2024-07-27 11:02:19
Appelman explains that the pressure on the breast is necessary to spread the breast tissue adequately. “It is understandable, but also frustrating to hear that women are afraid of this examination and may sometimes not want to be screened. That is not necessary,” she emphasizes.
“The group that seriously experiences pain is small, and we notice that good guidance makes a significant difference. So when the technician takes the time and adjusts the most optimal pressure in consultation, we often hear from women afterwards that it wasn’t as bad as they feared – even if they were scared due to a bad experience in the past. With attentive guidance, we really make a difference.”
Ultrasound can be as reliable in breast cancer screening as mammography
Fear
Looking forward to this examination might be asking too much, but it is good to know that only a small group of women actually experiences pain during it. What exactly causes this is not entirely clear. Some women have more sensitive breasts, but anxiety can also play a role.
“If you are very afraid of getting breast cancer, you are already tense,” explains Appelman. “Due to psychological stress, such as anxiety, you often experience pain more intensely. For women who have been irradiated or operated on, it is, of course, a different story, as they experience retrievable pain. What I especially want to emphasize is how important it is to still participate in the population screening, even if you find it scary.”
Referral
Regularly participating in screening reduces the chance of dying from breast cancer by half, compared to women who do not participate. Annually, about 7,000 women are diagnosed with a tumor through screening, often at an early stage and before women experience any symptoms. This can increase the chance of recovery.
For those who really cannot face a mammogram, De Jong points out that it is also possible to have the examination not in the ‘breast bus’, but in a hospital with possible extra assistance. “It is important to know: this examination will then count towards your own deductible, as it goes through your health insurance instead of the government. But such a referral through your own general practitioner is possible.”
Alternatives
Meanwhile, there are already several alternatives to mammography – at least on paper. In recent years, tomosynthesis has been increasingly applied. These are a kind of 3D images created using the mammogram. For this, less pressure needs to be exerted on the breast, making the whole process somewhat more comfortable. “For population screening, this is not a standard option, although this method is sometimes used for scientific research,” says Appelman. “In the Alexander Monro Hospital, almost all women routinely receive these 3D images.”
In the Netherlands, multiple research groups are working on optimizing mammography, but alternatives are also being sought. Think of the Mamma CT, a work in progress, but a promising one. This scan variant no longer requires breast compression to produce good images, Appelman explains.
“This technique is still in the research phase, but it definitely has potential. Enough data needs to be collected first to draw good conclusions, but we are keeping a close eye on this development. Just like with contrast-enhanced mammography: the Contrast Enhanced Mammography or CEM. In terms of accuracy, this seems comparable to an MRI, but more extensive research is still needed here. There are certainly many developments taking place that we are closely monitoring.”
Dense breast tissue
In recent decades, much research has been conducted into breast cancer and its treatment, resulting in many improvements in diagnostics. Nevertheless, Appelman and De Jong find it important to mention that we are not there yet. For example, a tailored screening method should be developed for women with very dense glandular tissue (so-called ‘dense breasts’).
Appelman: “This group of women – 8 percent of the screening population – has a higher chance of developing breast cancer due to this dense breast tissue. The current screening with only a mammogram is not optimal for them. They need additional imaging, for example in the form of an MRI scan where any abnormalities are visible.”
Self-examination
Therefore, this group of women deserves extra attention. Currently, the population screening does not monitor or register whether dense breast tissue is present, meaning the women in question are not aware of it. “I find that very difficult,” says De Jong. “To minimize the risk for these women, science is looking for studies we can use for this purpose. An extra MRI after a mammogram, for instance. But then you must already know that you belong to this group, and you don’t receive that information as standard now.”
That is why the former surgeon emphasizes the importance of self-examination, even between screening moments. “Such a screening is and remains a snapshot; it says nothing about tomorrow. Therefore, knowledge about your own breasts is something we always emphasize. You can feel a lump, but looking is just as important. There are as many as eleven symptoms you can observe. For more information, we refer you to the Breast Cancer Alphabet and kenjeborsten.nl, a campaign highlighting what to look out for in the early detection of breast cancer symptoms. Be alert and do not hesitate if you are in doubt.”
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Screening 2.0
According to Appelman, breast cancer screenings will look different in a few years. “Ideally, you want every woman to have a personalized screening,” she says. “One where we assess the risk of developing breast cancer based on medical data. Some have a heightened risk, for example due to a hereditary predisposition for breast cancer in their family. You would want to screen them more often or start earlier. But women with less glandular tissue and a low risk might not need to have a mammogram as often. Here, we might be able to find a better balance in the future.”
They are also looking at the age at which population screening is conducted. Currently, it is arranged that women between 50 and 75 receive an invitation every two to three years. “But,” De Jong emphasizes, “we must not forget that 20 to 25 percent of new breast cancer diagnoses occur in women under fifty.” A portion of these women are already being screened due to hereditary predisposition, but medical professionals are still considering those age categories, says Appelman.
“We are exploring the possibility of bringing forward the screening for certain groups, but this is again about personalization. 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 assessment of that within five years.”
Know your breasts
Outside of all scientific research and screenings, it remains essential to know your body as well as possible. Pay attention to your breasts, get to know them. And if you notice something that you do not understand, take action. “Breast cancer is simply the most common form of cancer in the Netherlands. One in seven women will deal with it,” says Appelman. “So, ‘wait and see’ when experiencing symptoms or changes is just a shame, considering the extra anxiety it causes.”
For example, Appelman recently saw a patient who experienced symptoms but delayed a visit to her general practitioner for months because she felt embarrassed. Fortunately, her mammogram and ultrasound showed that everything was fine, allowing this woman to return home reassured. “But that could have happened much earlier. Therefore, I would like to tell women: give yourself the best diagnostics, and no unnecessary worry. Do not hesitate, but go to your general practitioner and ask for that referral if needed.”
“Know that you can also choose where you are referred to,” De Jong adds. “We now have specialized hospitals and centers for various conditions. It is actually quite strange that we all thoroughly research when purchasing a new car or vacuum cleaner, but that we still have such limited choices regarding our health. That is why we find it important to mention these options. In the end, it is about teaching people how to gain more knowledge and control over their own body.”
This article is part of the LINDA dossier on women’s health. Want to know more?
Dossier: Women’s Health
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Future Trends in Breast Cancer Screening and Awareness
The ongoing conversation surrounding breast cancer screening highlights a crucial balance between patient comfort and effective diagnostics. Recent insights provided by healthcare professionals emphasize the necessity of pressure during mammograms, although it’s acknowledged that a small percentage of women may experience significant discomfort.
As technology evolves, the integration of alternative imaging methods like tomosynthesis and innovative concepts such as Mamma CT and Contrast Enhanced Mammography (CEM) is on the horizon. These advancements promise a more patient-friendly approach, potentially reducing the discomfort associated with traditional mammography while maintaining accuracy in cancer detection.
Personalized Screening Approaches
In the near future, a shift towards personalized screening protocols is anticipated. By assessing individual risk factors, including family history and breast density, healthcare providers can tailor screening regimens that better suit women’s unique needs. This personalization could mitigate the unnecessary anxiety surrounding screenings and enhance overall engagement in preventative measures.
Addressing Dense Breast Tissue
With one in eight women having dense breast tissue, future strategies will likely prioritize advancements specifically designed for this group. Developing screening protocols that include supplementary imaging—like MRI—will become essential to ensure early and accurate detection in women with dense breasts.
Empowerment through Self-Examination
The promotion of self-awareness among women regarding their bodies remains pivotal. Future initiatives will likely focus on education around recognizing breast changes and encouraging women to seek medical advice when necessary. Programs like “Know Your Breasts” aim to augment this knowledge, underscoring the importance of regular self-examinations and timely medical consultations.
Informed Choices and Patient Autonomy
As awareness spreads, women will be increasingly empowered to make informed choices about their healthcare. The emerging conversation around exploring various healthcare options will drive a culture where women feel confident in seeking specialized care tailored to their conditions. This autonomy will empower women not just to accept standard procedures but to advocate for the most effective diagnostic measures available.
In summary, the future of breast cancer screening is set to embrace technological advancements, personalized approaches, and increased patient awareness, ultimately aiming to provide women with optimal care and support in their health journeys.