Mammography

Process

• The examination takes place in a specialized X-ray institute. It is performed by specially trained staff.
• Calculate with 30 minutes of time.
• Do not use deodorant or underarm powder before the examination.
• For the examination, you must undress to the waist and remove any jewelry. Therefore, wear clothes which you can easily remove.
• Each breast is compressed between two plates for a few seconds. This can be uncomfortable, but does not last long.
• If possible, place the appointment in the first half of the cycle (the first two weeks after the start of menstruation). Then the breast is less sensitive to pain.
• A total of four images will be taken, two images per breast.

Findings

• A radiologist will evaluate the images of your breast, usually while you are still present.
• The radiologist will send the definitive report to your referring physician(s) 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 causing cancer because of the extra radiation is very small. The improved early detection overruns this risk.

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

The company health insurance (OKP) covers mammography in full every two years from the age of 50, provided that it takes place in the following institutes:

• Spital Grabs und Spital Walenstadt 
• Kantonsspital St. Gallen
• Kantonsspital Graubünden, Chur
• Landeskrankenhaus Feldkirch

Please submit the Confirmation filled out and signed by your physician / doctor within one month to your health insurance company. The confirmation can be found in the lower part of the invitation letter for mammography. You received this together with the invitation to the gynecological examination.

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

For mammograms that are not part of the gynecological checkup, you must pay the deductible.

The OKP pays women with increased risk of breast cancer for screening mammograms more often under certain conditions.  Ask your health care provider if you are unsure if you are at increased risk.

General principle

In a screening or a preventive examination, healthy persons of a certain population group are specifically examined for a certain disease. A preventive examination makes sense, if the illness in question can be discovered thereby at a very early time and therefore the healing chances increase. In addition, the examination should be low-risk. Healthy persons should not be harmed by it. A typical example of a preventive examination is the cancer smear test for the early detection of cervical cancer.

A conspicuous finding: What next?

In the mammogram something abnormal was found. At the beginning, however, it is often not clear what this something is. Is it a benign finding? Or 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 talk to him. He will determine the further procedure on an individual basis. Depending on the findings, you can wait and have another checkup at a certain time interval.

Possible further examinations are ultrasound, magnetic resonance imaging (MRI) or a biopsy. Your doctor will give you competent advice and arrange the right thing.

An abnormal finding is scary. But it doesn't have to. 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 being looked for is found.

In any medical examination, it can happen that the disease is supposedly found. However, the person examined is not ill at all. The result is a false diagnosis or a so-called false positive finding.

The result is a false positive finding

Simplified: In the mammography breast cancer is suspected, although the examined person has no breast cancer.

It is undisputed that false positive findings occur in mammography. According to experience, 60 out of 1000 women examined have a conspicuous finding. Further clarification reveals 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 about seven percent, or four women, only a biopsy ruled out breast cancer.

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

Numbers

Breast cancer, also called mammary carcinoma, is the most common cancer in women in Europe. One in ten women will develop breast cancer in her lifetime; thirteen out of every 100,000 women will die from it (EU mean).

Treatment and survival rates

For localized breast cancer confined to the breast, surgical treatment is the first line of treatment. Two-thirds of patients can undergo breast-conserving surgery. In most cases, this is followed by radiation and/or chemotherapy. Due to advances in therapy and early detection, the 5-year survival rate for localized breast cancer is now 98 percent. In other words, five years after diagnosis, 98 percent of patients are alive.

For metastatic breast cancer, there are several ways to slow tumor growth and allow for a good quality of life. In addition to surgery and radiation, these include chemotherapy, hormonal therapies, and modern immunologic approaches. A cure is not possible. Nevertheless, the 5-year survival rate is 26 percent, meaning 26 percent of patients are alive five years after diagnosis.

The treating medical team decides which is the best therapy or combination of therapies 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 what 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 include certain hormone replacement therapies, an early first menstrual period, and late-onset 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.
• The breast cancer - therapeutic standards and new therapeutic options 2013, an oncology review. Marcus Vetter, Christoph Rochlitz. Therapeutische Umschau, 2012;69(10):577-584
• Cancer Aid Liechtenstein
• Cancer League Switzerland
• Association of Breast Cancer Screening Programs
• Austrian Cancer Aid Vorarlberg