Mammography: Clinical Necessity and Preparation Guidelines

In clinical practice as a gynecologist, I often hear the question: "Can I just have an ultrasound?" Patient reluctance is understandable: as mammography can be perceived as uncomfortable, and there are many stereotypes surrounding it. But let's try to figure out in this article the clinical rationale for recommending mammography as a primary diagnostic tool.

Why it's important to talk about mammography

Mammography is a crucial screening tool, serving as a reliable method, capable of detecting changes in breast tissue several years before they can be felt. Mammography provides superior resolution for detecting lesions not palpable on clinical examination or visible via ultrasound.

Ultrasound examination perfectly complements the diagnosis, especially in young women with dense breast tissue, but it is mammography that is essential for detecting microcalcifications, which are often the earliest radiological sign of incipient malignancy.

The need for such early diagnosis is confirmed by statistics: almost one in ten women is at risk of facing breast cancer. Early detection significantly improves prognosis. When we find changes at the earliest stage, when the tumor is still very small, the chances of complete recovery reach 95-98%. Treatment becomes more gentle; often, organ-preserving surgery is used, and recovery is faster.

Annual mammography screening is recommended for all women aged 40 and older. For those with specific risk factors, consultation with a physician regarding earlier screening initiation is warranted.

How to make the procedure more comfortable

Many women admit that they worry about the need for breast compression during mammography. It is important to understand that this is a key element for obtaining the most informative and safe image. Compression makes the breast tissue more uniform, which allows X-rays to pass evenly and ensures the image clarity necessary to detect the smallest changes. Compression also significantly reduces the radiation dose.

The procedure lasts only 10-15 seconds for each image, and typically two images are taken of each breast. This brief duration of mild discomfort is essential for accurate image acquisition and diagnostic fidelity. And proper preparation can significantly reduce uncomfortable sensations. Here are my recommendations for a more comfortable mammography that I would like to share with you:

1. Schedule your mammography between days 5 and 12 of the menstrual cycle, counting from the first day of menstruation. During this time, estrogen levels drop, and the breasts become less swollen, less sensitive, and retain less fluid. You may have noticed that your breasts become painful before your period, and this is exactly the time when mammography should be avoided.
2. If you are in menopause, choose any convenient day—just try to have the examination around the same period each year so that the doctor can easily compare the dynamics of changes.
3. On the day of the examination, refrain from using deodorant, antiperspirant, talc, creams, lotions, and perfume in the breast and armpit area. This is extremely important. Aluminum particles contained in deodorants, as well as components of other cosmetic products, can show up on the image as microcalcifications and create a false alarm or, conversely, obscure important details. I recommend showering in the morning without using any products in this area or simply wiping the skin well with a damp cloth before leaving home.
4. Choose comfortable clothing—trousers or a skirt with a separate blouse or shirt, rather than a dress. This way, you won't have to undress completely, which adds psychological comfort.
5. Avoid clothing with metal elements, buttons, or zippers in the chest area—they will have to be removed. Also, remove all jewelry—chains, necklaces, earrings, if they are long. If you wear nipple piercing, it must also be removed.
6. If a patient anticipates discomfort, an over-the-counter analgesic may be taken one hour prior to the procedure. The radiologist must be informed.

When to see a doctor before your scheduled check-up

Sometimes, despite regular screening, alarming symptoms appear. You should not panic, but you also cannot postpone a visit to a specialist.

In addition to regular screening, there are symptoms for which you should not wait and must contact a mammologist immediately. These are:

• Palpable masses or lumps in the breast or axillary lymph nodes, regardless of tenderness.
• Pain, discomfort, or a feeling of heaviness in the breast, especially if they have appeared recently or changed their nature.
• Skin changes—redness, retraction, "orange peel" texture (peau d'orange).
• Change in nipple shape or discharge from it.
• Any asymmetry that was not present before.

Many breast diseases are completely asymptomatic in the early stages, so regular mammography and examination by a doctor are very important, as they allow changes to be detected before any signs appear. Early detection means the possibility of conservative treatment without surgical intervention in many cases.

Self-care is not selfishness, but responsibility

The modern rhythm of life, stress, hormonal changes—all this affects breast health. As a doctor, I know that the female breast goes through many changes throughout life. This is normal, but this is why it requires attention and regular monitoring.

I draw your special attention to periods of hormonal reorganization:

• Adolescence (breast development);
• Pregnancy, when they are preparing for lactation;
• Postpartum/Lactation cessation (tissue involution);
• Premenopause and menopause, when the hormonal background changes.

It is during these moments that the risk of developing changes increases, as breast tissue is very sensitive to hormone fluctuations.

There are factors that increase the risk of developing breast diseases, and it is important to know about them:

• A significant family history of breast cancer (especially in first-degree relatives and/or at an early age), —this is a very important signal for a proactive approach to health. In such a situation, it is critically important to consider genetic testing for mutations in the BRCA1 and BRCA2 genes. These genes are responsible for DNA repair, and changes in them significantly increase the risk of developing breast cancer, as well as ovarian cancer.
• Knowing about the presence of a BRCA mutation provides an opportunity to act preventively. For women with confirmed high risk, prophylactic mastectomy is available—a surgical procedure aimed at maximizing risk reduction. The actress Angelina Jolie, who publicly underwent this procedure, brought worldwide attention to the importance of this approach. Her example became an important step in raising awareness about the possibilities of modern preventive medicine.
• History of induced abortion.
• Nulliparity or lack of history of breastfeeding.
• Early menarche or late menopause.
• Gynecological diseases associated with hormonal imbalance (PCOS, endometriosis, uterine fibroids).
• Severe stress, serious life upheavals in the past year.

If you discover risk factors, this is a signal to become more attentive to your health and not miss scheduled examinations. As a doctor, I am convinced that taking care of your health is not selfishness; it is a responsibility to yourself and loved ones.

In addition to annual screening, monthly Breast Self-Examination (BSE) is recommended. This is a simple and important habit that allows you to get to know your body better and notice changes earlier. Every month (around the same day of the cycle, or day of the month for women in menopause), dedicate 5 minutes to inspecting and palpating your breasts. However, self-examination should never replace a professional examination and mammography; it is only a useful supplement to regular screening.

We started this article with the question: "Can we limit ourselves to just an ultrasound?" As a Women's Doctor, I want to emphasize that regular mammography is the gold standard after the age of 40. Please, do not postpone a visit to the doctor and try not to ignore these recommendations. Remember, your health is the most valuable investment you can make.

For a personalized consultation, we invite you to schedule an appointment with Irina Ivanovna Ergül — an experienced specialist.