MAMMOGRAPHY

 Mammography was 1st and only federally

SOFT TISSUE RADIOGRAPHY regulated imaging exam with implementation of
Mammography Quality Standards Act
WHAT IS MAMMOGRAPHY? MANDATORY FOLLOWING:
 it is a radiographic examination of the breast.
 It is the process of using low-energy x-ray to  Formal training and continuing education.
examine the human breast for diagnosis and  Required regular inspection of equipment
screening  Documentation of quality assurance
 Reporting results, follow-up, tracking patients and
monitoring outcomes

WHAT IS THE GOAL OF MAMMOGRAPHY?

 Is the early detection of breast cancer IN 1995
 The National Cancer Institute reported the first
HISTORY OF MAMMOGRAPHY reduction in breast cancer mortality in 50 years, and
 As a distinct type of radiographic examination, this trend continues.
mammography was first attempted in the 1920’s.
 With early mammographic diagnosis, more than
IN LATE 1950S ROBERT EGAN 90% are cured.

 renewed interest in mammography with his One most important consideration in the overall efficacy
demonstration of a successful technique that used of mammography is patient radiation dose because
low kilovolt peak (kVp), high milliampere seconds radiation can cause breast cancer as well as detect it.
(mAs), and direct film exposure.

RISK FACTORS FOR BREAST CANCER

1960 Robert Egan - considered as Father of
Mammography  Age
 Family History
 Genetics
 Breast architecture
IN 1960S WOLF AND RUZICKA
 Menstruation
 showed that Xeromammography was superior to
 Menopause
direct film exposure at much lower patient radiation
 Prolonged use of estrogen
dose, Spatial resolution and contrast resolution
 Late age at birth of first child or no children
were much improved because of characteristic
 Previous radiation therapy to the chest at an early
edge enhancement – the accentuation of the
age
interface between different tissues. This property
 Education
used frequently in the postprocessing of digital
 Socioeconomic
images.

Is a photographic method of recording an x-ray image SCREENING MAMMOGRAPHY

on a coated metal plate using low energy photon
beam  is performed on asymptomatic women with the use
of a two-view protocol, usually medial lateral
oblique and cranial caudad, to detect an
XEROMAMMOGRAPHY
unsuspected cancer
 was retired by 1990 because single screen-film
 In patients 50 years or older reduces cancer
mammography provided better images at even
mortality.
lower patient radiation dose.
 Results of clinical trials show that screening of
women in the 40 to 49 year age group is also
BREAST CANCER beneficial in reducing mortality
 cancer that forms in tissues of breast, usually ducts  Younger women have potentially more years of life
and lobules
left, screening in this group results in more years
of life saved.
MQSA ( MAMMOGRAPHY QUALITY STANDARDS
ACT ) DIAGNOSTIC MAMMOGRAPHY

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 is performed on patients with symptoms or elevated BREAST ANATOMY
risk factors. Two or three views of each breast may
be required  Young breasts are dense and are more difficult to
image because of glandular tissue
 Older breasts are more fatty and easier to image
WHO NEEEDS A MAMMOGRAM?
NORMAL BREAST CONSIST OF 3 PRINCIPAL
 40+ women age 40-49 are also beneficial in TISSUES:
reducing mortality
 Fibrous, glandular, and adipose (fat)
 <50 patient 50 years or older reduces cancer
 Fatty tissue fills the space between the fibrous
mortality
tissue, lobes, and ducts
  Fibrocystic breasts are composed of tissue that
feels lumpy or ropelike in texture
WHEN SHOULD YOU SCHEDULE A   Fibrous tissue and fat give breasts their size and
MAMMOGRAM? shape and hold the other structures in place

 Every year and monthly beginning at the age 40

 Aim for the week after your period
PREMENOPAUSAL STAGE
 the fibrous and glandular tissues are structured into
AMERICAN CANCER SOCIETY various ducts, glands, and connective tissues.
Surrounded by a thin layer of fat. (the screen-film
 Women perform monthly breast self-examinations;
radiographic appearance of glandular and
 Healthcare professional teaches a woman to check connective tissue is one of high optical density (OD)
her breast regularly for lumps, thickening of the
POSTMENOPAUSAL STAGE
skin, or any changes in size or shape.
 are characterized by a degeneration of this
BASELINE MAMMOGRAM
fibroglandular tissue and an increase in adipose
 is the first radiographic examination of the breasts tissue. ( Adipose tissue appears dark on film with
and is usually obtained before age 40 years. higher OD and requires less radiation exposure.)
Radiologists use it for comparison with future  If a malignancy is present, it appears as a distortion
mammograms 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,
Recommended Intervals for Breast Examination
microcalcifications smaller than approximately 500
WHY SHOULD YOU GET MAMMOGRAM? um are of interest)
 The incidence of breast cancer is higher in the
 Mammogram are best method for detecting early upper lateral quadrant of the breast..
breast cancer.

 Early detection improves your chance of survival.

FEATURED OF A DEDICATED MAMMOGRAPHY
 90% of survival rate SYSTEM FOR USE WITH SCREEN FILM
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.

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 Mammographic x-ray tubes are manufactured
with a tungsten (W), molybdenum (Mo), or Rhodium
(Rh) target.

TUNGSTEN L-SHELL X-RAYS

MAMMOGRAPHIC TECHNIQUE CHART  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

THE BREAST TISSUE MOST SENSITIVE TO spot is also important
CANCER BY RADIATION IS GLANDULAR TISSUE A CIRCULAR FOCAL SPOT is preferred, but rectangular
 Because the mass density and atomic number of shapes are common.
soft tissue components of breast are so similar, FILTRATION
conventional radiographic technique is useless.
 In 70-100 kVp range, Compton scattering  At low kVp used for mammography, it is important
predominates with soft tissue; thus, differential that the x-ray tube window not attenuate the x-ray
absorption within soft tissues is minimal. beam significantly. Therefore, dedicated
 Low kVp must be used to maximize the mammography x-ray tubes have either a beryllium
photoelectric effect and thereby enhance differential (Z=4) window or a very thin borosilicate glass
absorption and improve contrast resolution. window.
 Most mammography x-ray tubes have inherent
filtration in the window of approximately 0.1 mm Al
equivalent.
MAMMOGRAPHIC IMAGING SYSTEM
 If tungsten target x-ray tube is used, it should have
X-RAY MAMMOGRAPHY a molybdenum or rhodium filter.
 No filter element can absorb its own anode target
 became clinically acceptable with the introduction of characteristic radiation
molybdenum as target and filter (1996) and the
dedicated, single emulsion, screen film image HEEL EFFECT
receptor (1972).
-The conic shape of the breast requires that the radiation
By 1990, grid technique, emphasis on compression, high intensity near the chest wall must be higher than that to the
frequency generators, and automatic exposure control nipple side to ensure near-uniform exposure of the image
(AEC) raised mammography to level of excellence in breast receptors. ( this accomplished by positioning the cathode to
imaging. the chest wall)

HIGH VOLTAGE GENERATION COMPRESSION

 All mammography imaging system incorporate VIGOROUS COMPRESSION must be used in x-ray
high-frequency generators. mammography
 Such a generator accepts a single-phase input, -Reduced absorption blur and scatter radiation
which is rectified and capacitor-smoothed to -Compression improves spatial resolution and contrast
produce a direct current (DC) voltage waveform. resolution and reduces the patient radiation dose.
 A maximum limit of 600 mAs is standard for
preventing excessive patient radiation dose. GRIDS
TARGET COMPOSITION  A Unique grid that has been developed specifically
for mammography is the high-transmission cellular
(HTC) grid.
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 this grid has the clean-up characteristics of a  Digital mammography has superior contrast
crossed grid in that it reduces scatter radiation in resolution principally because of postprocessing
two directions rather than the single direction of a
parallel grid.
HTC has copper as grid strip material and air for the MIDTERM
interspace, and its physical dimension result in a 3.8:1 grid
ratio
AEC
What parts make up female breast anatomy?
PHOTOTIMERS
 There are many different parts to female breast
 designed to measure not only x-ray intensity at the
anatomy, including:
image receptor but also x-ray quality.
- called AEC devices LOBES
2 TYPES ARE USED:
1. IONIZATION CHAMBER  Each breast has between 15 to 20 lobes or
2. SOLID-STATE DIODE sections.

GLANDULAR TISSUE (LOBULES):

COMPOSITED AUTOMATIC EXPOSURE CONTROL
 These small sections of tissue found inside lobes
 The CAEC should be able to hold OD with 0.1 as have tiny bulblike glands at the end that produce
Voltage is varied from 23-32 kVp and for breast milk.
thickness of 2-8 cm regardless of breast
composition MILK (MAMMARY) DUCTS

MAGNIFICATION MAMMOGRAPHY  These small tubes, or ducts, carry milk from

glandular tissue (lobules) to nipples
MAGNIFICATION TECHNIQUES are used frequently in
mammography, producing up to twice the normal size. NIPPLES

Requires special equipment such as microfocus x-ray  The nipple is in the center of the areola.
tubes, adequate compression, and patient positioning  Each nipple has about nine milk ducts, as well as
devices. (Effective focal spot size should not exceed 0.1 nerves.
mm)
AREOLAE
Magnification mammography should not be used routinely.
 The areola is the circular dark-colored area of skin
surrounding the nipple.
SCREEN-FILM MAMMOGRAPHY Areolae have glands called MONTGOMERY’S GLANDS
FOUR TYPES OF IMAGE RECEPTOR HAVE BEEN BLOOD VESSELS
USED FOR X-RAY MAMMOGRAPHY
 circulate blood throughout the breasts, chest and
1. Direct exposure film body.

2. Xeroradiography LYMPH VESSELS

3. Screen-film  Part of the lymphatic system, these vessels

transport lymph, a fluid that helps your body’s
4. Digital detectors immune system fight els connect to lymph nodes,
or glands, found under the armpits, in the chest and
DIGITAL MAMMOGRAPHY
other places.
 Digital Mammography Imaging Study Trial (DMIST)  infection. Lymph vess
in early 2006
NERVES
 Designed to compare the efficiency of digital
 Nipples have hundreds of nerve endings, which
mammography with that of screen film
makes them extremely sensitive to touch and
mammography with which we had 30 years of
arousal.
experience.

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What about the Male breast? Follicular phase 1-13 days

 The structure of the male breast is nearly identical The first day of a period marks the beginning of a new
to that of the female breast, except that the male menstrual cycle.
breast tissue lacks the specialized lobules, as there
 The ovulatory phase
is no physiologic need for milk production by the
 The luteal phase 
male breast.
It lasts about 14 days (unless fertilization occurs) and ends
 Male hormone testosterone usually stops breasts
just before a menstrual period. In this phase, the ruptured
from developing like a females.
follicle closes after releasing the egg and forms a structure
 On the outside surface, males have nipples and called a CORPUS LUTEUM, which produces increasing
areolae. Internally, they have undeveloped milk quantities of progesterone.
ducts and no glandular tissue.
NOTE: The length of a woman’s menstrual cycle
 Male breast problems can include: determines when ovulation occurs:

GYNECOMASTIA, a benign condition that causes the  In 28 day cycle the most fertile days are days from
breasts to enlarge, and very rarely, breast cancer. 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
DEVELOPMENTAL STAGES
19 and 21 days
ROLE IN PUBERTY
 Females typically enter puberty between the ages
ROLE IN PREGNANCY
of 8 and 13 years, and puberty usually ends when
they are around 14 years old.  Pregnancy starts the moment a fertilized egg
 During puberty, the pituitary gland starts producing implants in the wall of a person’s uterus. Following
larger quantities of luteinizing hormone (LH) and implantation, the placenta begins to develop and
follicle-stimulating hormone (FSH), which stimulates starts producing a number of hormones, including
the production of estrogen and progesterone. progesterone, relaxin, and human chorionic
gonadotropin (hCG).
Increased levels of estrogen and progesterone initiate the
development of secondary sexual characteristics, which ROLE IN MENOPAUSE
include:
MENOPAUSE occurs when a person stops having
 breast development menstrual periods and is no longer able to become
 hair growth on the underarms, legs, and pubic pregnant. In the United States, the average age at which a
region woman experiences menopause is 52 years.
 increased height
 increased fat storage on the hips, buttocks, and PERIMENOPAUSE refers to the transitional period leading
thighs up a person’s final period. During this transition, large
 widening of the pelvis and hips fluctuations in hormone levels can cause a person to
 increased oil production in the skin experience a range of symptoms.

Symptoms of perimenopause can include:

ROLE IN MENSTRUATION
 irregular periods
 MENARCHE is the first time a person gets  hot flashes
their menstrual period, and it typically occurs  sleeping difficulties
between the ages of 12 and 13 years. However,  mood changes
menarche can occur at any time between 8 and 15  vaginal dryness
years of age.
 After menarche, many people have regular ROLE IN SEXUAL DESIRE AND AROUSAL
menstrual cycles until they reach menopause.
Menstrual cycles are usually around 28 days  Estrogen, progesterone, and testosterone all affect
long but can vary between 24 and 38 days. sexual desire and arousal. Having higher levels of
 The menstrual cycle occurs in three phases that estrogen in the body promotes vaginal lubrication
coincide with hormonal changes: and increases sexual desire.

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 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

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Clinical importance: Cancer cells spread through nodes — found under the armpit, above the
retromammary space.  collarbone behind the breastbone and in other parts
of the body — trap harmful substances that might
The breast tissue is encircled by a thin layer of connective
be in the lymphatic system and safely drain them
tissue called fascia. The deep layer of this fascia sits
from the body.
immediately atop the pectoralis muscle, and the superficial
layer sits just under the skin.

The different types of breast tissue include: VASCULATURE

Glandular:  Also called lobules, ARTERIAL SUPPLY
glandular tissue produce
milk  to the medial aspect of the breast is via the internal
thoracic artery – it is a branch of subclavian artery
Fatty:  This tissue determines
Lateral part of the breast receives blood from four
breast size
Connective or fibrous:  This tissue holds glandular vessels:
and fatty breast tissue in Lateral thoracic and thoracoacromial branches-Lateral
place. mammary branches – it originate from the posterior
intercostal arteries. They supply the lateral aspect of the
TERMINAL duct lobular units (TDLUs) breast in the 2nd 3rd and 4th intercostal
 Branching off a larger duct are the extralobular
MAMMARY BRANCH
terminal ducts which lead to the lobules
Lobule contain the intralobular terminal duct  The veins of the breast correspond with the
 Acini and terminal ducts produce and arteries, draining into the axillary and internal
transport milk while the larger ducts transport thoracic veins
milk to the nipple
What are the dense breast?
STROMA
 Dense breasts have more glandular and fibrous
 Stroma ('layer, bed, bed covering') is the part of a tissue and less fatty tissue.
tissue or organ with a structural or connective  Dense breast tissue and tumors both look white on
tissue. It is made up of all the parts without specific mammograms, making it more difficult to
functions of the organ - for example, connective detect breast cancer.
tissue, blood vessels, ducts, etc.  Up to half of women between the ages of 40 and 74
have dense breasts.
COOPER'S LIGAMENTS
 10% of women have almost entirely fatty breasts.
 are found under the skin of the breast, through and  10% have extremely dense breast
around the breast tissue. These ligaments maintain  80% are classified into one of two middle
the shape and structure of your breasts and help to categories.
prevent sagging. Cooper's ligaments support the
breasts on the chest wall, maintain their contour, DENSE BREAST
and keep them in position

LYMPHATIC CHANNELS  Breasts are made up of fat and breast tissue, the
milk ducts and lobules.
 Lymphatic circulation in breast tissue helps regulate Breast density compares the area of connective
the local fluid balance as well as filter out harmful tissue seen on a mammogram to the area of fat.
substances. But the breast's lymphatic system can  Breast and connective tissue appear denser than
also spread diseases such as cancer through the fat on a mammogram.
body. Lymphatic vessels provide a highway along  A high breast density indicates a greater amount of
which invasive cancerous cells move to other parts breast and connective tissue compared to fat.
of the body  Low breast density indicates a greater amount of fat
compared to breast and connective tissue.
LYMPH NODES AND LYMPH DUCTS
 Some breasts are mostly fat.
 The lymphatic system is a network of lymph nodes Mammograms of dense breasts are more difficult to
and lymph ducts that helps fight infection. Lymph read than mammograms of fatty breasts.
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 Women with high breast density are 4-5 times more  Fibrocystic breast changes (noncancerous lumps
likely to get breast cancer than women with low and tenderness).
breast density.  Mammary duct ectasia (swollen milk ducts).
In the U.S., 40-50 percent of women ages 40-74  Mastitis (breast infection).
have dense breasts.  Nipple discharge.
 Nearly 40,000,000 women undergo routine
mammogram studies in the US each year and
How do breasts work?
about 43% of these exams reveal the presence of
dense breasts. How can I keep my breasts healthy?
Breast density varies greatly by age and weight.
Dense breasts are more common in both young and thin Since breast cancer is a top concern, talk to your healthcare
women 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

fingertips. Use the middle fingers of your left hand to
Although testosterone is the main sex hormone in males, it check your right breast. Use the middle fingers of your
is also present in lower amounts in females. right hand to check your left breast. You can use an up-
In females, testosterone affects: and-down pattern or a spiral pattern. Move your fingers
slowly in small coin-sized circles.
• fertility
• sexual desire Use three different levels of pressure to feel all of your
• menstruation breast tissue. Light pressure is needed to feel the tissue
• tissue and bone mass close to the skin
• red blood cell production
1. to feel a little deeper, and firm pressure is used to feel
ESTROGEN your tissue close to your breastbone and ribs. Avoid
lifting your fingers away from the skin as you feel for
 stretches milk ducts and helps them create side branches lumps, unusual thicknesses, or changes of any kind.
to carry more milk.
FIVE THINGS YOU CAN DO TO BOOST
BREAST HEALTH
What conditions and disorders affect breast
anatomy?
BREAST CANCER
 Breast cancer is the number one threat to breast
health. Approximately 1 in 8 women will receive a BREAST CANCER
breast cancer diagnosis in her lifetime. Other o It is a disease wherein breast cells start to grow
conditions that affect breast health include: 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:
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o Ductal carcinoma in situ  These includes swelling and redness, caused by
o Invasive ductal carcinoma cancer cells blocking the lymph vessels in the skin
o Inflammatory breast cancer
o Metastatic breast cancer HOW IS INFLAMMATORY BREAST CANCER
DIFFERENT FROM OTHER TYPES OF BREAST
DUCTAL CARCINOMA IN SITU(DCIS) CANCER
 Type of cancer wherein the cells that makes up the
o When compared to other forms of the disease,
milk ducts of the breast is concern and have not
inflammatory breast cancer:
spread into the surrounding tissues
o Looks different
BREAST CONSERVING SURGERY o Is harder to diagnose
o Is more aggressive and spreads more quickly than
 Surgery to remove cancer or other abnormal
other types
tissue from the breast and some normal tissue
o Tends to be diagnosed at a younger age, especially
around it, but not the breast itself.
among African-American women
RADIATION THERAPY o Is more likely to affect overweight women
o Is often further along (your doctor may call this
 Radiation therapy (also called radiotherapy) is a locally advanced, meaning it’s moved into nearby
cancer treatment that uses high doses of radiation skin) when it’s diagnosed
to kill cancer cells and shrink tumors o Sometimes has spread past the breast (your doctor
MASTECTOMY will say it has metastasized) when it’s diagnosed,
which makes it harder to treat
 Mastectomy is breast cancer surgery that removes
the entire breast. 
WHAT ARE THE EARLY SIGNS AND SYMPTOMS OF
SENTINEL LYMPH NODES BIOPSY INFLAMMATORY BREAST CANCER?

 A sentinel node biopsy is a diagnostic procedure to o Symptoms of inflammatory breast cancer may
test if cancer has spread beyond the original tumor include:
o Pain in the breast
INVASIVE DUCTAL CARCINOMA
o Skin changes in the breast area. You may find pink
 Type of cancer wherein the cells that makes up the or reddened areas often with the texture and
milk ducts of the breast is concern and have not thickness of an orange.
spread into the surrounding tissues. o A bruise on the breast that doesn't go away

o Sudden swelling of the breast

SIGN AND SYMPTOMS: o Itching of the breast

o Nipple changes or discharge
According to the American Cancer Society, any of the o Swelling of the lymph nodes under the arm or in the
following unusual changes in the breast can be a first neck
sign of breast cancer, including invasive ductal
carcinoma:
o swelling of all or part of the breast STAGES OF INFLAMMATORY BREAST CANCER
o skin irritation or dimpling This type of cancer is usually in one of three stages:
o breast pain
o Stage IIIB: All Inflammatory breast cancers start in
o nipple pain or the nipple turning inward
this stage since they involve the skin of your breast.
o redness, scaliness, or thickening of the nipple
or breast skin o Stage IIIC: This cancer has spread to lymph nodes
o a nipple discharge other than breast milk around your collarbone or inside your chest.
o a lump in the underarm area o Stage IV: The cancer has spread outside your
breast and nearby lymph nodes to other parts of
INFLAMMATORY BREAST CANCER your body.

 Rare type of breast cancer

 1-5% of all breast cancer
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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
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- red, itchy, or scaly skin around the breast  Grade 2: A person can pull the nipple out, but not
- dimpled or puckered skin as easily, and the nipple tends to retract. They may
find it difficult to breastfeed.
Some underlying conditions that can affect breast size and
 Grade 3: A person may not be able to pull out their
shape include:
nipple. When pressing the nipple outward, it
- Tubular breasts: Also called breast hypoplasia, immediately retracts. Breastfeeding may be very
tubular breasts can develop in one or both breasts difficult or impossible.
during puberty.
How to determine your grade of nipple inversion?
- Amastia or amazia: A condition that causes
problems in the development of breast tissue, the Many people know that they have inverted nipples but
areola, or nipple. aren’t clear on how inverted their nipples are.
- Poland Syndrome: Where a chest muscle does not
develop properly, which can affect the breast on Here’s how to figure it out:
one side of the body. 1. Take off your shirt and any undergarments you
TREATMENT: have on.
2. While standing in front of a mirror, hold the areola
- is plastic, aesthetic and reconstructive surgery. on each breast between your thumb and forefinger.
- The surgical techniques used depend on the 3. Gently press inward. You should firmly press about
surgeon and on the patient’s characteristics. an inch or so into the breast.
However, in many cases, breast augmentation, 4. Take note of how your nipples respond and use this
breast reduction or a combination of both will be to assess their grade.
done.
 Breast augmentation - also known as You may only experience inversion in one nipple, or even
augmentation mammoplasty — is surgery to different grades of inversion in each nipple.
increase breast size. It involves placing breast INVERTED NIPPLES
implants under breast tissue or chest muscles.
 Reduction mammoplasty - (also breast reduction How to treat an inverted nipple
and reduction mammaplasty) is the plastic surgery
Talk with a doctor before trying the methods below:
procedure for reducing the size of large breasts.
1. Hoffman’s technique: This consists of a manual
INVERTED NIPPLES OR RETRACTED NIPPLES
home exercise for drawing out the nipple. Place the
- it lies flat against the areola or goes inward instead thumbs on either side of the nipple at its base.
of sticking out. The areola is the circular area of Press the thumbs firmly into the breast tissue and
pigmented skin around the nipple. separate them gently. This should cause the nipple
to point outward. The amount of time it stays out
WHAT CAUSES AN INVERTED NIPPLE: will vary from person to person.
2. Suction devices: These represent a noninvasive
Medical conditions that can cause nipple inversion include:
way to draw out the nipple.
 Congenital inversion 3. Piercings: A piercing may help to keep the nipple in
 mastitis, which is an infection of the mammary an upright position.
gland 4. Surgery;
 duct ectasia, which is an abnormal dilation of a duct  Surgery with partial preservation of milk ducts - This
in the breast tissue is also known as the “parachute flap” technique.
 an abscess under the areola Women undergoing this procedure should still be
 Complications of breast surgery able to breastfeed because some of the milk duct
 Aging system remains attached. You shouldn’t experience
 breast cancer a change in nipple sensation.
 Surgery with detached milk ducts -This procedure is
GRADES OF NIPPLE INVERSION more common. Women undergoing this procedure
won’t be able to breastfeed because of the removal
There are three grades of nipple inversion, depending on
of the milk ducts. You shouldn’t experience a
the degree of inversion and mobility of the nipple:
change in nipple sensation.
 Grade 1: A person can easily pull out the nipple, 5. In any procedure, the doctor aims to preserve the
and it maintains its projection. This grade of nipple’s usual sensation, avoid visible scarring, and
inversion causes no major problems with maintain the functioning of the breast duct to enable
breastfeeding. breastfeeding.

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The Hoffman technique for drawing out inverted nipples nipple area, but instead of breast tissue
has been in use since the 1950s. To try it: underneath, fat tissue is found instead.
6. Category six (known as polythelia) - A category six
 Place your thumbs on either side of your nipple. Be extra nipple is where the nipple appears alone and
sure to place them at the base of the nipple, not the there is no areola or breast tissue underneath it.
outside of the areola.
 Press firmly into your breast tissue. CLINICAL BREAST CHANGES:
 While still pressing down, gently pull your thumbs
 Breast Changes of Concern
away from each other.
- Some breast changes can be felt by a woman or
 Move your thumbs all around the nipple and repeat. her health care provider, but most can be detected
There are some suction devices promoted for reversing only during an imaging procedure such as a
inverted nipples. Most are worn under clothing for extended mammogram, MRI, or ultrasound. Whether a breast
periods of time. change was found by your doctor, or you noticed a
change, it’s important to follow up with your doctor
These products are sold under a variety of names, to have the change checked and properly
including: diagnosed.
• nipple retractors Check with your health care provider if your breast looks or
• nipple extractors feels different, or if you notice one of these symptoms:
• shells
• cups  Lump or firm feeling in your breast or under your
- These devices usually work by pulling the nipple arm. Lumps come in different shapes and sizes.
into a small cup. This stimulates the nipple and Normal breast tissue can sometimes feel lumpy.
makes it protrude. Doing breast self-exams can help you learn how
- When used over time, these devices can help your breasts normally feel and make it easier to
loosen the nipple tissue. This can help your nipples notice and find any changes, but breast self-exams
remain erect for longer periods of time. are not a substitute for mammograms.
 Nipple changes or discharge. Nipple discharge may
Popular options include: be different colors or textures. It can be caused by
birth control pills, some medicines, and infections.
 Avent Niplette
But because it can also be a sign of cancer, it
 Pippetop Inverted Nipple Protractor
should always be checked.
 Medel soft shells for Inverted nipples
 Skin that is itchy, red, scaled, dimpled or puckered
 Supple cups
 Breast Changes During Your Lifetime That Are Not
ACCESSORY NIPPLES Cancer
- Most women have changes in the breasts at
- “supernumerary nipple” different times during their lifetime.
- A third nipple is a condition where a person has an  Before or during your menstrual periods.
extra nipple on their body in addition to the two  During pregnancy.
nipples located on the breasts or chest.
 As you approach menopause
TYPES OF ACCESSORY NIPPLES:  If you are taking hormones
 After menopause
1. Category one (known as polymastia) - A category  Mammogram Findings
one extra nipple will have an areola around the - Mammograms are pictures (x-rays) of the breast,
outside. used to check for breast cancer. Possible
2. Category two - A category two extra nipple will not mammogram findings include:
have an areola around it, though the presence of
 Lumps (mass or tumor). Lumps come in different
breast tissue underneath is still apparent.
sizes and shapes. Fluid-filled cysts are usually
3. Category three - A category three extra nipple is
smooth and rounded, with clear, defined edges and
where the area has breast tissue present, but no
are not cancer. Lumps that have a jagged outline
actual nipple has formed.
and an irregular shape are of more concern.
4. Category four - A category for extra nipple is where
 Calcifications. There are two types of breast
breast tissue has formed underneath, but no nipple
calcifications, or calcium deposits:
or areola is present.
- Macrocalcifications, which look like small white
5. Category five (known as pseudomamma) - A
dots on a mammogram. They are often caused by
category five extra nipple, has an areola around the
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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