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What are the recommendations for screening?

Low risk women:

Low-risk women do not have a personal or family history of breast cancer or precursor lesions (Atypical Hyperplasias), without a known genetic mutation and have not undergone previous radiotherapy in the chest region before the age of 30 years.

Annual screening between 40 and 74 years of age, if possible, with digital mammography. Above 75 years, life expectancy must be considered. Ultrasound and MRI should be complementary tests to mammography.

High risk women:

Women with a mutation in the BRCA1 or BRCA2 gene, have a first-degree relative (father, brother, sister) with a mutation in the BRCA1 or BRCA2 gene, who have had previous radiotherapy in the chest region between 10 and 30 years of age, have a syndrome Li-Fraumeni, Cowden syndrome, or first-degree relatives with one of these syndromes.

Start mammography, if possible digital, at age 30, performing annually. Intercalate every 6 months with MRI. It is recommended to associate ultrasonography

special situations

Low-risk women under 40 years old

There is no recommendation for screening in low-risk women. Firstly, because of the extremely low risk of being diagnosed with breast cancer in this age group. The low accuracy of this exam in young women is associated with this, determining a high number of additional images and complementary exams.

Low-risk women over 75 years old

There is no consensus between the screening age limit or the ideal range, but it is known that age is the main risk factor for the development of breast cancer, showing an exponential growth after 60 years of age. When determining the indication for screening, one must consider life expectancy, associated diseases and the risks of death from cancer.

The article “World Review and Meta-Analysis of Cohort Studies Measuring the Effect of Incidence-Based Mammographic Screening Programs on Breast Cancer Mortality,” published in the journal Cancer 2020, concluded:

Mammographic screening programs are associated with up to 33% reduction in breast cancer mortality, based on incidence, according to a meta-analysis of studies worldwide.

The results indicate a substantial reduction in breast cancer mortality in mammography-based screening programs.

Breast cancer screening in the routine health setting continues to provide a substantial reduction in breast cancer mortality

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How is the diagnosis made?

It is important that the woman has the habit of observing and getting to know her body, so that she can identify any changes in the breasts. Self-examination is a fundamental tool for getting to know the breast. The signs and symptoms of cancer can vary, and some women who have cancer may be asymptomatic.

The non-palpable subclinical lesion is only detected by imaging methods. On clinical examination, a solid, hard, poorly mobile and partially adhered lesion to the deep planes or to the skin can be seen with palpation, and may be associated with enlarged nodes in the axillary extension. If it is a lesion that has grown too much, it may be ulcerated, or swollen (orange peel) or in the form of inflammation. Sometimes, there may just be redness, itching, and scaling along the areola and papilla (Paget's disease). Other symptoms are: skin retraction, inversion and discharge of secretion through the papilla, which can be bloody or in rock water.










                                                palpable breast tumor


Mammography can diagnose cancer at an early stage, even before a lump can be felt on palpation, when treatment may be more successful.

On mammography, the lesion appears well defined. It has a higher density than the rest of the tissue. It can also be associated with microcalcifications or have unclear outlines. They are spiculated lesions with a very dense center.

If a woman has breast implants, she can and should have a mammogram, but additional imaging will be needed so that the doctor can see as much of the breast tissue as possible.

Breast tomosynthesis, a limited-field tomography, added to the mammographic technique, appears as a breast imaging option that eliminates tissue overlap. In tomosynthesis, multiple projections are obtained, while the ray emitted by the source follows a pre-defined semicircular angle; the angulation used varies by manufacturer; the projections obtained (sections) can still be reconstructed into a synthesized mammographic image, depending on the software model. The radiation dose of the method associated with digital mammography, both performed in a single step, does not exceed the average safe glandular dose. A workstation monitor allows you to view the images produced cut by cut, in addition to comparing these images with each other: 2D mammography, tomosynthesis and synthesized mammography, improving the quality of the report


                                                            spiculated nodule


                                                 Clustered pleomorphic microcalcifications

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Obrigado por enviar!

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Sorocaba Medical Center


Rua Sorocaba, 464 - room 202

Tel. 21 2537-0138 / 2539-5093

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Americas Medical City

Barra da Tijuca

Av. Jorge Curi, 550 - rooms 252/253

Tel. 21 3264-4866 / 3264-4863

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