1. Why is early diagnosis important?

It can take several years from the start of the development of breast cancer until it is detectable. As the tumor grows, the cells acquire an increasingly aggressive potential, with greater capacity to metastasize and to become resistant to treatment. There is irrefutable scientific evidence that the lower the stage (I-IV), the greater the chances of cure; the smaller the tumor, the greater the possibility of conservative surgery; and the lower the stage, the less chance of needing chemotherapy and other aggressive treatments.

Imaging techniques are mainly indicated for the study of oncological diseases, although it has been shown to be useful in neurological, psychiatric, and cardiological diseases. Therefore, we are certain that detecting breast cancer at an early stage significantly increases the chances of cure.

2. What is a screening mammogram?

It is an x-ray of the breast that is used to detect changes within it, in women who do not have signs or symptoms of cancer, that is, in an asymptomatic situation. Two projections of each breast are required. Mammography can detect microcalcifications (small calcium deposits in the breasts, which are sometimes an indication of the presence of cancer) or a tumor that cannot be felt. Mammography has a sensitivity of 85 to 95%.

3. What is a diagnostic mammogram?

It is an x-ray of the breast that is used to diagnose abnormal changes, such as lumps, pain, thickening or discharge from the nipple, or a change in the size or shape of the breast. Diagnostic mammography is also used to evaluate the changes seen on a screening mammogram. Diagnostic mammography may be necessary if it is difficult to obtain a clear image with a detection or screening mammogram, due to special circumstances, such as the presence of breast prostheses. A diagnostic mammogram takes longer, because it sometimes requires special projections to get views of the breast from various angles. The technician can zoom in on a suspicious area to get a detailed image that will help the doctor make an accurate diagnosis.

4. What are microcalcifications?

Microcalcifications are calcium deposits that appear in the mammary gland and are detected on mammography as small white dots. Its importance lies in the fact that approximately 50% of palpable and non-palpable breast cancers present this type of images.

They may be more or less suspicious for malignancy depending on the characteristics they present. Those that are small, and of irregular morphology and density, are most frequently associated with carcinoma when they are grouped in large numbers in a small area and when they appear forming molds of the mammary ducts. Calcifications are often the only abnormal finding and are not associated with a palpable lesion. In these cases, a stereotactic-guided biopsy should be performed.

5. When is it recommended that women have screening mammograms?

Women age 40 and older should have mammograms every one-to-two years. Women who have family or personal risk factors for developing breast cancer should assess the need for mammograms and frequency with their doctor before the age of 40.

6. Should young women have mammograms?

The main international organizations advise an annual mammography of both breasts from the age of 40 for the screening of breast cancer. In women who are at high risk of suffering from this tumor (with a history of young first-degree relatives or carriers of genetic alterations such as BRCA1 and BRCA2), screening should begin at 25 years of age or at an age ten years younger than that of the affected family member when they were diagnosed.

7. What is the BIRADS® system and what is it for?

The American College of Radiology, in collaboration with other entities such as the National Cancer Institute, FDA (Food and Drug Administration), and the American College of Pathologists, created the BI-RADS (Breast Imaging Reporting Data System) classification with the intention of standardizing the results of mammography reports and reduce its ambiguities.Five categories were initially establishedwhich were later extended to seven. This system is a guide that aids quality control. It establishes different categories based on the degree of image suspicion, BIRADS 1 (Normal) and BIRADS 5 (High suspicion), as well as their subsequent approach (normal follow-up, close surveillance in 6 months or biopsy). Its design makes it possible to standardize mammographic reports, reduces confusion in the interpretation of diagnostic imaging, and facilitates subsequent monitoring of patients.

8. Does breast ultrasound see the same things as mammography?

Yes and no. Ultrasound complements mammography, it allows you to see things that are seen in mammography, to see them better, or even to see things that are hidden in mammography. However, on other occasions, it does not detect certain findings that mammography does, such as microcalcifications.

9. Does ultrasound produce radiation?

No, it uses high frequency ultrasound waves and is completely harmless.

10. Can I get an ultrasound and do without mammography?

Initially, in a woman over 40 years old withno just cause, no. Mammography should be performed, and ultrasound should or should not be associated. If we only performed ultrasound, we could overlook some entities of great importance such as microcalcifications and some distortions that are often the initial manifestation of breast cancer.

11. How long does an MRI of the breast last?

Approximately between 35 and 45 minutes.

12. Could you do an MRI without contrast?

The fundamental key to breast MRI for the diagnosis of breast lesions is their uptake of contrast. The sensitivity of a breast MRI without contrast is very low and, therefore, it is better not to do it without contrast. There is a case where we can do breast MRI without contrast – when we only want to assess the state of the breast prostheses.

13. Can the MRI contrast give me an allergy?

The contrast that we use in magnetic resonance imaging is the GADOLINIUM. Gadolinium allergic reactions are rare and much less frequent than iodinated contrast (CAT) reactions.

14. Should I be fasting to do a CT scan?

In principle, if it is to be performed with intravenous contrast, you should be fasting for 6 hours due to the risk of vomiting caused by the administration of the contrast agent.

15. If they indicate a breast biopsy, is it because I have something wrong?

Not necessarily. A high percentage of the processes that we biopsy are benign. If they indicate a breast biopsy, it is necessary to try to be calm as much as possible and to do it within a reasonable time to avoid states of anxiety and worry.

16. How do I know which biopsy I should have?

You should trust what your doctor and radiologist advise you.

17. Should I be fasting before a biopsy?

It is not necessary to skip breakfast.

18. Do biopsies hurt?

In most cases they do not hurt – we use local anesthesia. However, there is a subjective component of pain, the personal experience of the process that is sometimes difficult to control. So, trying to remain calm on test day helps a lot.

19. Do breast biopsies have any contraindications?

Only allergies to local anesthetics, caution when there is any type of coagulation disorder, and stop taking anticoagulant drugs, as directed by your doctor.

20. What will they do to you on the day of your lymphogram scan?

The doctor will inject you, around the lesion, with a substance that will produce a low dose of radiation, similar to that emitted during radiological studies. This substance is distributed through the lymphatic channels. Images will be obtained after the injection using the gamma camera to identify the location of the sentinel node.

21. Is lymphogammagraphy painful?

A scintigraphic examination is not painful. You will need to remain very still during imaging.

22. Does lymphogammagraphy have undesirable effects?

The dose administered is very low and, therefore, does not frequently produce any side effect or adverse reaction, and it will not prevent you from living your normal life. The irradiation received to perform lymphogammagraphy is very small, being even less than that received in an equivalent conventional radiological examination.