Mammography: “Do it every year”, the poignant message from Carla Bruni who reveals her breast cancer

There half of women do not screen for breast cancer with mammography, offered free of charge in France for those aged 50 to 74. A harsh observation for doctors when we know that the breast cancer caught early maybe cured in 9 out of 10 cases. “Get your mammograms. It’s about your lives“ threw Carla Bruni in a message posted on her Instagram account on October 4, 2023. In this message, the singer aged 55 years reveals to have been diagnosed with breast cancer, 4 years ago : “Surgery, radiotherapy, hormonal therapy, I follow the usual path to treat this type of cancer. But I was lucky : My cancer was not yet aggressive. Why was this cancer not aggressive? It’s because he didn’t have time to become one. Because every year, on the same date, I have a mammogram. If I hadn’t done this every yearI would no longer have a left breast today.” Out of modesty, she “a long time” hesitated to talk about his illness but right Pink Octoberbreast cancer awareness month, wife of Nicolas Sarkozy spoke up with courage to deliver “a fundamental message for all women who read me: Get your mammograms every year.”

Definition: what is a mammogram?

Mammography is an x-ray examination which makes it possible to detect an anomaly in the breast tissue and in particular breast cancer, even small ones. Mammography uses low-dose X-rays to image inside the breast (the mammary gland) to detect a potential tumor. This screening exam is a surveillance examthat must be performed even in the absence of symptoms. The goal ? Being able to act as soon as possible, because, detected at an early stage, breast cancer can be cured in 9 out of 10 cases. Screening mammography can be unilateral (one breast only) or bilateral (both breasts) according to the signs observed.

Indications: when to do a mammogram?

Mammography is most often used to detect possible breast cancer. It is proposed:

• during a organized screening campaign for women between 50 and 74 years old,
• by your doctor, for individual screening,
• after the discovery of an abnormality during a clinical breast examination,
• as part of surveillance, after treatment for breast cancer.

At what age should you have a mammogram?

Mammograms are offered to all women between 50 and 74 years old without symptoms and having no particular risk factors for breast cancer, other than their age. Women are at greatest risk of developing breast cancer between the ages of 50 and 74.

► “Before 50 years, only women at risk are invited to have a mammogram. We suggest that women who have risk factors (family or personal history, genetic predisposition, etc.) do individual breast cancer screening from age 40“, explains Dr Brigitte Séradour, radiologist at Beauregard hospital in Marseille. Too few studies have shown the effectiveness of a mammogram before the age of 50.

► After 74 years, you no longer receive a systematic invitation to have a mammogram. The issue of screening should be discussed with your doctor. Performing a mammogram should be assessed based on your level of risk of breast cancer (family history, personal medical history, genetic predisposition, etc.).

Mammography in young women

“Mammograms are generally not done in young women because their glandular tissue is too dense and X-rays are difficult to pass through. Mammography therefore provides little informationunlike ultrasound which is a more relevant examination for analyzing the mammary gland in young womenadds Dr Brigitte Raccah-Tebeka, gynecologist-endocrinologist. On the other hand, a clinical breast examination (palpation) carried out by a midwife, a general practitioner or a gynecologist is recommended every year from the age of 25“.

How to do your check-up mammogram?

To have a mammogram, you need a medical prescription, which your doctor has prescribed for you. Or the letter sent by Health Insurance if you are between 50 and 74 years old (you receive it every two years). All you have to do is give it to the radiologist on the day of the exam. Mammography is performed on appointment In a radiology office or one radiology department of a clinic or hospital.

Do not put cream, powder, perfume or deodorant under the armpits or on the breasts

On the day of the appointment:

• Take all the images and reports of your old mammograms as well as all the ultrasounds, MRIs and biopsy results carried out for your breasts as well as your vital card. If it is a mammogram carried out as part of organized screening, bring the care voucher received by mail.
• Do not put cream, powder, perfume or deodorant under the armpits or on the breasts : these products sometimes interfere with carrying out the examination and distort the interpretation of the results.
• Dress so that you can remove just the top of your outfit.
• Remove your jewelry (chain, earrings, etc.)

Mammography is an examination of a duration of 10 to 15 minutes.

Examination process: step by step

► Before the mammogram

When you arrive, the radiologist who takes the mammogram images asks you about your medical and family history, whether you are menopausal, whether you are taking hormonal treatment, whether you are pregnant or likely to be pregnant, whether you wear prostheses. breasts…

► During mammography

• The radiologist directs you to a cubicle so that you can put your clothes there. This cabin is adjacent to the examination room. You are invited to undress completely to the waist and remove your jewelry (chains, necklaces, earrings, etc.).
• The radiologist invites you to stand near the mammograph in a standing position. One of your two breasts is placed between two plates which tighten and flatten the breast from top to bottom for a few seconds. This compression lasts less than a minute and is necessary to obtain an image of good resolution and less irradiation.
• The radiologist stands behind a protective screen and asks you not to move or breathe while taking the image. He activates the mammograph remotely to obtain a first image. As soon as the X-ray is recorded, the plates automatically loosen.
• The mammograph then rotates 45° to compress the breast from the side, obliquely. A second image is produced. Sometimes a profile image or one focused on a particular region of the breast may be necessary. The radiologist repeats these same steps for the second breast. When the mammograph is digital, the images obtained appear immediately on a screen, and are printed on films.
• While the radiologist reads the images and checks their quality in the interpretation room, you wait in another room. If the photos are not of good enough quality, you will be asked to take them again.

► After the mammogram

• Once the mammogram is finished, the radiologist performs a clinical examination to check the appearance of your breasts (skin and nipples), palpates your breasts as well as your armpits to ensure that there are no abnormal lymph nodes or swelling, which is sometimes undetectable on mammography.
• The radiologist communicates the first results to you and gives you the photos, accompanied by the report. These images are also sent to the prescribing doctor. It is advisable to keep the images and results of all your mammograms so that you can present them at a future examination.

Good to know : if you perform a mammogram as part of organized breast cancer screening, the images systematically benefit froma second reading by another expert radiologist to confirm the results of the mammogram. This is a guarantee of reliability.

Is a mammogram painful?

A mammogram is not a painful test, strictly speaking. However, the compression made on the breast can be uncomfortable, even slightly painful, but only lasts a few seconds. If your breasts are particularly sensitive, mention this to the radiologist. To minimize the risk of pain, choose an appointment between 10 and 15 days after the start of your period : during this period, the breasts are less sensitive.

If the mammogram is carried out as part of organized screening, the images are read twice. The provisional results are communicated to you at the end of the exam, however, the final results are sent to you by mail within 15 days. Mammography is classified into 6 categories called ACR (for American College of Radiology, the American institute which developed this classification):

• ACR0 classification: the mammogram cannot be interpreted and requires additional investigations.
• ACR1 classification: the mammogram is normal.
• ACR2 classification: the mammogram shows one or more benign anomalies, therefore not serious, which do not require additional examinations.
• ACR3 classification: the mammogram shows one or more anomalies that are probably benign, which require short-term monitoring (3 or 6 months)
• ACR4 classification: the mammogram shows one or more indeterminate or suspicious abnormalities that require a biopsy.
• ACR5 classification: the mammogram presents an abnormality suggestive of cancer and which requires a biopsy.

In the event of an anomaly identified in the images, additional examinations may be prescribed to clarify the diagnosis: ultrasound, MRI, puncture, biopsy, etc.

How much does a mammogram cost? Is this reimbursed?

A mammogram performed as part of organized screening is completely free and therefore 100% covered by Health Insurance, without advance costs. Health Insurance will automatically pay the radiologist. A mammogram performed outside the organized screening framework costs on average 41.58€ (unilateral mammogram) and 66.42€ (bilateral mammogram). It is generally reimbursed up to 70% by Health Insurance. The rest can be covered by complementary health insurance.

Thanks to Dr Brigitte Séradour, radiologist at Beauregard hospital in Marseille and Dr Brigitte Raccah-Tebeka, gynecologist-endocrinologist.