October is considered  as the month of prevention and information about breast cancer and comes to remind us of the importance of early examination and check up for every woman after the age of 35 on an annual basis. 

 

Dr Papadogiannakis, at what percentage are women at risk of breast cancer? 

According to official surveys in European countries as well as in North America, breast cancer is considered the most frequent cancer in women. According to the latest epidemiological data, one in seven women will present cancer in her lifetime. 

 

When should women get a preventive breast exam? 

First of all, we should emphasize that every woman after the age of 35 should be examined once a year for preventive reasons. The exception is, of course, cases of family history, i.e. hereditary, breast cancer, which is when we start the check-up, 10 years earlier than the age of onset in the youngest relative. In such cases the screening can start even from the age of 20. 

 

Which methods can a woman use for the examination of her breast? 

After the age of 30-32, digital mastography is our main weapon in breast cancer prevention. Fortunately in our country this specific examination is prescribed to women and is accordingly covered by the specific insurance fund. At younger ages we mainly use ultrasound, which at older ages can have an auxiliary role by complementing the mastography findings. Also, in recent years, magnetic resonance imaging has emerged as the method with the highest sensitivity and accuracy. Finally, self palpation on a monthly basis can be conducted regardless of age. 

 

Why is annual mastography  important? 

Since the 70s, according to valid Swedish studies, it was found that women who had participated in prevention programs were by 30% less likely to die from breast cancer than those who did not have a mastography. 

 

So would you recommend mastography, ultrasound or MRI? 

Depending on the increased risk and each case separately, I would  say that the MRI outperforms the combination of mastography and ultrasound by 10-15% but is not indicated for all cases. It is a time-consuming, expensive and claustrophobic method for some women and is contraindicated in cases of allergies to the paramagnetic substance and in patients with kidney problems. 

 

In which cases is MRI the most appropriate method? 

MRI is indicated for women who belong to the following categories:

• Those who belong to high-risk groups with more than a 20-25% chance of developing cancer during their lifetime, either because they are BRCA gene carriers or because they have been irradiated to the chest. 
• Those with silicone implants. 
• Those in which the combination of mastography and ultrasound has not yielded the desired imaging results (cases of dense breasts and in relatively young women). 
• Women who have persistent nipple discharge without other imaging findings. 
• Women with metastasis in the axillary lymph nodes. 
• Women who undergo preoperative chemotherapy or post-operative monitoring.

 

So why is prevention and early examination so important? 

Because they lead to comprehensive treatment and complete cure of the disease. Whereas, if the diagnosis is delayed, we may have an expansion of the cancer to the lymph nodes and metastases to other organs with devastating consequences on a woman’s survival. 

 

Which doctor should a woman see a for a preventive check of her breast?

The family doctor who knows the full history of both the woman herself and her family, and a pathologist, but also a gynecologist, who, performing an asymptomatic check-up, will promptly refer her to a mastologist for the most appropriate diagnostic approach and  treatment. While the specialist doctor will treat the woman, the non-specialist will literally save her through early diagnosis.