In the fight against cancer, there are two possible strategies: prevention of the disease by adopting a healthy lifestyle (primary prevention), or to catch the disease as early as possible, before it manifests itself on a clinical level (secondary prevention). A screening test is a test that allows the identification of a certain disease (specifically tumors) in asymptomatic people at an early stage. In an organized screening program, the health company directly invites the entire segment of the population deemed at risk of developing a certain disease to participate, offering the test and any further information free of charge.
Participation in the program is entirely voluntary. The test used to screen for breast cancer is the mammography, which is an X-ray of the breasts. The examination is performed by placing the breasts on a surface one at a time, where they are lightly compressed and x-rayed both horizontally and vertically. The examination typically is not painful and not associated with any health risk, given that the doses of radiation emitted are very low.
Recently, new 3D digital equipment has been introduced, which in future could replace the old mammograms for screening purposes. Breast cancer screening, according to the indications of the Italian Ministry of Health, is aimed at women between the ages of 50 and 69, and in this age group can reduce mortality rates by 40 percent. According to some experts, extending the age for a mammography to forty years old could guarantee a further reduction in breast cancer mortality, though at a lower rate than that obtained in the 50-69 age group.
Furthermore, the lengthening of the average life span and the continuation of a stable state of health even at an advanced age suggests that it may be advantageous to offer screening services to women up to 74 years old. 5-7 percent of breast cancers are linked to inherited risk factors, including mutations in the BRCA 1 or BRCA 2 genes. For healthy women with a family history of breast cancer or who carry a mutation, it is expected they partake in a personalized clinical-instrumental surveillance program.
Different Regions have activated specific pathways that, depending on the case, require annual magnetic resonance imaging (MRI) scans with a contrast agent, paired with a mammography and / or ultrasound; this screening for those with hereditary risk factors is carried out from the age of 25, or from 10 years before the onset age of the disease on the youngest family member.