All About Mammography: ‘Still the Best Screening Group’

Appleman explains that this chest compression is necessary to spread the breast tissue well enough. “It’s understandable, but it’s also upsetting to hear that women are afraid of this test and therefore sometimes don’t want to be screened. This is not necessary,” she stresses.

“The group with serious pain is a small group, and we find that good guidance makes a huge difference. So if the technician takes the time and sets the right pressure in the consultation, we often hear from women afterwards that it wasn’t so bad – even if they were scared because of a bad experience, for example. With careful guidance we can make a real difference.”

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He is afraid

This research may seem a bit ambitious, but it’s good to know that only a small group of women actually experience pain. It’s not entirely clear why this happens. Some women have sensitive breasts, but fear can also play a role.

“For example, if you’re really afraid of getting breast cancer, you’re already stressed,” Appleman explains. “Stress, like anxiety, often makes you experience pain more intensely. It’s a completely different story for women who have had radiation or surgery, of course, where there are pain complaints that can be tracked. What I want to emphasize in particular is how important it is to participate in a population-based survey, even if you find it exciting.”

Referral

Regular participation in screening reduces the risk of dying from breast cancer by half, compared with women who do not participate. Each year, about 7,000 women are diagnosed with a tumor through screening, often at an early stage and before women have any symptoms. This can increase the chance of recovery.

For people who really don’t dare to undergo such a mammogram, De Jong points out that there is also the option of not having this examination done on the “breast bus”, but in the hospital with the possibility of additional supervision. “It is important to know: the examination is counted towards your deductible, because it is done through your health insurance rather than the government. But such a referral through your GP is possible.

Alternatives

There are also now a number of alternatives to mammography—at least on paper. For example, tomosynthesis has been increasingly used in recent years. These are a type of 3D image that is created using mammograms. They require less pressure on the chest, making the whole thing more comfortable. “This is not a standard option for population research, although it is sometimes used in scientific research,” says Appleman. “At Alexander Monroe Hospital, almost all women receive these 3D images as standard.”

In the Netherlands, several research groups are working on improving mammography, but alternatives are also being sought. Consider Mama CT. A Work in progressBut it’s promising. Appleman says this scanning variant no longer requires chest compressions to produce good images.

“This technology is still in the research phase, but it certainly has potential. We must first collect enough data to be able to draw good conclusions, but we are closely monitoring this development. Just like mammography with contrast fluid: contrast-enhanced mammography, or CEM. In terms of accuracy, this seems to be comparable to MRI, but here too more intensive research is needed. In any case, there are many developments underway and we are following them closely.”

dense breast tissue

In recent decades, much research has been done on breast cancer and its treatment, leading to many improvements in diagnosis. However, Appleman and De Jong believe it is important to point out that we are not there yet. For example, a screening method that is suitable for women with very compact glandular tissue (so-called “dense breasts”) needs to be developed.

Appleman: “This group of women – 8 percent of the screening population – have a higher chance of developing breast cancer because of dense breast tissue. Current screening with mammography alone is not optimal for them. They need additional imaging, for example in the form of an MRI scan where any abnormalities can be seen.

Self-control

That’s why this group of women deserves more attention. At present, the population survey does not yet detect and record whether there is dense breast tissue, so the women concerned are not aware of it. “I find that very difficult,” says De Jong. “To reduce the risks for these women, science is looking for studies that we can use for this purpose. Additional MRI after mammography, for example. But you have to already know that you belong to this group, and you don’t receive this information as standard now.

That’s why the former surgeon stresses the importance of self-monitoring, also between possible screening moments. “Such a symptom is and will remain just a snapshot, and says nothing about tomorrow. That’s why knowledge about your breasts is something we always emphasize. You can feel a lump, but the appearance is no less important. There are at least eleven symptoms that you can see. For more information, we would like to refer to the breast cancer alphabet and kenjeborsten.nla campaign that highlights what you can look for to recognize early symptoms of breast cancer. Be vigilant and don’t walk away if you have doubts about something.

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Check 2.0

If Appleman has his way, breast cancer screening could look different in a few years. “You’re essentially giving all women a personalized screening,” she says. “A place where we estimate their breast cancer risk based on medical data. Some people have an increased risk, for example because of a genetic predisposition to breast cancer in their family. They might want to have those things checked more often, or start doing it earlier. But women with less glandular tissue and a lower risk might not need to have mammograms as often. We might be able to find a better balance on that in the future.”

The age at which the population is screened is also taken into account. Women between the ages of 50 and 75 are now scheduled to receive an invitation every two to three years. “But we must not forget that 20 to 25 percent of new breast cancer diagnoses occur in women under the age of 50,” says de Jong. Although some of these women have already been screened for genetic predisposition, doctors still consider these age groups, according to Abelmann.

“For example, we are investigating the possibility of offering screening to certain groups, but again it is a question of personalisation. From what age do you invite someone? I find the group of women between 40 and 50 particularly interesting. I hope that we will have a clear opinion on this in five years.”

Get to know your breasts

Aside from all the scientific research and examinations, it is still essential to know your body as much as possible. Pay attention to your breasts and get to know them. If you notice something and you don’t know what it is, do something about it. “Breast cancer is the most common cancer in the Netherlands. One in seven women will have to deal with it,” says Apelman. “So ‘continuing to look at complaints or changes’ is simply shameful, even if only because of the extra anxiety it causes.”

For example, Appleman recently saw a patient who had complaints but had put off seeing her GP for months because she felt unwell. Fortunately, a mammogram and ultrasound showed nothing was wrong, so the woman was able to go home with peace of mind. “But it could have been done much earlier. So I would say to women: give yourself the best possible prognosis, and don’t worry about it. Don’t hesitate, go to your GP and ask for a referral if you need to.”

“Know that you can also choose where you are referred,” adds de Jong. “Nowadays we have hospitals and specialist centres for different conditions. It’s actually strange that we all read up on buying a new car or a new vacuum cleaner, but when it comes to health, we still have little choice about where we want to go. That’s why we think it’s important to mention these options. Ultimately, it’s all about teaching people how to gain more knowledge and control over their bodies.”

This article is part of the LINDA Dossier on Women’s Health. Learn more?

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