MAMMOGRAPHY
 Mammography was 1st and only federally
SOFT TISSUE RADIOGRAPHY
WHAT IS MAMMOGRAPHY?
 it is a radiographic examination of the breast.
 It is the process of using low-energy x-ray to
examine the human breast for diagnosis and
screening
WHAT IS THE GOAL OF MAMMOGRAPHY?
 Is the early detection of breast cancer
HISTORY OF MAMMOGRAPHY
 As a distinct type of radiographic examination,
mammography was first attempted in the 1920’s.
IN LATE 1950S ROBERT EGAN
 renewed interest in mammography with his
demonstration of a successful technique that used
low kilovolt peak (kVp), high milliampere seconds
(mAs), and direct film exposure.
1960 Robert Egan - considered as Father of
Mammography
IN 1960S WOLF AND RUZICKA
 showed that Xeromammography was superior to
direct film exposure at much lower patient radiation
dose, Spatial resolution and contrast resolution
were much improved because of characteristic
edge enhancement – the accentuation of the
interface between different tissues. This property
used frequently in the postprocessing of digital
images.
Is a photographic method of recording an x-ray image
on a coated metal plate using low energy photon
beam
XEROMAMMOGRAPHY
 was retired by 1990 because single screen-film
mammography provided better images at even
lower patient radiation dose.
BREAST CANCER
 cancer that forms in tissues of breast, usually ducts
and lobules
MQSA ( MAMMOGRAPHY QUALITY STANDARDS
ACT )
regulated imaging exam with implementation of
Mammography Quality Standards Act
MANDATORY FOLLOWING:
 Formal training and continuing education.
 Required regular inspection of equipment
 Documentation of quality assurance
 Reporting results, follow-up, tracking patients and
monitoring outcomes
IN 1995
 The National Cancer Institute reported the first
reduction in breast cancer mortality in 50 years, and
this trend continues.
 With early mammographic diagnosis, more than
90% are cured.
One most important consideration in the overall efficacy
of mammography is patient radiation dose because
radiation can cause breast cancer as well as detect it.
RISK FACTORS FOR BREAST CANCER
 Age
 Family History
 Genetics
 Breast architecture
 Menstruation
 Menopause
 Prolonged use of estrogen
 Late age at birth of first child or no children
 Previous radiation therapy to the chest at an early
age
 Education
 Socioeconomic
SCREENING MAMMOGRAPHY
 is performed on asymptomatic women with the use
of a two-view protocol, usually medial lateral
oblique and cranial caudad, to detect an
unsuspected cancer
 In patients 50 years or older reduces cancer
mortality.
 Results of clinical trials show that screening of
women in the 40 to 49 year age group is also
beneficial in reducing mortality
 Younger women have potentially more years of life
left, screening in this group results in more years
of life saved.
DIAGNOSTIC MAMMOGRAPHY
MAMMOGRAPHY | 

 is performed on patients with symptoms or elevated
risk factors. Two or three views of each breast may
be required
WHO NEEEDS A MAMMOGRAM?
 40+ women age 40-49 are also beneficial in
reducing mortality
 <50 patient 50 years or older reduces cancer
mortality
WHEN SHOULD YOU SCHEDULE
MAMMOGRAM?
 Every year and monthly beginning at the age 40
 Aim for the week after your period
AMERICAN CANCER SOCIETY
 Women perform monthly breast self-examinations;
 Healthcare professional teaches a woman to check
her breast regularly for lumps, thickening of the
skin, or any changes in size or shape.
BASELINE MAMMOGRAM
 is the first radiographic examination of the breasts
and is usually obtained before age 40 years.
Radiologists use it for comparison with future
mammograms
Recommended Intervals for Breast Examination
WHY SHOULD YOU GET MAMMOGRAM?
 Mammogram are best method for detecting early
breast cancer.
 Early detection improves your chance of survival.
 90% of survival rate
MAMMOGRAPHY
 is considered very safe and effective. The ratio of
benefit (lives saved) to risk (deaths caused) is
estimated at 1000 to 1
BASELINE MAMMOGRAM
 is the first radiographic examination of the breast
and is usually obtained before age 40 years.
 The risk of radiation-induced breast cancer
resulting from x-ray mammography has been given
a lot of attention.
MAMMOGRAPHY
BREAST ANATOMY
 Young breasts are dense and are more difficult to
image because of glandular tissue
 Older breasts are more fatty and easier to image
NORMAL BREAST CONSIST OF 3 PRINCIPAL
TISSUES:
 Fibrous, glandular, and adipose (fat)
 Fatty tissue fills the space between the fibrous
tissue, lobes, and ducts
  Fibrocystic breasts are composed of tissue that
feels lumpy or ropelike in texture
A   Fibrous tissue and fat give breasts their size and
shape and hold the other structures in place
PREMENOPAUSAL STAGE
 the fibrous and glandular tissues are structured into
various ducts, glands, and connective tissues.
Surrounded by a thin layer of fat. (the screen-film
radiographic appearance of glandular and
connective tissue is one of high optical density (OD)
POSTMENOPAUSAL STAGE
 are characterized by a degeneration of this
fibroglandular tissue and an increase in adipose
tissue. ( Adipose tissue appears dark on film with
higher OD and requires less radiation exposure.)
 If a malignancy is present, it appears as a distortion
of normal ductal and connective tissue patterns.
Approximately 80% of breast cancer is ductal and
may have associated deposits of microcalcifications
(in terms of detecting breast cancer,
microcalcifications smaller than approximately 500
um are of interest)
 The incidence of breast cancer is higher in the
upper lateral quadrant of the breast..
FEATURED OF A DEDICATED MAMMOGRAPHY
SYSTEM FOR USE WITH SCREEN FILM
MAMMOGRAPHY | 

MAMMOGRAPHIC TECHNIQUE CHART
THE BREAST TISSUE MOST SENSITIVE TO
CANCER BY RADIATION IS GLANDULAR TISSUE
 Because the mass density and atomic number of
soft tissue components of breast are so similar,
conventional radiographic technique is useless.
 In 70-100 kVp range, Compton scattering
predominates with soft tissue; thus, differential
absorption within soft tissues is minimal.
 Low kVp must be used to maximize the
photoelectric effect and thereby enhance differential
absorption and improve contrast resolution.
MAMMOGRAPHIC IMAGING SYSTEM
X-RAY MAMMOGRAPHY
 became clinically acceptable with the introduction of
molybdenum as target and filter (1996) and the
dedicated, single emulsion, screen film image
receptor (1972).
By 1990, grid technique, emphasis on compression, high
frequency generators, and automatic exposure control
(AEC) raised mammography to level of excellence in breast
imaging.
HIGH VOLTAGE GENERATION
 All mammography imaging system incorporate
high-frequency generators.
 Such a generator accepts a single-phase input,
which is rectified and capacitor-smoothed to
produce a direct current (DC) voltage waveform.
 A maximum limit of 600 mAs is standard for
preventing excessive patient radiation dose.
TARGET COMPOSITION
MAMMOGRAPHY
 Mammographic x-ray tubes are manufactured
with a tungsten (W), molybdenum (Mo), or Rhodium
(Rh) target.
TUNGSTEN L-SHELL X-RAYS
 are of no value in mammography because their 12-
keV energy is too low to penetrate the breast
FOCAL SPOT SIZE
 The size of focal spot is an important characteristic
of mammography x-ray tubes because of the higher
demands for spatial resolution. Imaging of
microcalcifications requires small focal spots.
 Mammography x-ray tubes usually have stated
focal-spot-sizes (large and small)
 Smaller the better; however the shape of the focal
spot is also important
A CIRCULAR FOCAL SPOT is preferred, but rectangular
shapes are common.
FILTRATION
 At low kVp used for mammography, it is important
that the x-ray tube window not attenuate the x-ray
beam significantly. Therefore, dedicated
mammography x-ray tubes have either a beryllium
(Z=4) window or a very thin borosilicate glass
window.
 Most mammography x-ray tubes have inherent
filtration in the window of approximately 0.1 mm Al
equivalent.
 If tungsten target x-ray tube is used, it should have
a molybdenum or rhodium filter.
 No filter element can absorb its own anode target
characteristic radiation
HEEL EFFECT
-The conic shape of the breast requires that the radiation
intensity near the chest wall must be higher than that to the
nipple side to ensure near-uniform exposure of the image
receptors. ( this accomplished by positioning the cathode to
the chest wall)
COMPRESSION
VIGOROUS COMPRESSION must be used in x-ray
mammography
-Reduced absorption blur and scatter radiation
-Compression improves spatial resolution and contrast
resolution and reduces the patient radiation dose.
GRIDS
 A Unique grid that has been developed specifically
for mammography is the high-transmission cellular
(HTC) grid.
MAMMOGRAPHY | 

 this grid has the clean-up characteristics of a
crossed grid in that it reduces scatter radiation in
two directions rather than the single direction of a
parallel grid.
HTC has copper as grid strip material and air for the
interspace, and its physical dimension result in a 3.8:1 grid
ratio
AEC
PHOTOTIMERS
 designed to measure not only x-ray intensity at the
image receptor but also x-ray quality.
- called AEC devices
2 TYPES ARE USED:
1. IONIZATION CHAMBER
2. SOLID-STATE DIODE
COMPOSITED AUTOMATIC EXPOSURE CONTROL
 The CAEC should be able to hold OD with 0.1 as
Voltage is varied from 23-32 kVp and for breast
thickness of 2-8 cm regardless of breast
composition
MAGNIFICATION MAMMOGRAPHY
MAGNIFICATION TECHNIQUES are used frequently in
mammography, producing up to twice the normal size.
Requires special equipment such as microfocus x-ray
tubes, adequate compression, and patient positioning
devices. (Effective focal spot size should not exceed 0.1
mm)
Magnification mammography should not be used routinely.
SCREEN-FILM MAMMOGRAPHY
FOUR TYPES OF IMAGE RECEPTOR HAVE BEEN
USED FOR X-RAY MAMMOGRAPHY
1. Direct exposure film
2. Xeroradiography
3. Screen-film
4. Digital detectors
DIGITAL MAMMOGRAPHY
 Digital Mammography Imaging Study Trial (DMIST)
in early 2006
 Designed to compare the efficiency of digital
mammography with that of screen film
mammography with which we had 30 years of
experience.
MAMMOGRAPHY
 Digital mammography has superior contrast
resolution principally because of postprocessing
MIDTERM
What parts make up female breast anatomy?
 There are many different parts to female breast
anatomy, including:
LOBES
 Each breast has between 15 to 20 lobes or
sections.
GLANDULAR TISSUE (LOBULES):
 These small sections of tissue found inside lobes
have tiny bulblike glands at the end that produce
milk.
MILK (MAMMARY) DUCTS
 These small tubes, or ducts, carry milk from
glandular tissue (lobules) to nipples
NIPPLES
 The nipple is in the center of the areola.
 Each nipple has about nine milk ducts, as well as
nerves.
AREOLAE
 The areola is the circular dark-colored area of skin
surrounding the nipple.
Areolae have glands called MONTGOMERY’S GLANDS
BLOOD VESSELS
 circulate blood throughout the breasts, chest and
body.
LYMPH VESSELS
 Part of the lymphatic system, these vessels
transport lymph, a fluid that helps your body’s
immune system fight els connect to lymph nodes,
or glands, found under the armpits, in the chest and
other places.
 infection. Lymph vess
NERVES
 Nipples have hundreds of nerve endings, which
makes them extremely sensitive to touch and
arousal.
MAMMOGRAPHY | 

What about the Male breast?
 The structure of the male breast is nearly identical
to that of the female breast, except that the male
breast tissue lacks the specialized lobules, as there
is no physiologic need for milk production by the
male breast.
 Male hormone testosterone usually stops breasts
from developing like a females.
 On the outside surface, males have nipples and
areolae. Internally, they have undeveloped milk
ducts and no glandular tissue.
 Male breast problems can include:
GYNECOMASTIA, a benign condition that causes the
breasts to enlarge, and very rarely, breast cancer.
DEVELOPMENTAL STAGES
ROLE IN PUBERTY
 Females typically enter puberty between the ages
of 8 and 13 years, and puberty usually ends when
they are around 14 years old.
 During puberty, the pituitary gland starts producing
larger quantities of luteinizing hormone (LH) and
follicle-stimulating hormone (FSH), which stimulates
the production of estrogen and progesterone.
Increased levels of estrogen and progesterone initiate the
development of secondary sexual characteristics, which
include:
 breast development
 hair growth on the underarms, legs, and pubic
region
 increased height
 increased fat storage on the hips, buttocks, and
thighs
 widening of the pelvis and hips
 increased oil production in the skin
ROLE IN MENSTRUATION
 MENARCHE is the first time a person gets
their menstrual period, and it typically occurs
between the ages of 12 and 13 years. However,
menarche can occur at any time between 8 and 15
years of age.
 After menarche, many people have regular
menstrual cycles until they reach menopause.
Menstrual cycles are usually around 28 days
long but can vary between 24 and 38 days.
 The menstrual cycle occurs in three phases that
coincide with hormonal changes:
MAMMOGRAPHY
Follicular phase 1-13 days
The first day of a period marks the beginning of a new
menstrual cycle.
 The ovulatory phase
 The luteal phase 
It lasts about 14 days (unless fertilization occurs) and ends
just before a menstrual period. In this phase, the ruptured
follicle closes after releasing the egg and forms a structure
called a CORPUS LUTEUM, which produces increasing
quantities of progesterone.
NOTE: The length of a woman’s menstrual cycle
determines when ovulation occurs:
 In 28 day cycle the most fertile days are days from
12 to 14 days.
 In 24 day, cycles, the most fertile days are days
from 8 to 10 days
 In 35 day cycles the most fertile days are between
19 and 21 days
ROLE IN PREGNANCY
 Pregnancy starts the moment a fertilized egg
implants in the wall of a person’s uterus. Following
implantation, the placenta begins to develop and
starts producing a number of hormones, including
progesterone, relaxin, and human chorionic
gonadotropin (hCG).
ROLE IN MENOPAUSE
MENOPAUSE occurs when a person stops having
menstrual periods and is no longer able to become
pregnant. In the United States, the average age at which a
woman experiences menopause is 52 years.
PERIMENOPAUSE refers to the transitional period leading
up a person’s final period. During this transition, large
fluctuations in hormone levels can cause a person to
experience a range of symptoms.
Symptoms of perimenopause can include:
 irregular periods
 hot flashes
 sleeping difficulties
 mood changes
 vaginal dryness
ROLE IN SEXUAL DESIRE AND AROUSAL
 Estrogen, progesterone, and testosterone all affect
sexual desire and arousal. Having higher levels of
estrogen in the body promotes vaginal lubrication
and increases sexual desire.
MAMMOGRAPHY | 
 MAMMOGRAPHY
 Low levels of testosterone may lead to reduced  “CLOCK FACE” method, in which the location of
sexual desire in some women. However, breast findings is described as though a clock were
testosterone therapy appears ineffective at treating superimposed on each breast as the woman faces
low sex drive in females. the examiner.
 This means that the upper outer quadrant in the
right breast is between the 9- and 12-o’clock
According to a systematic review from 2016 Trusted positions, but the upper outer quadrant in the left
Source, testosterone therapy can enhance the effects of breast is between the 12 to 3 o clock position
estrogen, but only if a doctor administers the testosterone at EXTERNAL ANATOMY
higher-than-normal levels.
 Montgomery (also known as Morgagni) tubercles,
This can lead to unwanted side effects.
which are located near the periphery of the areola,
These side effects can include: are elevations formed by the openings of the
ducts of the Montgomery glands, large
 weight gain sebaceous glands that represent an intermediate
 irritability stage between sweat and mammary glands.
 balding
 excess facial hair Montgomery's tubercles are sebaceous (oil)
 clitoral enlargement glands that appear as small bumps around the dark
area of the nipple.
HORMONAL IMBALANCE  Nipple is at the very center portion of your breast,
 Hormonal balance is important for general health. and is linked to the mammary glands, where milk is
Although hormonal levels fluctuate regularly, long- produced.
term imbalances can lead to number of symptoms  Areola area of dark-colored skin on the breast that
and conditions.
surrounds the nipple.
Signs and symptoms of hormone imbalances can
SEBACEOUS GLANDS
include:
 are small, sack-shaped glands which release an
 irregular periods
oily substance onto the hair follicle that coats and
 excess body and facial hair
protects the hair shaft from becoming brittle. These
 acne
glands are located in the dermis.
 vaginal dryness
 low sex drive SWEAT GLANDS
 breast tenderness
 gastrointestinal problems  are coiled tubular structures vital for regulating
 hot flashes human body temperature.
 night sweats
TAIL OF SPENCE (SPENCE'S TAIL, AXILLARY
 weight gain
PROCESS, AXILLARY TAIL)
 fatigue
 irritability and irregular mood changes  is an extension of the tissue of the breast that
 anxiety extends into the axilla.
 depression
 difficulty sleeping INFRAMAMMARY FOLD (IMF)
 It is anatomically defined as the area where the
skin of the lower pole of glandular breast tissue
DIVISION OF THE BREAST : meets the chest wall forming a groove known as
the INFRAMAMMARY CREASE
Upper (superior)–outer (lateral)
RETROMAMMARY SPACE
1. Upper (superior)–inner (medial),
2. Lower (inferior)–inner (medial)  loose connective tissue plane between the breast
3. Lower (inferior)–outer (lateral). and the fascia of the pectoralis major m., allows
4. The subareolar area (central portion)  movement of the breast on pectoral fascia
 breast implantation
CLOCKFACE METHOD

MAMMOGRAPHY | 

Clinical importance: Cancer cells spread through
retromammary space.  collarbone behind the breastbone and in other parts
The breast tissue is encircled by a thin layer of connective
tissue called fascia. The deep layer of this fascia sits
immediately atop the pectoralis muscle, and the superficial
layer sits just under the skin.
The different types of breast tissue include:
Glandular:  Also called lobules,
glandular tissue produce
milk
Fatty:  This tissue determines
breast size
Connective or fibrous:  This tissue holds glandular
and fatty breast tissue in
place.
TERMINAL duct lobular units (TDLUs)
 Branching off a larger duct are the extralobular
terminal ducts which lead to the lobules
Lobule contain the intralobular terminal duct
 Acini and terminal ducts produce and
transport milk while the larger ducts transport
milk to the nipple
STROMA
 Stroma ('layer, bed, bed covering') is the part of a
tissue or organ with a structural or connective
tissue. It is made up of all the parts without specific
functions of the organ - for example, connective
tissue, blood vessels, ducts, etc.
COOPER'S LIGAMENTS
 are found under the skin of the breast, through and
around the breast tissue. These ligaments maintain
the shape and structure of your breasts and help to
prevent sagging. Cooper's ligaments support the
breasts on the chest wall, maintain their contour,
and keep them in position
LYMPHATIC CHANNELS
 Lymphatic circulation in breast tissue helps regulate
the local fluid balance as well as filter out harmful
substances. But the breast's lymphatic system can
also spread diseases such as cancer through the
body. Lymphatic vessels provide a highway along
which invasive cancerous cells move to other parts
of the body
LYMPH NODES AND LYMPH DUCTS
 The lymphatic system is a network of lymph nodes
and lymph ducts that helps fight infection. Lymph
MAMMOGRAPHY
nodes — found under the armpit, above the
of the body — trap harmful substances that might
be in the lymphatic system and safely drain them
from the body.
VASCULATURE
ARTERIAL SUPPLY
 to the medial aspect of the breast is via the internal
thoracic artery – it is a branch of subclavian artery
Lateral part of the breast receives blood from four
vessels:
Lateral thoracic and thoracoacromial branches-Lateral
mammary branches – it originate from the posterior
intercostal arteries. They supply the lateral aspect of the
breast in the 2nd 3rd and 4th intercostal
MAMMARY BRANCH
 The veins of the breast correspond with the
arteries, draining into the axillary and internal
thoracic veins
What are the dense breast?
 Dense breasts have more glandular and fibrous
tissue and less fatty tissue.
 Dense breast tissue and tumors both look white on
mammograms, making it more difficult to
detect breast cancer.
 Up to half of women between the ages of 40 and 74
have dense breasts.
 10% of women have almost entirely fatty breasts.
 10% have extremely dense breast
 80% are classified into one of two middle
categories.
DENSE BREAST
 Breasts are made up of fat and breast tissue, the
milk ducts and lobules.
Breast density compares the area of connective
tissue seen on a mammogram to the area of fat.
 Breast and connective tissue appear denser than
fat on a mammogram.
 A high breast density indicates a greater amount of
breast and connective tissue compared to fat.
 Low breast density indicates a greater amount of fat
compared to breast and connective tissue.
 Some breasts are mostly fat.
Mammograms of dense breasts are more difficult to
read than mammograms of fatty breasts.
MAMMOGRAPHY | 

 Women with high breast density are 4-5 times more
likely to get breast cancer than women with low
breast density.
In the U.S., 40-50 percent of women ages 40-74
have dense breasts.
 Nearly 40,000,000 women undergo routine
mammogram studies in the US each year and
about 43% of these exams reveal the presence of
dense breasts.
Breast density varies greatly by age and weight.
Dense breasts are more common in both young and thin
women
MAMMOGRAPHY
 Fibrocystic breast changes (noncancerous lumps
and tenderness).
 Mammary duct ectasia (swollen milk ducts).
 Mastitis (breast infection).
 Nipple discharge.
How do breasts work?
How can I keep my breasts healthy?
Since breast cancer is a top concern, talk to your healthcare
provider about when and how often to get mammograms.

Recommendations vary depending on risk factors, such as

How do breasts work? family history of disease. Breast self-exams can help you
get familiar with how your breasts look and feel so you more
 Prolactin
easily notice changes or potential problems.
TYPES OF FEMALE SEX HORMONE
To do a breast self-examination:
Estrogen.
1. Remove all your clothes above the waist. Lie down.
Testosterone
Lying down spreads your breasts evenly over your
Progesterone
chest and makes it easier to feel lumps or changes.
PROGESTERONE
Check your entire breast by feeling all of the tissue from
 increases the number and size of lobules in the collarbone to the bottom of the bra line and from the
preparation for breastfeeding armpit to the breastbone.

TESTOSTERONE 2. Use the pads of your three middle fingers—not your

Although testosterone is the main sex hormone in males, it
is also present in lower amounts in females.
In females, testosterone affects:
• fertility
• sexual desire
• menstruation
• tissue and bone mass
• red blood cell production
ESTROGEN
 stretches milk ducts and helps them create side branches
to carry more milk.
What conditions and disorders affect breast
anatomy?
 Breast cancer is the number one threat to breast
health. Approximately 1 in 8 women will receive a
breast cancer diagnosis in her lifetime. Other
conditions that affect breast health include:
fingertips. Use the middle fingers of your left hand to
check your right breast. Use the middle fingers of your
right hand to check your left breast. You can use an up-
and-down pattern or a spiral pattern. Move your fingers
slowly in small coin-sized circles.
Use three different levels of pressure to feel all of your
breast tissue. Light pressure is needed to feel the tissue
close to the skin
1. to feel a little deeper, and firm pressure is used to feel
your tissue close to your breastbone and ribs. Avoid
lifting your fingers away from the skin as you feel for
lumps, unusual thicknesses, or changes of any kind.
FIVE THINGS YOU CAN DO TO BOOST
BREAST HEALTH
BREAST CANCER
BREAST CANCER
o It is a disease wherein breast cells start to grow
uncontrolled..

 Benign (noncancerous) breast disease. o Kinds of breast cancer varies depending on which
 Breast cysts. cells in the breast grows out of control and turns
 Breast lumps. into cancer.
 Breast pain (mastalgia).
 Breast rash.
TYPES OF BREAST CANCER:
MAMMOGRAPHY | 

o Ductal carcinoma in situ
o Invasive ductal carcinoma
o Inflammatory breast cancer
o Metastatic breast cancer
DUCTAL CARCINOMA IN SITU(DCIS)
 Type of cancer wherein the cells that makes up the
milk ducts of the breast is concern and have not
spread into the surrounding tissues
BREAST CONSERVING SURGERY
 Surgery to remove cancer or other abnormal
tissue from the breast and some normal tissue
around it, but not the breast itself.
RADIATION THERAPY
 Radiation therapy (also called radiotherapy) is a
cancer treatment that uses high doses of radiation
to kill cancer cells and shrink tumors
MASTECTOMY
 Mastectomy is breast cancer surgery that removes
the entire breast. 
SENTINEL LYMPH NODES BIOPSY
 A sentinel node biopsy is a diagnostic procedure to
test if cancer has spread beyond the original tumor
INVASIVE DUCTAL CARCINOMA
 Type of cancer wherein the cells that makes up the
milk ducts of the breast is concern and have not
spread into the surrounding tissues.
SIGN AND SYMPTOMS:
According to the American Cancer Society, any of the
following unusual changes in the breast can be a first
sign of breast cancer, including invasive ductal
carcinoma:
o swelling of all or part of the breast
o skin irritation or dimpling
o breast pain
o nipple pain or the nipple turning inward
o redness, scaliness, or thickening of the nipple
or breast skin
o a nipple discharge other than breast milk
o a lump in the underarm area
INFLAMMATORY BREAST CANCER
 Rare type of breast cancer
 1-5% of all breast cancer
MAMMOGRAPHY
 These includes swelling and redness, caused by
cancer cells blocking the lymph vessels in the skin
HOW IS INFLAMMATORY BREAST CANCER
DIFFERENT FROM OTHER TYPES OF BREAST
CANCER
o When compared to other forms of the disease,
inflammatory breast cancer:
o Looks different
o Is harder to diagnose
o Is more aggressive and spreads more quickly than
other types
o Tends to be diagnosed at a younger age, especially
among African-American women
o Is more likely to affect overweight women
o Is often further along (your doctor may call this
locally advanced, meaning it’s moved into nearby
skin) when it’s diagnosed
o Sometimes has spread past the breast (your doctor
will say it has metastasized) when it’s diagnosed,
which makes it harder to treat
WHAT ARE THE EARLY SIGNS AND SYMPTOMS OF
INFLAMMATORY BREAST CANCER?
o Symptoms of inflammatory breast cancer may
include:
o Pain in the breast
o Skin changes in the breast area. You may find pink
or reddened areas often with the texture and
thickness of an orange.
o A bruise on the breast that doesn't go away
o Sudden swelling of the breast
o Itching of the breast
o Nipple changes or discharge
o Swelling of the lymph nodes under the arm or in the
neck
STAGES OF INFLAMMATORY BREAST CANCER
This type of cancer is usually in one of three stages:
o Stage IIIB: All Inflammatory breast cancers start in
this stage since they involve the skin of your breast.
o Stage IIIC: This cancer has spread to lymph nodes
around your collarbone or inside your chest.
o Stage IV: The cancer has spread outside your
breast and nearby lymph nodes to other parts of
your body.
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SIGNS OF METASTATIC BREAST CANCER

o You should always speak with your doctor if you

experience any new signs or symptoms, but here
are some of the most common signs that breast
cancer has spread:
o Bone pain or bone fractures due to tumor cells
spreading to the bones or spinal cord
o Headaches or dizziness when cancer has spread to
the brain
o Shortness of breath or chest pain, caused by lung
cancer
o Jaundice or stomach swelling

SYMPTOMS OF METASTATIC BREAST CANCER

o The symptoms of breast cancer metastasis may

also vary depending on where in the body the
cancer has spread. For example:
o If the breast or chest wall is affected, symptoms
may include pain, nipple discharge, or a lump or
thickening in the breast or underarm.
FINALS
o If the cancer has spread to bones, symptoms may
include pain, fractures or decreased alertness due BREAST PATHOLOGY
to high calcium levels.
BREAST ASYMMETRY - refers to the appearance of a part
o If the cancer has spread to the lungs, symptoms
of the breast in comparison to the remainder of that breast
may include shortness of breath, difficulty
and to the other breast.
breathing, coughing, chest pain or fatigue.
o If the cancer has spread to the liver, symptoms may CAUSES OF BREAST ASYMMETRY
include nausea, fatigue, swelling of the feet and
hands or yellowing skin. During puberty, the left and right breast often develop at a
o If cancer has spread to the central nervous system, slightly different pace. Breasts may appear asymmetrical
until they have finished growing, or they may remain
which includes the brain or spinal cord, symptoms
different shapes and sizes throughout a person’s life.
may include pain, memory loss, headache, blurred
or double vision, difficulty with and/or movement or Hormonal changes can cause one or both breasts to
seizures. change at any point in a person’s life, for example:

 at specific points in the menstrual cycle

 during or near menopause
UNDERSTANDING BIRADS SCORING  during pregnancy or breast-feeding
 when using a hormonal contraceptive, such as birth
control pills
BIRADS SCORING  Trauma, infection, or radiation
 Juvenile hypertrophy
 “A numerical scoring system used to evaluate the
 Unknown syndrome
risk of breast cancer”
 It is based on reports from images taken from Any unusual changes in the breast should be checked by a
different modalities such as mammogram, breast doctor. Changes to look out for include:
ultrasound, or breast MRI
 Scoring ranges between 0-6 - a lump in or around the breast
- a lump under the arm
- tissue that feels thick or firm near the breast or
under the arm
- a change in the size or shape of a breast
- changes to the nipple, such as it starts to point
inward
- fluid or discharge from the nipple
MAMMOGRAPHY | 

- red, itchy, or scaly skin around the breast
- dimpled or puckered skin
Some underlying conditions that can affect breast size and
shape include:
- Tubular breasts: Also called breast hypoplasia,
tubular breasts can develop in one or both breasts
during puberty.
- Amastia or amazia: A condition that causes
problems in the development of breast tissue, the
areola, or nipple.
- Poland Syndrome: Where a chest muscle does not
develop properly, which can affect the breast on
one side of the body.
TREATMENT:
- is plastic, aesthetic and reconstructive surgery.
- The surgical techniques used depend on the
surgeon and on the patient’s characteristics.
However, in many cases, breast augmentation,
breast reduction or a combination of both will be
done.
 Breast augmentation - also known as
augmentation mammoplasty — is surgery to
increase breast size. It involves placing breast
implants under breast tissue or chest muscles.
 Reduction mammoplasty - (also breast reduction
and reduction mammaplasty) is the plastic surgery
procedure for reducing the size of large breasts.
INVERTED NIPPLES OR RETRACTED NIPPLES
- it lies flat against the areola or goes inward instead
of sticking out. The areola is the circular area of
pigmented skin around the nipple.
WHAT CAUSES AN INVERTED NIPPLE:
Medical conditions that can cause nipple inversion include:
 Congenital inversion
 mastitis, which is an infection of the mammary
gland
 duct ectasia, which is an abnormal dilation of a duct
in the breast tissue
 an abscess under the areola
 Complications of breast surgery
 Aging
 breast cancer
GRADES OF NIPPLE INVERSION
There are three grades of nipple inversion, depending on
the degree of inversion and mobility of the nipple:
 Grade 1: A person can easily pull out the nipple,
and it maintains its projection. This grade of
inversion causes no major problems with
breastfeeding.
MAMMOGRAPHY
 Grade 2: A person can pull the nipple out, but not
as easily, and the nipple tends to retract. They may
find it difficult to breastfeed.
 Grade 3: A person may not be able to pull out their
nipple. When pressing the nipple outward, it
immediately retracts. Breastfeeding may be very
difficult or impossible.
How to determine your grade of nipple inversion?
Many people know that they have inverted nipples but
aren’t clear on how inverted their nipples are.
Here’s how to figure it out:
1. Take off your shirt and any undergarments you
have on.
2. While standing in front of a mirror, hold the areola
on each breast between your thumb and forefinger.
3. Gently press inward. You should firmly press about
an inch or so into the breast.
4. Take note of how your nipples respond and use this
to assess their grade.
You may only experience inversion in one nipple, or even
different grades of inversion in each nipple.
INVERTED NIPPLES
How to treat an inverted nipple
Talk with a doctor before trying the methods below:
1. Hoffman’s technique: This consists of a manual
home exercise for drawing out the nipple. Place the
thumbs on either side of the nipple at its base.
Press the thumbs firmly into the breast tissue and
separate them gently. This should cause the nipple
to point outward. The amount of time it stays out
will vary from person to person.
2. Suction devices: These represent a noninvasive
way to draw out the nipple.
3. Piercings: A piercing may help to keep the nipple in
an upright position.
4. Surgery;
 Surgery with partial preservation of milk ducts - This
is also known as the “parachute flap” technique.
Women undergoing this procedure should still be
able to breastfeed because some of the milk duct
system remains attached. You shouldn’t experience
a change in nipple sensation.
 Surgery with detached milk ducts -This procedure is
more common. Women undergoing this procedure
won’t be able to breastfeed because of the removal
of the milk ducts. You shouldn’t experience a
change in nipple sensation.
5. In any procedure, the doctor aims to preserve the
nipple’s usual sensation, avoid visible scarring, and
maintain the functioning of the breast duct to enable
breastfeeding.
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The Hoffman technique for drawing out inverted nipples
has been in use since the 1950s. To try it:
 Place your thumbs on either side of your nipple. Be
sure to place them at the base of the nipple, not the
outside of the areola.
 Press firmly into your breast tissue.
 While still pressing down, gently pull your thumbs
away from each other.
 Move your thumbs all around the nipple and repeat.
There are some suction devices promoted for reversing
inverted nipples. Most are worn under clothing for extended
periods of time.
These products are sold under a variety of names,
including:
• nipple retractors
• nipple extractors
• shells
• cups
- These devices usually work by pulling the nipple
into a small cup. This stimulates the nipple and
makes it protrude.
- When used over time, these devices can help
loosen the nipple tissue. This can help your nipples
remain erect for longer periods of time.
Popular options include:
 Avent Niplette
 Pippetop Inverted Nipple Protractor
 Medel soft shells for Inverted nipples
 Supple cups
ACCESSORY NIPPLES
- “supernumerary nipple”
- A third nipple is a condition where a person has an
extra nipple on their body in addition to the two
nipples located on the breasts or chest.
TYPES OF ACCESSORY NIPPLES:
1. Category one (known as polymastia) - A category
one extra nipple will have an areola around the
outside.
2. Category two - A category two extra nipple will not
have an areola around it, though the presence of
breast tissue underneath is still apparent.
3. Category three - A category three extra nipple is
where the area has breast tissue present, but no
actual nipple has formed.
4. Category four - A category for extra nipple is where
breast tissue has formed underneath, but no nipple
or areola is present.
5. Category five (known as pseudomamma) - A
category five extra nipple, has an areola around the
MAMMOGRAPHY
nipple area, but instead of breast tissue
underneath, fat tissue is found instead.
6. Category six (known as polythelia) - A category six
extra nipple is where the nipple appears alone and
there is no areola or breast tissue underneath it.
CLINICAL BREAST CHANGES:
 Breast Changes of Concern
- Some breast changes can be felt by a woman or
her health care provider, but most can be detected
only during an imaging procedure such as a
mammogram, MRI, or ultrasound. Whether a breast
change was found by your doctor, or you noticed a
change, it’s important to follow up with your doctor
to have the change checked and properly
diagnosed.
Check with your health care provider if your breast looks or
feels different, or if you notice one of these symptoms:
 Lump or firm feeling in your breast or under your
arm. Lumps come in different shapes and sizes.
Normal breast tissue can sometimes feel lumpy.
Doing breast self-exams can help you learn how
your breasts normally feel and make it easier to
notice and find any changes, but breast self-exams
are not a substitute for mammograms.
 Nipple changes or discharge. Nipple discharge may
be different colors or textures. It can be caused by
birth control pills, some medicines, and infections.
But because it can also be a sign of cancer, it
should always be checked.
 Skin that is itchy, red, scaled, dimpled or puckered
 Breast Changes During Your Lifetime That Are Not
Cancer
- Most women have changes in the breasts at
different times during their lifetime.
 Before or during your menstrual periods.
 During pregnancy.
 As you approach menopause
 If you are taking hormones
 After menopause
 Mammogram Findings
- Mammograms are pictures (x-rays) of the breast,
used to check for breast cancer. Possible
mammogram findings include:
 Lumps (mass or tumor). Lumps come in different
sizes and shapes. Fluid-filled cysts are usually
smooth and rounded, with clear, defined edges and
are not cancer. Lumps that have a jagged outline
and an irregular shape are of more concern.
 Calcifications. There are two types of breast
calcifications, or calcium deposits:
- Macrocalcifications, which look like small white
dots on a mammogram. They are often caused by
aging, an old injury, or inflammation and are usually
benign.
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- Microcalcifications, which look like white specks
on a mammogram. If found in an area of rapidly
dividing cells or grouped together in a certain way,
they may be a sign of DCIS or breast cancer.
 Dense breast tissue: A dense breast has relatively
less fat and more glandular and connective tissue.

TEST TO DIAGNOSE BREAST CHANGES:

1. MAMMOGRAPHY - A type of mammography in

which more x-ray pictures of the breast are taken
from different angles to allow a possible
abnormality to be examined more closely.
2. MAGNETIC RESONANCE IMAGINE -procedure
that uses a powerful magnet, radio waves, and a
computer to take detailed pictures of areas inside
the breast. An MRI can be used to learn more
about breast lumps or large lymph nodes that were
found during a clinical breast exam or breast self-
exam but were not seen on a mammogram or
ultrasound.
3. DUCTOGRAPHY/GALACTOGRAPHY - is an
imaging technique which is used to evaluate lesions
causing nipple discharge. It helps in precisely
locating the mass within breast tissue and gives
useful information for surgical approach and
planning
4. BIOPSY - A procedure that removes a sample of
breast tissue or an entire lump so that it can be
checked for signs of disease. Imaging procedures
(such as ultrasound, MRIs, or x-rays) are often
used during a biopsy to guide the surgeon. A
pathologist then examines the sample under a
microscope or performs other tests on it
 Core needle biopsy: The use of a wide needle to
remove small tissue sample(s) that are about the
size of a grain of rice. It may cause a temporary
bruise. Also called core biopsy.
 Fine-needle aspiration biopsy: The use of a thin
needle to drain fluid and/or to remove cells.
 Surgical biopsy: The removal of part, or all, of a
lump so it can be checked for signs of cancer. An
incisional biopsy removes a sample of breast
tissue. An excisional biopsy removes an entire lump
or suspicious area. Wire localization (also called
needle localization and needle (wire) localization)
may be used to mark the area of abnormal tissue
before the biopsy.
 Vacuum-assisted biopsy: The removal of a small
sample of breast tissue using a probe that is
connected to a vacuum device. The small cut made
in the breast is much smaller than with surgical
biopsy. This procedure causes little scarring, and
no stitches are needed. It may also be called
vacuum-assisted core biopsy.

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