Breast diseases are common and most are benign. Still, early detection of changes in the breast can make a major difference, especially when it comes to breast cancer. Screening combines clinical breast examination and imaging tests such as mammography and breast ultrasound, adapted to your age and risk profile.
Many women feel worried or confused about when to start mammography, how often to repeat it and what to do if a lump is found. Clear information helps you make informed decisions and avoid both unnecessary fear and dangerous delays.
In Lisbon, Dra. Joana Faria offers breast screening guidance within gynecology consultations, in collaboration with radiology teams experienced in breast imaging.
What it is
Breast diseases screening means looking for breast changes before they cause symptoms or when they are still small. It usually combines three elements:
- Clinical breast examination where the doctor looks at and gently palpates the breasts and armpit areas.
- Mammography an X ray of the breast that can detect small calcifications and nodules.
- Breast ultrasound an imaging test that uses sound waves to characterise lumps and dense breast tissue, without radiation.
The exact tests and intervals depend on your age, personal and family history, previous imaging and national recommendations. For some women, routine screening mammography at defined intervals is advised. For others, targeted imaging is performed only in the presence of symptoms or specific risk factors.
Main symptoms and when to worry
Screening often takes place when you feel well. However, certain changes in the breast should always prompt a consultation, even if your last mammogram was normal.
You should seek medical advice if you notice:
- A new lump or thickening in the breast or underarm that persists after your period.
- Changes in the shape or size of one breast.
- Skin changes such as dimpling, redness, an orange peel appearance or areas that feel different to the touch.
- Changes in the nipple, such as inversion, crusting or scaling.
- Spontaneous nipple discharge, especially if it is bloody or occurs in only one breast.
- Persistent, localised breast pain that does not follow your cycle.
Most of these signs are caused by benign conditions such as cysts or fibroadenomas. They are a reason to be evaluated, not a reason to panic. Your doctor will decide whether imaging or further tests are needed.
If you notice a rapidly growing mass, significant swelling, signs of infection such as fever and redness or feel very unwell, you should contact emergency services or go directly to the nearest emergency department.
Diagnosis: exams and what to expect
Breast screening and assessment combine physical examination with imaging tailored to your situation. The goal is to obtain enough information while keeping the experience as comfortable as possible.
During breast screening you can expect:
- Clinical history
Discussion about your age, menstrual status, pregnancies, breastfeeding, use of hormones, family history of breast or ovarian cancer and any current symptoms. - Clinical breast exam
The doctor inspects and palpates both breasts and armpits while you are sitting and lying down. This helps detect lumps, asymmetries or skin changes. - Mammography when indicated
Each breast is placed between two plates and compressed for a few seconds while X ray images are taken. Compression can be uncomfortable but should be brief. Modern equipment uses low radiation doses. - Breast ultrasound
A probe with gel is moved over the breast and underarm region. This exam is painless and particularly helpful in women with dense breasts or focal findings. - Additional exams in selected cases
In some situations, further imaging such as breast MRI or targeted biopsies may be recommended to clarify a finding.
Your doctor and the radiology team will explain which tests are appropriate for you and what the results mean. Not every abnormal image is cancer, and many findings are classified as probably benign with planned follow up.
Treatment options and follow up
Screening does not automatically lead to treatment. Most findings either confirm that everything is normal or reveal benign changes that can simply be monitored.
Depending on your results, management may include:
- Routine follow up with clinical exam and imaging at defined intervals.
- Short term imaging control when a lesion is considered probably benign.
- Image guided biopsy of a suspicious area to obtain a precise diagnosis.
- Referral to breast surgery or oncology when a malignant lesion is confirmed.
When treatment is needed, options range from local surgery to systemic therapies, depending on the type and stage of disease. Decisions are taken within a multidisciplinary team and discussed with you in detail.
How Dra. Joana Faria approaches breast screening in practice
Dra. Joana Faria sees breast screening as part of comprehensive women’s health care, not as an isolated test. She works closely with breast radiologists and surgeons to ensure that you receive coherent information and follow up.
In practice she:
- Reviews your personal and family history to estimate your level of breast cancer risk.
- Explains when screening mammography is recommended for you and what alternatives exist.
- Prepares you for what to expect during mammography and ultrasound, including possible discomfort and how to minimise it.
- Discusses imaging reports with you in clear, non technical language.
- Coordinates referrals to breast specialists when a biopsy or further treatment is needed.
For many women, having a trusted gynecologist to interpret results and guide next steps significantly reduces anxiety around breast screening.
