OBJECTIVE: To demonstrate the efficacy of core-needle biopsy to avoid unnecessary surgery; to assess the technical difficulties of this method; to establish decision criteria for clinical follow-up or surgery in patients with lesions classified as suspicious for malignancy (BI-RADS IV); to expedite surgery in patients with lesions classified as highly suspicious for malignancy (BI-RADS V). MATERIALS AND METHODS: The patients were submitted to clinical examination, mammography and ultrasound. Core-needle biopsy was done using a 14-gauge needle, and 4-8 cores per lesion were obtained. RESULTS: A hundred lesions were studied, 47 of them underwent surgery and biopsy, and 34 cancers were diagnosed. In 23 lesions classified as probably benign (III) only one case of cancer was diagnosed (4.34%). In 43 lesions classified as IV, seven (16.28%) cancers were found whereas in 34 lesions classified as V, 26 (76.47%) cases of cancer were identified. It was possible to avoid surgery in 53 cases (53%). Difficulties in core-needle biopsy occurred in seven cases including insufficient material, risk of malignancy due to sclerosing lesions and lack of correlation between imaging and core-needle biopsy results. All the core biopsy diagnoses of malignancy were confirmed by surgery. There was one false negative result when the core biopsy specimen examination showed atypical hyperplasia while surgery specimen analysis revealed a carcinoma. There were no false positive cases.

Keywords: Breast disease, Breast cancer, Core-needle biopsy, Breast ultrasound

Superior vena cava syndrome is defined by a set of signs and symptoms secondary to superior vena cava obstruction caused principally by malignant diseases. The present report describes the case of an unusual clinical manifestation of this syndrome with bilateral breast swelling, and emphasizes the relevance of knowledge on mammographic signs of systemic diseases.

Keywords: Mammography; Superior vena cava syndrome; Subclavian vein thrombosis.

Breast cancer is the most common malignancy among women in Brazil and the leading cause of cancer-related death in the female population of the country. Despite advances in treatment and the implementation of mammography screening programs, mortality rates have continued to rise. This increase is particularly evident among women under 50 years of age and those 70 years of age or older, groups that account for a substantial proportion of diagnosed cases and registered deaths in the country. Until recently, these age groups were not included in the screening guidelines established by the Brazilian National Ministry of Health, although consistent scientific evidence demonstrates significant benefits of early detection in these populations, including reduced mortality, a higher proportion of early-stage diagnoses, and less aggressive therapeutic interventions. This article analyzes epidemiological data, the socioeconomic impacts of breast cancer, and the scientific evidence regarding mammography screening, discussing the outcomes and limitations of national programs in Brazil. On the basis of that analysis, we advocate for the revision and expansion of public breast cancer screening policies to include women 40–49 and ≥ 70 years of age, as an essential strategy to reduce mortality, improve clinical outcomes, and promote greater equity in access to diagnosis and treatment of breast cancer in Brazil.

Keywords: Breast neoplasms; Mammography; Mass screening; Brazil; Middle aged; Aged.