Breast cancer: Mammogram Programme
The Mammogram Programme (MP) is the national breast cancer screening programme in Luxembourg.
It is aimed at all women from the age of 45 to 74, with the recommendation that they have a mammogram every two years to screen for breast cancer. Mammograms are carried out free of charge as part of the screening programme.
Early diagnosis of breast cancer is only possible using screening mammography.
Mammography
Mammography is a medical imaging technology that uses X-rays. It is currently the best available method for detecting breast cancer. It detects small abnormalities that cannot be detected by palpation.
These abnormalities, which are not visible and cannot be detected by palpation of the breasts, could be a sign of cancer.
Purposes of the Mammogram Programme
- to screen for small breast cancers measuring less than 10 millimetres,
- to reduce the number of breast biopsies for benign lesions,
- to increase the number of cases where the breast is saved,
- to improve the quality of screening and medical monitoring for women for whom a diagnostic procedure has been recommended,
- to reduce mortality from breast cancer over the long term.
These aims can only be achieved if the majority of women in the target group take part in the programme.
Organisation of the MP
How to use the MP
Women in Luxembourg between the ages of 45 and 74 are invited to have a mammogram every two years. They must be registered with the National Health Fund (Caisse nationale de santé - CNS) and live in Luxembourg.
Non-residents may also attend the MP if they are subscribers to the CNS.
The mammograms must be carried out in the Grand Duchy of Luxembourg, and the result of the screening must be sent to a physician. A doctor who practises abroad may also be sent the result if the patient so wishes.
Where should you go for a mammogram?
You can make an appointment for a mammogram at any approved radiology centre of your choice, preferably 3-4 weeks before your annual appointment with your gynaecologist or GP.
Please note that you are only entitled to one appointment as part of the MP, which means that you cannot make appointments at several different screening centres. Only the first appointment will be valid and entitle you to the examination.
What documents do I need to bring to my appointment?
- Social security card (CNS) and identity documents.
- Bring your invitation and your payment voucher (8V53).
- If you have already had a mammogram abroad and have recent X-ray images or a CD, it is important to bring those too. The radiographer will be able to compare the two mammograms and more easily identify any changes.
Practical advice for your appointment
- Wear clothing that is easy to remove.
- To ensure the images are the best possible quality:
- Do not apply deodorant, powder or body lotion.
- Do not apply perfume to your breasts or armpits.
- Do not wear jewellery on the top half of your body.
What does screening involve?
- The mammogram itself takes a few minutes. You should expect your appointment to last between 20 and 30 minutes in total.
- During this time, you will be looked after personally by the radiology technician, who will also perform the mammogram.
- You will be asked to strip to the waist for the mammogram.
- Each breast is compressed between two plates for a few seconds. This can be uncomfortable but the procedure is very quick.
- If you have mobility problems, the mammogram can be carried out in a seated position.
What happens after the radiological examination?
Your mammogram will be viewed by two separate radiologists, independently of one another.
- It is first submitted to the radiologist at your chosen screening centre for an initial examination.
- The images will then be sent to the Coordination Centre for a second assessment. The second radiologist will interpret the images without being aware of the results of the first.
It is therefore not possible for the radiologist (initial examination) to give you the results immediately, as the second examination is needed for definitive interpretation of your mammogram.
If the two radiologists have differing interpretations, they will re-examine the mammogram once more – this time in consultation with one another – to reach a conclusion about which they are in agreement.
How are the results of the mammogram communicated?
A letter will always be sent to your doctor (practising in Luxembourg or abroad) and to your home address a few days after your appointment. This timeframe is necessary to enable two radiologists to interpret the results.
Normal result
- This means that your mammogram did not show any anomalies and no further examination is recommended.
- However, an annual clinical examination during a routine consultation is still recommended.
- You will continue to be invited for a mammogram every two years until the age of 74.
Abnormal result
- This means that the radiologists detected an anomaly. This happens in around 8 % of mammograms.
- In this case, further examinations will be needed to investigate the anomaly. These will usually include additional mammograms, an ultrasound scan, an MRI scan or a biopsy. The majority of cases are found to be benign, non-cancerous abnormalities, but it is always advisable to obtain confirmation.
- Your doctor will be sent a registered letter detailing the results of the screening and the recommended course of action. Your doctor will explain the results to you and arrange for the additional examinations as required. This consultation is free of charge if you countersign form E20, which will have been sent to your doctor.
- If no cancer is found, you will continue to be invited for a mammogram every two years.
- If cancer is detected, you will be treated immediately.
- If additional tests are being carried out, the doctor and radiologists can send you a copy of the results upon request. They will also let the Coordination Centre know by sending a copy of the results with their conclusions to the doctor responsible. In order to assess the quality of the screening programme, the Mammography Programme doctor must be kept up to date with the results of additional examinations. This is done fully in keeping with the principle of professional secrecy.
- You may object to the Coordination Centre being sent the results of your additional tests.
Benefits of screening
Early detection
Mammography can be used to detect small tumours that have not yet metastasised. Early detection and treatment increase the chances of survival and recovery.
Quality of life improves, thanks to less invasive and more effective treatments.
Early detection of a tumour generally means that a less aggressive form of treatment can be used. For example, it can enable breast-conserving surgery (as opposed to a mastectomy) and, in some cases, avoid the need for chemotherapy. This reduces secondary effects and helps maintain quality of life during and after the disease.
It helps reduce breast cancer mortality rates.
Early detection and advances in treatment are contributing to a reduction in breast cancer mortality rates among women in the relevant age group.
Every year in Luxembourg, more than 90 % of the women who die from breast cancer are over the age of 45. A woman who participates in a screening programme every two years from the age of 45 onwards has a lower risk of dying from breast cancer.
Reassuring approach thanks to the programme's quality control.
Women are given an examination the quality of which meets strict criteria that are regularly monitored and accredited.
Disadvantages and risks of screening
Diagnosis and treatment of slow-growing cancers
Some cancers develop so slowly that they have no impact on the person's health. In this case, death occurs due to another cause and cancer screening is of little use.
Based on current scientific knowledge, however, it is not possible to formally distinguish between cancers that will progress rapidly – which are the majority – and those that will progress slowly or have no impact on the health of the woman concerned (approximately 10 % of detected cancers). These cancers would not have been detected without a mammogram: we refer to 'overdiagnosis'.
Similarly, some of these slow-growing cancers, which are treated, might not actually have required treatment or might not have needed all the treatments administered: this is referred to as 'overtreatment'.
Numerous research studies are attempting to identify cancers that are likely to be slow-growing in order to offer treatments that are better tailored to each individual situation.
False positive result or false alarm
When mammography reveals abnormalities, further investigations are necessary. In most cases, the changes detected are diagnosed as benign and there is no breast cancer present. The term used in these cases is 'false positive', which can be very worrying and difficult to cope with at the time.
The onset of cancer before the date of the next mammogram: interval cancer
Some cancers are not visible on the mammogram or are not detected by the radiologists, while others may advance quickly after the screening.
This is referred to as 'interval cancer'. These situations are rare.
Based on many statistical studies, offering women a mammogram every two years is the best way to minimise the number of interval cancers and, at the same time, women's level of exposure to X-rays.
Radiation linked to mammography and cancer risk
The dose of X-rays required for a mammogram is very low, thanks to the use of high-quality radiological equipment and the safeguards required by law. After menopause, the risk of developing breast cancer as a result of regular mammograms is practically zero. This risk is higher in younger women.
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