Breast Cancer, is the most common cancer seen in women. On average, one out of every 8-10 women worldwide develops breast cancer.

Cancer that is 1 cm in size or smaller and cannot be felt during manual examination is called early-stage breast cancer. Early-stage breast cancers can be detected thanks to mammographic screenings. Screening mammography is a mammographic examination performed regularly for women over the age of 40 who have no complaints. The generally accepted recommendation is that this examination should be performed once a year. Scientific studies have shown that detecting breast cancer at an early stage results in a 20-30% reduction in death rates related to breast cancer. Despite all advances, not all breast cancers can be detected with mammographic examination (average 10%). There are 3 factors that determine this situation:

  1. Breast tissue, has a complex structure consisting of milk glands, milk ducts, and the connective and supporting tissues between them. In some women, these tissues are quite tight and dense. In this type of breast, cancer can hide within normal tissue and may not appear in standard mammographic examination.
  2. Structure of the tumor, some tumors can progress within breast tissue without causing any abnormality. In fact, in some cases, while there is no tumor within the breast tissue, spread to the lymph nodes under the arm can be detected (occult cancer).
  3. Technical factors, if the positioning during mammography and the quality of the X-ray are not at the best level, some tumors may not be visible.

Mammography:

It is a very important radiological method that has existed from the 1960s to the present day. It still maintains its presence as the most superior method in the diagnosis of breast cancer and continuous technological developments are being made on it.

The basic principle is “partial compression of breast tissue between two plates and obtaining an X-ray film using X-rays”. Despite all technological developments

this principle has not changed, so even very old mammography devices can still be used in daily practice. Developments in digital technology have provided a lower-radiation, more comfortable, and more detailed examination environment. According to the transition date to application in these digital systems, they are CR-digital, FF-digital, and Tomosynthesis-digital mammography.

The breast structure of the person may be easy or difficult in terms of tumor detection.  The structure of the breast tumor may also be easy to see or hidden. However, since it is not possible for us to change these structural features, the most important duty for us physicians in early diagnosis is to perform mammographic examination at the highest standard;

  1. The best device (the most advanced technology possible and the lowest dose)
  2. The best positioning (experienced radiology technician)
  3. The best interpretation (experienced radiology specialist)

The absence of any one of these 3 factors causes delays in diagnosis.

Digital TOMOSYNTHESIS Mammography

In standard mammography, examinations are 2-dimensional. That is, just like on a flat X-ray film. In this case, normal tissues are reflected on the film as overlapping. Images suspicious for cancer are searched among these tissues.  For this reason, the radiologist is expected to be experienced when evaluating the film. Overlapping tissues can hide the tumor, and conversely, overlapping tissues may cause tumor-like images.

All technological developments and innovations made in mammography devices have always been for obtaining better images. Significant progress has been made in image quality by transitioning from old-type film-screen analog mammograms to CR-digital and full-field digital (FFDM) mammograms.

However, for the first time, imaging with Digital Tomosynthesis Mammography started to be performed in 3 dimensions. In this way, problems caused by overlapping tissues have been eliminated.  Due to the elimination of false tumor images, unnecessary intermediate controls and even biopsy numbers have decreased.

Unlike standard mammography, in TOMOSYNTHESIS examination, the X-ray tube of the device moves and sectional images of 1 mm thickness are obtained from the breast tissue. 60-80 images are produced from each breast. Millimetric tumor diagnoses can be made.

Another important innovation that all digital systems bring to general mammography practice is the superiority in archiving.  Thanks to images that can be easily stored and reproduced as much as desired, a person's annual regular follow-up and therefore early diagnosis become possible.

Digital Tomosynthesis Mammography, which has started to be used in increasing numbers all over the world and in our country, is also available at Lamed Imaging Center in İzmir. The device, which started service in April 2012, is still İzmir’s first and only Digital Tomosynthesis Mammography system.

Dr. Feray Özgür Saraçoğlu / Radiology Specialist