two years as a precaution. The costs are covered by the health insurance companies or the compulsory health insurance (statutory cancer screening program).
For women over the age of 70, the recommendations for breast cancer screening examinations (such as mammography) are based on several factors: The individual cancer risk, the general state of health and the individual life expectancy of the woman are taken into account.
Women at increased risk of breast cancer
Some women have an increased risk of breast cancer, for example because their mother or sister has already had breast cancer or because breast cancer risk genes have already been definitely identified in the woman's genome. Then it can make sense to routinely perform a mammography before the age of 50 or 45 - often supplemented by magnetic resonance imaging (magnetic resonance imaging, MRI) of the breast. Such intensified early cancer detection is based on the individual risk profile of a woman with an increased risk of breast cancer.
Experts have taken these advantages and disadvantages of mammography into account when developing the mammography screening: In the age group of 50 to 69 year olds (Germany, Switzerland) and 45 to 69 year olds (Austria), the benefits of the routine predominate Chest x-ray. For all other women, it depends on individual factors (specific suspicion of breast cancer, genetic predisposition for breast cancer, etc.) whether a mammography makes sense.
How does the mammography work?
Mammography is an outpatient examination. At the first visit you have to fill out a questionnaire on which personal data, previous illnesses and especially breast cancer in the family are recorded. The doctor will also talk to you personally about important background information (anamnesis interview).
You should not apply deodorant before the mammography, as this can impair the informative value of the X-ray image.
For the mammography itself, you have to completely free your upper body and remove any jewelry that could cover the breast tissue (necklaces, breast percings, etc.). Then your breasts are carefully elongated and pressed together as flat as possible between two sheets of plexiglass. This mammography step may be painful. Then the breast tissue is x-rayed. Usually two x-rays are taken from different directions: from top to bottom (cranio-caudal) and diagonally from the center to the side (mediolateral oblique).
In good radiological practices, the four-eyes principle applies when assessing x-ray images. This means that two x-ray specialists (radiologists) examine the images independently of each other. If the findings differ, a new mammography or a further examination such as magnetic resonance imaging (MRI) or galactography (mammography in which the milk ducts are displayed with a contrast medium) is carried out.
These examination methods are also used if the mammography x-ray shows a suspicious finding or the breast is difficult to assess using the mammography. This can be the case with dense breast tissue, especially in younger women, silicone pillows, pronounced mastopathy (benign changes in the breast tissue) or after radiation therapy. An MRT mammography then provides more precise results than an X-ray mammography.
After the mammography
The results of the mammography are available after a few days. If suspicious tissue changes are discovered, further examinations are necessary for clarification, such as a new mammography, ultrasound examinations, MRI mammography or a tissue removal (biopsy).
Mammography: yes or no?
Mammography is a quick and easy examination that can be used to detect abnormal changes in the breast. Even tumors that are only three to five millimeters in size and not yet palpable can be detected using chest X-rays. That means: This examination method has a high sensitivity.
However, mammography also has disadvantages and risks:
- As with any X-ray examination, the radiation dose during a mammography can damage the genetic material in the cells. Under certain circumstances, this can lead to the cells degenerating and transforming into cancer cells. However, according to experts, the risk of developing breast cancer as a result of a mammogram is very low.
- Squeezing (compressing) the chest can rarely cause bruising (but not cancer).
- Mammography screening has a low specificity: it also detects tissue changes and classifies them as (possible) breast cancer, which are actually harmless (misdiagnosis). The women affected must undergo further examinations and possibly interventions (such as tissue removal), which ultimately prove to be unnecessary. In addition, the misdiagnoses put women in unfounded concern.
- The most serious damage of mammography is the so-called overdiagnosis. This means that breast cancer would never have been found without mammography, but it would not have caused any symptoms. The usual procedure with surgery, radiation and chemotherapy is of no use in the event of an overdiagnosis, but unnecessarily restricts the patient's quality of life.
Experts have taken these advantages and disadvantages of mammography into account when developing the mammography screening: In the age group of 50 to 69 year olds, the benefits of routine chest x-rays predominate. For all other women, it depends on individual factors (specific suspicion of breast cancer, genetic predisposition for breast cancer, etc.) whether a mammography makes sense.
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