October is, worldwide, the month of awareness about breast cancer. And although during these weeks campaigns, pink ribbons and prevention messages multiply, the question we are asked most in our consultations remains very specific: “What can I do?”
The exam is due to me, and how often should I take it?”

This is not a minor question. There are several studies related to breast and gynecological health, and not all of them are useful for the same purpose or recommended at the same time in a person's life. Understanding the difference between mammography, breast ultrasound, and gynecological evaluation is key to ensuring that prevention is effective and not just an annual formality.

In this article we explain what each of these tests is, when it is recommended, and why, in many cases, they complement each other rather than replacing each other.

Why early detection changes everything

Breast cancer is one of the most common types of cancer in women, but it is also one of those that has the best prognosis when detected at an early stage. The vast majority of breast tumors do not cause any symptoms in their early stages: they do not hurt, they are not always felt as a noticeable lump, and many times they are only visible through imaging studies.

This means that waiting to “feel something strange” is not a reliable prevention strategy. Early detection depends on performing the appropriate tests on a regular basis, even when there are no symptoms or family history.

Mammography: the reference study for breast cancer

Mammography is a specialized x-ray of the breast that allows for the detection of changes in the breast tissue, including masses, calcifications, or distortions that may not yet be visible to the naked eye. To this day, it is the study with the highest scientific evidence for the
Early detection of breast cancer at the population level.

When is it recommended?

• Most international guidelines recommend starting annual mammograms starting at age 40 in women without additional risk factors.
• In women with a direct family history of breast or ovarian cancer, the doctor may recommend starting earlier and even complement it with other genetic or imaging studies.
• Once initiated, the general recommendation is to repeat it annually, although the specialist can adjust the frequency based on previous findings and the risk profile of each patient.

Mammography is particularly effective at detecting microcalcifications and patterns that are difficult to see with other methods, making it the foundation of annual breast screening.

Breast ultrasound: the key complement

Mammogramming uses sound waves to generate images of the breast tissue, and it serves a different role than mammography: it does not replace it, but complements it.

When is breast ultrasound recommended?

• In young women, generally under 40 years of age, whose breast tissue is denser and where mammography may have lower sensitivity.
• As a complementary study when mammography detects a finding that needs further characterization. To evaluate palpable masses, cysts or areas of localized pain, regardless of age.
• In women with dense fibrous breast tissue, where ultrasound can detect findings that mammography does not clearly visualize.

One of the most common misconceptions is to think that ultrasound is a “simpler version” of mammography, or that it can replace it.
in women over 40 years of age. In reality, each study has different strengths depending on age, breast tissue density, and the reason for the consultation, and it is the doctor who determines whether one, another, or both are needed.

Annual gynecological evaluation: the foundation of everything

Beyond breast imaging studies, annual gynecological evaluation remains a fundamental pillar of women's health.
woman. This consultation includes the specialist's clinical examination of the breasts, a review of the menstrual and reproductive history, and—depending on age and background—a Pap smear and other studies related to the health of the uterus and ovaries.

Many women assume that if they have already had a mammogram or ultrasound, they do not need a gynecological evaluation. But the gynecologist not only interprets those results in the full clinical context of the patient: he or she also performs a physical examination that can detect changes that imaging studies alone do not capture, and follows up on other aspects of reproductive health that go beyond the breast.

So, what do I need and when?

Although each case must be evaluated individually by the doctor, here is a general guide:

• People under 40 years of age without risk factors: Annual gynecological evaluation, which includes a clinical examination of the breasts. Breast ultrasound is indicated if there are symptoms, a palpable finding, or relevant family history.
• Starting at age 40: Annual mammography, annual gynecological evaluation, and breast ultrasound as a complement if mammography is required or if the breast tissue is dense.
• With a family history of breast or ovarian cancer: The specialist may indicate starting the studies before the age of 40 and adjust the frequency or type of study according to the level of risk.

In the event of any symptoms—a lump, change in the skin of the breast, discharge, or persistent pain—the corresponding study (usually ultrasound, and in some cases mammography) should be performed immediately, without waiting for the date of the annual checkup.

Prevention is not an event; it is a habit.

One of the biggest obstacles to early detection is not the lack of information, but procrastination. It is easy to postpone a checkup when there are no symptoms, especially in the busy routine of work and family responsibilities that many women live.
But that is exactly the point: early detection studies are designed to find what is not yet felt.

At Hospital Clínica San Fernando we offer mammography, breast ultrasound and gynecological evaluation in one place, allowing us to coordinate these studies efficiently and with the interpretation of specialists trained in women's health.

This October, beyond wearing the pink ribbon, we invite you to make prevention a must-attend event on your calendar. Schedule your annual mammogram and gynecological checkup: it is one of the simplest and at the same time most important decisions you can make for your health.