10 questions about screening mammography

1. What is a screening mammogram?

A screening mammogram is a specialized medical examination that involves taking an X-ray of both breasts with a low dose of X-rays. This photograph (mammogram) allows detection of breast cancer or other irregularities in the breasts. A screening mammogram is done at a hospital radiology department, an outpatient clinic or in a radiologist's private practice.

2. Why should I have a screening mammogram done?

A screening mammogram is used to detect breast cancer early, at a time when you cannot yet feel a lump yourself. The earlier breast cancer is detected, the better it can be treated. Thanks to this research, many breast cancers are detected at an early stage, greatly improving breast cancer survival rates.

If you have already felt something in your breast that you are worried about, a mammogram is also performed. This is then called a diagnostic mammogram.

3. Can I prepare for a screening mammogram?

You can. It is best not to schedule a screening mammogram the week before your period if you have sensitive breasts then. The best week for you is the first week after your period, when the breasts are the least sensitive. It is also better not to have a screening mammogram if you are (possibly) pregnant, or be sure to notify the radiologist.

Prefer not to use deodorant on the day of the examination. Some deodorants contain aluminum, which are microscopic metal particles that can light up on a mammogram. They can be mistaken for microscopic calcifications in the armpit region.

4. What does such a screening mammography device look like?

It is a column topped by a section with two plates at breast height. You stand next to the column and one by one your breasts are brought between the plates and then compressed. This compression is necessary to see as much breast tissue as possible on the image. It is an uncomfortable feeling, sometimes painful, but it lasts only a few seconds.

The device is used for mammography only.

5. What is the procedure for a screening mammogram?

The examination takes place with your upper body bared. You keep your other clothing on as usual. Once the technician places a breast in the correct position between the two plates of the mammography machine, the breast is briefly compressed. You are asked to hold your breath for a moment, and after pressing a button, the machine chases a low dose of X-rays through the breast. You don't feel that. The rays are captured by a detector or sensitive plate and an image appears that gives information about the inside of your breast. This is then repeated for the other breast.

The whole procedure takes half an hour.

A radiologist, which is a doctor who specializes in reviewing radiology images, looks at the images and reviews them. In the case of a screening mammogram, the images are always reviewed separately by two radiologists, to be sure not to overlook anything. The first at the hospital where the mammogram took place and the second by a radiologist at a cancer screening center.

6. I have large breasts. Is that a problem for a screening mammogram and are the results reliable?

No matter how large your breasts are, good x-rays can always be taken as part of a screening mammogram. Because compressing a large breast between the two plates of the machine is sometimes less successful, sometimes multiple images are taken. The breast is not compressed harder. You indicate up to what point that compressing is okay for you.

7. How will I be informed of the outcome?

About two weeks after your screening mammogram, the radiology center that reviewed the mammograms will provide you and your doctor with a letter with the result. You can look up and read this letter yourself on the MijnGezondheid.be platform, which contains your medical reports. You can register on this website with your (Belgian) identity card or via the app itsme. If an abnormality has been detected that could indicate breast cancer, the letter will mention that you are requested to have additional examinations. You should then visit your family doctor or gynecologist to have this additional examination scheduled.

8. Is screening mammography reliable?

A screening mammogram is the best possible examination we currently have to quickly detect incipient breast cancers, but it is not perfect. Unfortunately, even with this examination, cancers are still sometimes missed. A bigger drawback is that the mammogram sometimes shows abnormalities that later turn out not to be breast cancer. However, you only know that after going through additional tests and struggling with a lot of anxiety in the meantime. Also, sometimes tumors are discovered that never grow into a "full-blown" breast cancer, with calls this "in situ" lesions. Because one cannot predict which way they will go, they are treated as breast cancer. These 'in situ' lesions are one of the reasons why there are so many breast cancers in Belgium. They are included in the figures, which is not quite correct.

9. I have had breast augmentation. Can I have a screening mammogram done?

Yes, you can. The reliability depends on the location and size of the breast implants. If the implants are behind the pectoral muscle, then a mammogram is perfectly possible and the mammary gland tissue remains clearly visible. If they are in front of the pectoral muscle, which is usually the case, then a mammogram can also be performed, but the image of the mammogram will be partially obscured by the implant, making the mammary gland tissue less visible and a small tumor could be missed. In case of insufficient visibility, an additional ultrasound is then done.

There is no danger of implant rupture when the breast is compressed between the two plates of the mammography device.

10. I am a young woman with a lot of glandular tissue in the breasts. Can I also have a screening mammogram done?

A screening mammogram is perfectly possible with dense mammary gland tissue, but slightly less reliable. Because of the dense glandular tissue in the breasts, any abnormalities are more difficult to see and more difficult to interpret. If in doubt, an additional ultrasound of the breasts will be done more often.