Mammography

Procedure

• The examination takes place in a specialized X-ray institute. It is carried out by specially trained staff.
• You should allow 30 minutes for the examination.
• Do not use deodorant or underarm powder before the examination.
• For the examination, you must undress to the waist and remove any jewelry. You should therefore wear clothes that you can easily take off.
• Each breast is pressed between two plates for a few seconds. This can be uncomfortable, but does not last long.
• If possible, schedule the appointment for the first half of your menstrual cycle (the first two weeks after the start of your period). The breast is then less sensitive to pain.
• A total of four images are taken, two images per breast.

Findings

• A radiologist will assess the images of your breasts, usually while you are still present.
• The radiologist will send the final report to your referring doctor a few days later.
• If necessary, your doctor will discuss the findings with you again.

Radiation exposure

• The radiation exposure is extremely low. The theoretical risk of developing cancer due to the additional radiation is very low. The improved early detection more than makes up for the risk.

The radiation exposure from mammography is 0.7mSv. This amount is comparable to natural radiation for three months.

Compulsory health insurance (OKP) covers mammography in full every two years from the age of 50, provided that it is carried out at the following institutions:

• Hospital region Rheintal Werdenberg Sarganserland: Grabs Hospital and Walenstadt Hospital
• Cantonal Hospital St. Gallen
• Cantonal Hospital Graubünden, Chur
• Regional hospital Feldkirch

Please submit the confirmation completed and signed by your doctor to your health insurance company within one month. The confirmation can be found at the bottom of the invitation letter for the mammogram. You received this together with the invitation to the gynecological check-up.

The OKP only covers mammograms at institutes other than those listed above if you have extended compulsory health insurance.

You must pay the deductible for mammograms outside of the preventive check-up.

The OKP pays for women with an increased risk of breast cancer to have a screening mammogram more frequently under certain conditions. Ask your doctor if you are unsure whether you have an increased risk.

General principle

In a screening or preventive examination, healthy individuals from a certain population group are specifically examined for a certain disease. A preventive examination makes sense if the disease in question can be detected at a very early stage and the chances of recovery therefore increase. The examination should also be low-risk. Healthy people should not be harmed by it. A typical example of a preventive examination is a cancer smear test for the early detection of cervical cancer.

An abnormal finding: what next?

The mammogram has detected something abnormal. At the beginning, however, it is often not clear what this something is. Is it a benign finding? Or is it a malignant finding, which is much rarer?

If your doctor sees an abnormal finding in your mammogram, he will inform you immediately and ask you to come in for a consultation. The further procedure will be determined individually. Depending on the findings, you can wait and have another check-up at a certain interval.

Possible further examinations include ultrasound, magnetic resonance imaging (MRI) or a direct tissue examination, a so-called biopsy. Your doctor will give you expert advice and make the right decision.

An abnormal finding can be frightening. But it doesn't have to be. The chances are good that it is a benign finding. In less than 10% of cases it is actually breast cancer.

False positive findings

In medical parlance, a finding is called positive if something abnormal that is typical of the disease in question is found.

In any medical examination, it can happen that the disease you are looking for is supposedly found. However, the person being examined is not actually ill. The result is an incorrect diagnosis or a so-called false positive result.

To put it simply: breast cancer is suspected in the mammogram, although the person being examined does not have breast cancer.

It is undisputed that there are false positive findings in mammography. Experience shows that 60 out of 1000 women examined have abnormal findings. Further investigations show that 55 women have a benign change. Only five women actually have cancer. In retrospect, however, the 55 women had unnecessary examinations and experienced fear and uncertainty. In around seven percent, i.e. four women, only a biopsy ruled out breast cancer.

Unfortunately, even an inconspicuous mammogram does not give you one hundred percent certainty that you do not have breast cancer. Over a period of ten years, one in 1000 women dies of breast cancer despite an inconspicuous mammogram.

Figures

Breast cancer, also known as breast carcinoma, is the most common cancer in women in Europe. One in ten women will develop breast cancer in the course of her life; thirteen out of 100,000 women die from it (EU average).

Treatment and survival rates

Surgical treatment is the first choice for localized breast cancer confined to the breast. Two thirds of patients can undergo breast-conserving surgery. In most cases, this is followed by radiotherapy and/or chemotherapy. Thanks to advances in therapy and early detection, the 5-year survival rate for localized breast cancer is now 98 percent. This means that 98 percent of patients are alive five years after diagnosis.

In metastatic breast cancer, there are several ways of slowing down tumor growth and enabling a good quality of life. In addition to surgery and radiotherapy, these include chemotherapy, hormonal therapies and modern immunological approaches. A cure is not possible. Nevertheless, the 5-year survival rate is 26 percent, i.e. 26 percent of patients are alive five years after diagnosis.

The treating medical team decides which therapy or combination of therapies is best in each individual case.

Risk factors

By far the most important factor is a genetic predisposition. If you have a family history of breast cancer, your risk is increased. Your doctor will advise you on which preventive measures and any further investigations are appropriate. In rare cases, the so-called breast cancer gene (BRCA1/2) occurs. A well-known carrier of this gene is the Hollywood actress Angelina Jolie. Carriers of this gene have an even higher risk of breast cancer and ovarian cancer.

Other factors that increase the risk of breast cancer are certain hormone replacement therapies, an early first menstrual period and a late onset of the menopause.

• The Benefits and Harms of Breast Cancer Screening: an Independent Review. Independent UK Panel on Breast Cancer Screening. The Lancet, 2012;380(9855):1778-1786.
• Breast cancer - treatment standards and new treatment options 2013, an oncologic review. Marcus Vetter, Christoph Rochlitz. Therapeutic Review, 2012;69(10):577-584
• Cancer Aid Liechtenstein
• Swiss Cancer League
• Association of Breast Cancer Early Detection Programs
• Austrian Cancer Aid Vorarlberg
• Austrian Cancer Aid Vorarlberg