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Breast cancer screening (mammography)

An X-ray of each breast, read by two radiologists, repeated every two years across a band of ages that starts at 40 in Sweden and 50 almost everywhere else. What it finds, what it misses and what a call-back means.

Šī lapa apraksta skrīninga programmas; tā nav diagnoze, nav personīgs riska novērtējums un neaizstāj jūsu veselības aprūpes dienestu. Vecuma grupas nosaka katra valsts un tās mainās — saņemtais uzaicinājums un jūsu valsts lapā nosauktā iestāde ir svarīgāki par jebko, kas rakstīts šeit. Skrīnings ir domāts cilvēkiem bez simptomiem: jauns sabiezējums, redzamas asinis, mainījusies dzimumzīme, neizskaidrojams svara zudums vai pēkšņas redzes vai dzirdes pārmaiņas prasa ārsta apskati tūlīt, lai arī ko būtu rādījis nesenais skrīninga rezultāts.

Kur tas tiek organizēts un kādā vecumā

Katra šī reģiona valsts, kas to īsteno kā organizētu programmu, ar savu vecuma diapazonu. Diapazoni atšķiras tāpēc, ka nacionālās iestādes vienus un tos pašus pierādījumus izsver atšķirīgi, nevis tāpēc, ka kāda no tām kļūdītos.

What actually happens

You undress to the waist, and a radiographer positions one breast at a time on a plate while a second plate presses down from above. The compression is the part people dread and the part that makes the image work: it spreads the tissue so overlapping structures do not hide a small tumour, and it lets the machine use a lower dose. Two views are taken of each breast, from above and from an angle. The whole visit is around twenty minutes and the imaging itself takes a couple of minutes. Do not wear deodorant, antiperspirant or body cream, because the metallic particles in them show up as specks that look like calcifications. If you still menstruate, days five to fifteen of the cycle are the least tender.

Why two people read it

In the Nordic and Baltic programmes each set of images is read independently by two radiologists, with a third opinion where they disagree. This is not bureaucracy: double reading finds meaningfully more cancers than single reading and is one reason European programmes call fewer women back than American ones. A call-back means the readers want another look, usually with extra views, ultrasound, or both. Being called back is common and is not a diagnosis. The great majority of women who are called back turn out not to have cancer.

What it finds and what it misses

Screening finds cancers that are too small to feel, including ductal carcinoma in situ — abnormal cells confined to a duct, some of which would go on to become invasive cancer and some of which never would. It misses cancers too, particularly in dense breast tissue, where both tumour and normal tissue appear white. It also misses the ones that appear and grow between two rounds; these interval cancers are counted and published by the programmes. A normal mammogram means no cancer was visible on that day, not that none can appear next year, which is why a new lump still needs to be examined even a month after a clear result.

The honest arithmetic

This is the most argued-over screening programme in medicine, and it is worth reading the numbers rather than the headline. The Cochrane review of the mammography trials, by Gøtzsche and Jørgensen, put it like this: for every 2 000 women invited to screening over ten years, one will avoid dying of breast cancer, about ten healthy women will be diagnosed and treated for a cancer that would never have troubled them, and more than 200 will go through a period of anxiety over a finding that turns out to be nothing. Other analyses of the European programmes estimate a larger mortality benefit and less overdiagnosis. Both sets of authors are looking at the same trials. This is why the age bands differ across the region: Sweden reads the evidence as justifying screening from 40, several neighbours read it as justifying screening from 50.

Avoti:Padomes 2022. gada 9. decembra Rekomendācija par vēža skrīningu (CELEX 32022H1213(01)) · Cochrane Database of Systematic Reviews — Screening for breast cancer with mammography (Gøtzsche and Jørgensen) · Socialstyrelsen — breast cancer screening recommendation · Sõeluuring.ee — what the mammography appointment involves· pārbaudīts2026-09-07

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