When is it time to contact a mammologist

2024 Author: James Gerald | [email protected]. Last modified: 2023-12-17 14:00

Unfortunately, breast cancer is the most common cancer in women. According to sad statistics, in Russia every 10th representative of the fairer sex falls ill with it. Therefore, we decided to seek advice from the mammologist Alla Kartasheva, the host of the “10 Decisions of Doctor Kartasheva” program on the Doctor TV channel.

A mammologist is a narrow specialist who diagnoses breast diseases. As a rule, mammologists have primary specialization in oncology or gynecology, less often in radiation diagnostics.

The examination of the mammary glands begins in girls and women from the moment menstruation occurs and the mammary glands begin to grow and respond to hormonal changes in the body. Since I am an adult doctor, patients come to me from the age of 18.

As a rule, the main complaints in young patients are pain in the second half of the menstrual cycle, asymmetry, discharge from the ducts. Also, girls may experience discomfort or feel the seals. We, mammologists, prefer to conduct an examination from 5 to 12 days from the beginning of the menstrual cycle. During this period, the breast is less painful on examination, less edematous and, if necessary, a puncture biopsy, the diagnostic result is most reliable.

Basic diagnostic tests

When the patient is up to 40 years old, the consultative reception is necessarily supplemented by an ultrasound examination of the mammary glands and regional lymph nodes. Since the “passport” age does not always correspond to the biological age, the structure of the gland has its own individual characteristics: fibrous-fatty involution in young women and glandular hyperplasia (adenosis) in very mature women.

Depending on what he sees on the ultrasound, the doctor decides how informative the mammography study will be for this patient. If the gland is dense, and additional examination is required, then it is preferable for young women to undergo contrast-enhanced MRI mammography or tomosynthesis.

For women over 40, mammography is still the gold standard, and the above ultrasound, tomosynthesis, and MR mammography are performed as an addition and as needed.

It is important to emphasize that breast ultrasound, mammography and contrast-enhanced MR mammography are aimed at identifying different problems and are not mutually exclusive methods of examination.

So an ultrasound will help to distinguish a fibroadenoma from a cyst, and it will be possible to see an accumulation of microcalcifications and a small area of tissue restructuring (the first, preclinical signs of cancer) only on mammograms.

Highlights: what do they mean?

During the examination, the mammologist can identify discharge from the ducts.

• If the discharge is cloudy, greenish or white, then this is a sign of diffuse mastopathy, a background disease and, as a rule, not dangerous. The doctor will take a swab-print on a glass slide to make sure there is no danger.
• If the discharge is clear, straw, yellow, brown or bloody, then this may be a sign of intraductal papillomas or malignant pathology. In this case, it is especially important to visit the mammologist immediately.

With such discharge, in addition to a smear, a special study of the ducts, ductography, will be performed, and, after that, the doctor will decide on further tactics.

Examination and pregnancy

It is very important to be examined by a mammologist before such an important event in life as pregnancy.

With the onset of pregnancy, the breast changes, swells, swells and, against this background, you can skip the onset of a serious illness. Hormonal changes during pregnancy can also affect the growth of the formation already present in the mammary gland. The same recommendations - before starting IVF, prescribing hormonal contraceptives or hormone replacement therapy.

A few words about self-examination

Self-examination is performed first in front of a mirror in good light, on the same day of the first half of the menstrual cycle.

• To begin with, raise your hands, assess the presence of retractions or deformities of the skin.
• Then move on to palpation. Press on the gland with your fingertips: first superficially, then with greater pressure. Movements are best done in a circle.
• Then press down on the nipples and check the armpits.

In this way, you can independently identify changes in the mammary glands that were not there before.

It should not be overestimated, with “hands”, even very sensitive ones, it is possible to determine a tumor starting from 1–2 cm, while using special examination methods we detect tumors from 3 mm.

To summarize everything that has been said:

• Examination by a mammologist must be started at the age of 18-19. In the absence of pathology and serious oncological heredity - once a year in the first half of the menstrual cycle.
• An ultrasound of the mammary glands should be performed at least once a year.
• Mammography is indicated for women after 40 years of age 1 time in 1, 5-2 years.
• An ultrasound or mammogram does not replace a visit to a specialist.
• Before planning a pregnancy, undergoing an IVF procedure, prescribing GC or HRT, a visit to a mammologist is required.
• If you find discharge from the ducts, nodules in the mammary glands or other alarming symptoms, you must urgently visit a mammologist, regardless of the phase of the menstrual cycle.

Trust the specialists and don't get sick!