MAMMOGRAPHY

Prepared By: Nicole Briones, RRT

• WEEK 1&2
Breast anatomy and
mammographic correlation
1.Male versus female
2. Developmental stages
a. Fetal
b. Puberty
c. Menstruation d. Pregnancy
e. Lactation
f. Menopause
g. Post menopause
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
What are breasts?
• Breasts are part of the female and male sexual
anatomy. For females, breasts are both
functional (for breastfeeding) and sexual
(bringing pleasure).
• Male breasts don’t have a function. The visible
parts of breast anatomy include the nipples
and areolae.
What are breasts made of?
Several kinds of tissue form female
breasts. The different types of breast tissue
include:
•Glandular
• Fatty
•Connective or fibrous
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
What parts make up breast
anatomy?
There are many different parts to female
breast anatomy, including:
•Lobes: Each breast has between 15 to 20 lobes or
sections. These lobes surround the nipple like
spokes on a wheel.
•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.
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
•Areolae: The areola is the circular dark-colored
area of skin surrounding the nipple. Areolae have
glands called Montgomery’s glands that secrete a
lubricating oil. This oil protects the nipple and
skin from chafing during breastfeeding.
•Blood vessels: 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 infection.
Lymph vessels connect to lymph nodes, or
glands, found under the armpits, in the chest and
other places.
•Nerves: Nipples have hundreds of nerve
endings, which makes them extremely sensitive
to touch and arousal.
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
•Areolae: The areola is the circular dark-colored
area of skin surrounding the nipple. Areolae have
glands called Montgomery’s glands that secrete a
lubricating oil. This oil protects the nipple and
skin from chafing during breastfeeding.
•Blood vessels: 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 infection.
Lymph vessels connect to lymph nodes, or
glands, found under the armpits, in the chest and
other places.
•Nerves: Nipples have hundreds of nerve
endings, which makes them extremely sensitive
to touch and arousal.
MALE BREAST VS. FEMALE BREAST
• Both males and females
have breasts.
• 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.
 DEVELOPMENTAL STAGES
1. FETAL
• Breasts begin to form while the unborn baby is still growing in the
mother’s uterus. This starts with a thickening in the chest area called the
mammary ridge or milk line. By the time a baby girl is born, nipples and
the beginnings of the milk-duct system have formed.
2. PUBERTY
• As a girl approaches her teen years, the first visible signs of breast
development begin. When the ovaries start to produce and release
(secrete) estrogen, fat in the connective tissue starts to collect. This
causes the breasts to enlarge. The duct system also starts to grow. Often
these breast changes happen at the same that pubic hair and armpit hair
appear.
 DEVELOPMENTAL STAGES
3. MENSTRUATION
• During menstruation, many women also have changes in breast texture.
Their breasts may feel very lumpy. This is because the glands in the
breast are enlarging to get ready for a possible pregnancy. If pregnancy
does not happen, the breasts go back to normal size. Once menstruation
starts, the cycle begins again.
4. PREGNANCY AND LACTATION
• Many healthcare providers believe the breasts are not fully mature until
a woman has given birth and made milk. Breast changes are one of the
earliest signs of pregnancy. This is a result of the hormone progesterone.
In addition, the dark areas of skin around the nipples (the areolas) begin
to swell. This is followed by the rapid swelling of the breasts themselves.
Most pregnant women feel soreness down the sides of the breasts, and
nipple tingling or soreness. This is because of the growth of the milk
duct system and the formation of many more lobules.
 DEVELOPMENTAL STAGES
5. MENOPAUSE
• By the time a woman reaches her late 40s and early 50s, perimenopause is starting
or is well underway. At this time, the levels of estrogen and progesterone begin to
change. Estrogen levels dramatically decrease.
• This leads to many of the symptoms commonly linked to menopause. Without
estrogen, the breast’s connective tissue becomes dehydrated and is no longer
elastic. The breast tissue, which was prepared to make milk, shrinks and loses
shape. This leads to the "saggy" breasts associated with women of this.
END OF WEEK 1&2
• WEEK 3
Divisions of breast
1. Quadrants
2. Clock face references
External anatomy
1 Nipple
2 Areola
3 Montgomery’s glands
4 Morgagni’s tubercle
Skin
1 Sebaceous glands
2 Sweat (sudiferous) glands
3 Hair follicles
Axillary tail
Inframmammary fold
Breast margins
1. Superio- inferior
2. Axillary-medial
DIVISIONS OF BREAST
QUADRANTS
• A single breast can be divided into four
quadrants:
• Upper outer (OU)
• Upper inner (UI),
• Lower outer (LO)
• Lower inner (LI)
by two perpendicular planes intersected at
the nipple.
• The breast is divided into quadrants or
described in comparison to a clock face
for ease of communication of any findings.
The upper outer quadrant of the breast
contains a greater volume of tissue than
elsewhere, and this is also the most common
location for a breast malignancy to arise
Clock face references
• The clock face location of breast findings is described by imaging a clock on
both the left and the right breast as the woman faces the examiner.
• Note that the outer portion of the breast on the right is at the 9-o'clock position
and the outer portion on the left is at the 3-o'clock position
Note: C50.6 is the code for axillary tail or tail of breast.
EXTERNAL ANATOMY
1. Nipple
2. Areola
3. Montgomery’s glands
4. Morgagni’s tubercle
SKIN
1. Sebaceous glands
2. Sweat (sudiferous) glands
3. Hair follicles
AXILLARY TAIL
• The tail of Spence (Spence's tail, axillary process,
axillary tail) has historically been described as an
extension of the tissue of the upper lateral
quadrant of the breast traveling into the axilla.
IMFRAMAMMARY FOLD
• the inframammary fold (IMF), inframammary
crease or inframammary line is the natural lower
boundary of the breast, the place where the breast
and the chest meet.
BREAST MARGINS
• The breast tissue extends horizontally (side-to-
side) from the edge of the sternum (the firm flat
bone in the middle of the chest) out to the
midaxillary line (the center of the axilla, or
underarm).
• A tail of breast tissue called the "axillary tail of
Spence” extend into the underarm area.

1. Supero- inferior
2. Axillary-medial
END OF WEEK 3
• WEEK 4
Internal anatomy
1 Fascial layers
2 Retrommary (fat) space
3 Breast parenchymal ccomponents
a. Fibrous tissues
b.Glandular (secretory)tissues
Glandular lobes lobules
Terminal ductal lobular unit (TDLU)
4. Adipose (fatty) tissues
5. Connective and support stroma
6. Cooper’s ligaments
7. Extralobular/intralobular stroma
8. Lympatic channels
9.Circulatory (blood supply) system
a. Arteries
b.Veins
10. Pectoral muscle
MAMMOGRAPHY

Prepared By: Nicole Briones, RRT

• WEEK 1&2
Breast anatomy and
mammographic correlation
1.Male versus female
2. Developmental stages
a. Fetal
b. Puberty
c. Menstruation d. Pregnancy
e. Lactation
f. Menopause
g. Post menopause
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
What are breasts?
• Breasts are part of the female and male sexual
anatomy. For females, breasts are both
functional (for breastfeeding) and sexual
(bringing pleasure).
• Male breasts don’t have a function. The visible
parts of breast anatomy include the nipples
and areolae.
What are breasts made of?
Several kinds of tissue form female
breasts. The different types of breast tissue
include:
•Glandular
• Fatty
•Connective or fibrous
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
What parts make up breast
anatomy?
There are many different parts to female
breast anatomy, including:
•Lobes: Each breast has between 15 to 20 lobes or
sections. These lobes surround the nipple like
spokes on a wheel.
•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.
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
•Areolae: The areola is the circular dark-colored
area of skin surrounding the nipple. Areolae have
glands called Montgomery’s glands that secrete a
lubricating oil. This oil protects the nipple and
skin from chafing during breastfeeding.
•Blood vessels: 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 infection.
Lymph vessels connect to lymph nodes, or
glands, found under the armpits, in the chest and
other places.
•Nerves: Nipples have hundreds of nerve
endings, which makes them extremely sensitive
to touch and arousal.
BREAST ANATOMY AND MAMMOGRAPHIC CORRELATION
•Areolae: The areola is the circular dark-colored
area of skin surrounding the nipple. Areolae have
glands called Montgomery’s glands that secrete a
lubricating oil. This oil protects the nipple and
skin from chafing during breastfeeding.
•Blood vessels: 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 infection.
Lymph vessels connect to lymph nodes, or
glands, found under the armpits, in the chest and
other places.
•Nerves: Nipples have hundreds of nerve
endings, which makes them extremely sensitive
to touch and arousal.
MALE BREAST VS. FEMALE BREAST
• Both males and females
have breasts.
• 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.
 DEVELOPMENTAL STAGES
1. FETAL
• Breasts begin to form while the unborn baby is still growing in the
mother’s uterus. This starts with a thickening in the chest area called the
mammary ridge or milk line. By the time a baby girl is born, nipples and
the beginnings of the milk-duct system have formed.
2. PUBERTY
• As a girl approaches her teen years, the first visible signs of breast
development begin. When the ovaries start to produce and release
(secrete) estrogen, fat in the connective tissue starts to collect. This
causes the breasts to enlarge. The duct system also starts to grow. Often
these breast changes happen at the same that pubic hair and armpit hair
appear.
 DEVELOPMENTAL STAGES
3. MENSTRUATION
• During menstruation, many women also have changes in breast texture.
Their breasts may feel very lumpy. This is because the glands in the
breast are enlarging to get ready for a possible pregnancy. If pregnancy
does not happen, the breasts go back to normal size. Once menstruation
starts, the cycle begins again.
4. PREGNANCY AND LACTATION
• Many healthcare providers believe the breasts are not fully mature until
a woman has given birth and made milk. Breast changes are one of the
earliest signs of pregnancy. This is a result of the hormone progesterone.
In addition, the dark areas of skin around the nipples (the areolas) begin
to swell. This is followed by the rapid swelling of the breasts themselves.
Most pregnant women feel soreness down the sides of the breasts, and
nipple tingling or soreness. This is because of the growth of the milk
duct system and the formation of many more lobules.
 DEVELOPMENTAL STAGES
5. MENOPAUSE
• By the time a woman reaches her late 40s and early 50s, perimenopause is starting
or is well underway. At this time, the levels of estrogen and progesterone begin to
change. Estrogen levels dramatically decrease.
• This leads to many of the symptoms commonly linked to menopause. Without
estrogen, the breast’s connective tissue becomes dehydrated and is no longer
elastic. The breast tissue, which was prepared to make milk, shrinks and loses
shape. This leads to the "saggy" breasts associated with women of this.
END OF WEEK 1&2
• WEEK 3
Divisions of breast
1. Quadrants
2. Clock face references
External anatomy
1 Nipple
2 Areola
3 Montgomery’s glands
4 Morgagni’s tubercle
Skin
1 Sebaceous glands
2 Sweat (sudiferous) glands
3 Hair follicles
Axillary tail
Inframmammary fold
Breast margins
1. Superio- inferior
2. Axillary-medial
DIVISIONS OF BREAST
QUADRANTS
• A single breast can be divided into four
quadrants:
• Upper outer (OU)
• Upper inner (UI),
• Lower outer (LO)
• Lower inner (LI)
by two perpendicular planes intersected at
the nipple.
• The breast is divided into quadrants or
described in comparison to a clock face
for ease of communication of any findings.
The upper outer quadrant of the breast
contains a greater volume of tissue than
elsewhere, and this is also the most common
location for a breast malignancy to arise
Clock face references
• The clock face location of breast findings is described by imaging a clock on
both the left and the right breast as the woman faces the examiner.
• Note that the outer portion of the breast on the right is at the 9-o'clock position
and the outer portion on the left is at the 3-o'clock position
Note: C50.6 is the code for axillary tail or tail of breast.
EXTERNAL ANATOMY
1. Nipple
2. Areola
3. Montgomery’s glands
4. Morgagni’s tubercle
SKIN
1. Sebaceous glands
2. Sweat (sudiferous) glands
3. Hair follicles
AXILLARY TAIL
• The tail of Spence (Spence's tail, axillary process,
axillary tail) has historically been described as an
extension of the tissue of the upper lateral
quadrant of the breast traveling into the axilla.
IMFRAMAMMARY FOLD
• the inframammary fold (IMF), inframammary
crease or inframammary line is the natural lower
boundary of the breast, the place where the breast
and the chest meet.
BREAST MARGINS
• The breast tissue extends horizontally (side-to-
side) from the edge of the sternum (the firm flat
bone in the middle of the chest) out to the
midaxillary line (the center of the axilla, or
underarm).
• A tail of breast tissue called the "axillary tail of
Spence” extend into the underarm area.

1. Supero- inferior
2. Axillary-medial
END OF WEEK 3
• WEEK 4
Internal anatomy
1 Fascial layers
2 Retrommary (fat) space
3 Breast parenchymal ccomponents
a. Fibrous tissues
b.Glandular (secretory)tissues
Glandular lobes lobules
Terminal ductal lobular unit (TDLU)
4. Adipose (fatty) tissues
5. Connective and support stroma
6. Cooper’s ligaments
7. Extralobular/intralobular stroma
8. Lympatic channels
9.Circulatory (blood supply) system
a. Arteries
b.Veins
10. Pectoral muscle
Three Layers of Breast Tissue:
1. Premammary Layer:
❖ AKA subcutaneous fat layer
❖ Lies between the skin and the superficial
layer of the superficial fascia
❖ Contains varied levels of fat related to
age, obesity and pregnancy
❖ Present across the breast EXCEPT
immediately posterior to the nipple
❖ Sebaceous cysts and lipomas occur in
this layer
Three Layers of Breast Tissue:
2. Mammary Layer
❖ AKA glandular or parenchymal layer
❖ Between the superficial and deep layers
of the superficial fascia
❖ Only layer that contains glandular
tissues (functional tissues)
❖ Most breast pathology originates in this
layer
❖ Contains epithelial and stromal tissues
❖ Epithelial tissue is considered the
functional tissue of the breast includes
TDLU, lobules, lobes, lactiferous ducts
Three Layers of Breast Tissue:
2. Mammary Layer
❖ Stromal Tissue is the structural tissue of the
breast includes fat and connective tissue
❖ Cooper’s ligaments course between lobes from
the chest wall/axilla toward the nipple to
support the breast parenchyma; AKA
interlobular connective tissue
❖ Intralobular connective tissue is a less dense
form of connective tissue that surrounds each
individual lobule of breast tissue
❖ Upper outer quadrant of each breast contains
the most glandular tissue
❖ The amount of glandular tissue in the mammary
layer varies with age and menopause
Three Layers of Breast Tissue:
3. Retromammary Layer:
❖ Located posterior to the mammary
layer
❖ Contains varied levels of fat related
to age, obesity and pregnancy
❖ Deep fascia also within the
retromammary space
❖ This layer of tissue allows breast
motion over the chest wall
Superficial Fascia:
❖ Surrounds all mammary tissues and
separates the breast into superficial and
deep tissues
❖ Composed of two layers; superficial and
deep
❖ Superficial layer (superficial fascia)
within the premammary layer
❖ Deep layer (deep fascia) lies posterior to
the mammary layer within the
retromammary space
❖ Irregularities of the deep fascia posterior
to a malignancy can indicate metastasis
to the chest wall.
Terminal Ductolobular Unit (TDLU):
❖ Acini cells are considered the
"functional unit" of the breast
❖ Several hundred acini cells are in the
breast
❖ TDLU refers to 30-50 acinar cells
grouped together in a lobule and their
associated terminal duct
❖ Acini cells are the smallest functional
unit of the breast
❖ TDLU usually less than 2mm in size
❖ # and size of TDLUs vary with age and
hormone levels
Terminal Ductolobular Unit (TDLU):
❖ Proliferation of the TDLUs normally occurs
during reproductive years and
pregnancy/lactation
❖ Atrophy of the breast lobules normally occurs
with cessation of breast feeding and in
postmenopausal women
❖ Nearly all breast pathology originates in the
TDLU
❖ Most malignancies arise from the terminal duct
near the junction of the intralobular and
extralobular segments
❖ Most TDLUs are in the anterior breast, therefore
most breast pathology arises in the superficial
half of the mammary zone, just deep to the
superficial layer of the superficial fascia
Terminal Ductolobular Unit (TDLU):
 Circulatory (blood supply) system
❖ Arterial Supply:
❖ Lateral thoracic artery:
❖Originates from the axillary artery and courses lateral and inferior
along the pectoralis major muscle
❖Supplies lateral breast tissues
❖ Internal thoracic artery (AKA internal mammary artery)
❖Originates at the subclavian artery
❖Courses lateral to the sternum
❖Supplies medial breast tissues
❖Used for coronary bypass surgery when other vessels unavailable
(great saphenous vein, radial artery)
❖ Thoracoacromial artery supplies superior breast tissue
❖ Intercostal artery supplies the inferior breast tissue
 Lymphatic Channel
❖ Intramammary nodes are found within the breast
parenchyma
❖ Lymph nodes are most concentrated in the upper outer
quadrants
❖ Lymph vessels closely follow the venous drainage system
of the breast
❖ Lymphatic system function is important for assessing
possible routes for metastasis
Pectoral Muscle
❖ Pectoralis muscles lie posterior to
retromammary layer and line the chest
wall from the 2nd - 6th rib from sternum
to axilla
❖ The pectoralis minor muscle lies posterior
to the pectoralis major muscle
❖ The breast lies superior to the 7th rib and
inferior to the 1st or 2nd rib
❖ Ribs lie posterior to the pectoralis muscles;
a rib is the most common palpable finding
that is mistaken for a mass
❖ Right and left intercostal nerves innervate
each breast
END OF WEEK 4
• WEEK 5
Histology of the breast
1. Terminal ductal lobular unit
2. Extralobular terminal duct
3. Intralobular terminal duct
4. Ductal sinus (acinus)

Cellular Components
1.Epithelial cells
2.Myoepithelial cells Basement
membrane
 Histology of the Breast
Ductal System:
•Lined with epithelial cells to reduce friction for easier milk flow
•Middle layer composed of myoepithelial cells which aids in the movement
of milk
•Basement membrane forms the outer layer of the duct which is in contact
with the intralobular stroma
•Each breast lobe has one ductal system
•Normal ducts in a non-lactating female should measure <2mm diameter
and increase in size closer to the nipple
•Normal ducts in a lactating female should measure <8mm diameter
•Each terminal duct begins within the lobule and extends to the nipple
1. Intralobular terminal ducts - carry milk
from the acini
2. Extralobular terminal ducts
3. Interlobular terminal ducts - travel
between the breast lobes to reach the
main duct
4. Main Terminal Duct/Lactiferous Sinus
or Ampulla - end at the Lactiferous Sinus
or Ampulla which is an area of ductal
enlargement just prior to the opening to
the nipple; usually 2-3mm in diameter
indicates a normal finding
 End of week 5! ☺
Prepare for prelim exam.
 Breast
Pathology
Presented By Group 1

PAGE
 1 BREAST ANOMALIES
TOPICS 1.1 ASYMMETRY
1.2INVERTED NIPPLES
1.3 ACCESSORY BREAST TISSUE

2 CLINICAL BREAST CHANGES

2.1 LUMPS 2.4 DIMPLING
2.2 THICKENING 2.5.SKIN IRRITATION
2.3 SWELLING 2.6 PAIN
 BREAST
ANOMALIES
ARE DEFORMITIES IN THE GROWTH OF THE BREAST, SUCH AS ASYMMETRY,
UNDERDEVELOPMENT AND MASSIVE OVERGROWTH.

BREAST DEVELOPMENT IS AN IMPORTANT MARKER OF THE TRANSITION TO

ADULTHOOD FOR MANY TEENS. COMING TO TERMS WITH BREAST ANOMALIES
CAN BE PARTICULARLY DIFFICULT FOR MANY GIRLS AND WOMEN DURING
THIS TIME PERIOD. FORTUNATELY, MOST BREAST ABNORMALITIES IN
CHILDREN AND ADOLESCENTS ARE MEDICALLY BENIGN, BUT THE IMPACT
ON SELF-ESTEEM AND SOCIAL SELF-CONSCIOUSNESS CAN BE STRIKING
FOR SOME GIRLS AND YOUNG WOMEN.

PAGE
 EARLY CONSULTATION WITH A SPECIALIST CAN BE
BENEFICIAL FOR TWO PRIMARY REASONS:

SOME CONGENITAL BREAST ANOMALIES CAN BE COMPLEX, WITH

A HIGHER LIKELIHOOD FOR BEST RESULTS FROM
RECONSTRUCTION THROUGH EARLIER INTERVENTION.
FOR TEENS AND YOUNG ADULTS WITH HEIGHTENED
SENSITIVITY ABOUT THEIR ANOMALY, EARLIER INTERVENTION
MAY PRE-EMPT MORE SIGNIFICANT PSYCHOSOCIAL ADJUSTMENT
CONCERNS.

PAGE
 CONGENITAL ABNORMALITIES OF THE BREAST AND CHEST WALL ARE
COMMON. THE FIRST EVER DOCUMENTED EVIDENCE OF CONGENITAL
BREAST DEFORMITY (ATHELIA: ABSENCE OF A BREAST) WAS
REPORTED IN THE BIBLE: “WE HAVE A LITTLE SISTER, AND SHE
HATH NO BREAST, WHAT SHALL WE DO FOR OUR SISTER IN THE
DAY THAT SHE SHALL BE SPOKEN FOR?” (SONG OF SOLOMON).
THERE IS ALSO EVIDENCE OF CONGENITAL ABNORMALITIES IN
GREEK MYTHOLOGY AND ART. ARTEMIS, THE GODDESS OF
CHILDBIRTH IS DEPICTED AS HAVING MULTIPLE ACCESSORY
BREASTS (POLYMASTIA). THE WOOD CARVING OF ‘THERESE VENTRE
OF MARSEILLES’ SHOWS A SUPERNUMERARY BREAST AND NIPPLE ON
HER THIGH (POLYTHELIA).

PAGE
PAGE
 CLASSIFICATION OF COMMON CONGENITAL
ABNORMALITIES OF THE BREAST AND CHEST WALL.

PAGE
 CONGENITAL ABNORMALITIES OF THE
NIPPLE

ACCESSORY NIPPLES (ALSO

KNOWN AS POLYTHELIA)

ACCESSORY NIPPLES DEVELOP ALONG

THE MILK LINE; MORE THAN 90% ARE
SEEN IN THE INFRAMAMMARY REGION.
THESE NIPPLES CAN BE UNILATERAL
OR BILATERAL AND ARE QUITE WELL
DEVELOPED WITH SURROUNDING AREOLA
IN SOME. THEY ARE PRONE TO THE
SAME DISEASES AS NORMAL NIPPLES.

PAGE
 CONGENITAL NIPPLE
INVERSION
SIR ASHLEY COOPER FIRST DESCRIBED
CONGENITAL INVERTED NIPPLES IN 1840. IT
IS SEEN IN 2% OF THE GENERAL POPULATION
WITH A FAMILY HISTORY OF SUCH A
CONDITION IN 50% OF PATIENTS. THE CAUSE
FOR THIS ABNORMALITY IS THOUGHT TO BE
TETHERING AND SHORTENING OF BREAST
DUCTS, AND DEVELOPMENT OF FIBROUS BANDS
BEHIND THE NIPPLES DURING INTRAUTERINE
LIFE.
IT CAN CAUSE MECHANICAL PROBLEMS WITH
BREAST FEEDING; HOWEVER, MANY CAN BREAST
FEED WITHOUT ANY DIFFICULTY, PROBABLY
BECAUSE OF CHANGES THAT OCCUR IN THE
BREAST DURING PREGNANCY.

PAGE
 ATHELIA
COMPLETE ABSENCE OF NIPPLE AND
AREOLA IS TERMED AS ATHELIA. THIS
CONDITION CAN BE FAMILIAL
(AUTOSOMAL DOMINANT), AND MAY BE
UNILATERAL OR BILATERAL, AND IS
SEEN IN ASSOCIATION WITH AMASTIA
OR RARE SYNDROMES SUCH AS SCALP-
EAR-NIPPLE OR SEN SYNDROME (SCALP
NODULES AND EAR MALFORMATION), AL-
AWADI/RASS-ROTHSCHILD SYNDROME AND
POLAND'S SYNDROME

PAGE
 ACCESSORY BREAST TISSUE OR
SUPERNUMERARY BREASTS:
POLYMASTIA
POLYMASTIA IS USUALLY DIAGNOSED
AT PUBERTY OR DURING PREGNANCY
WHEN THE ACCESSORY BREAST TISSUE
DEVELOPS ALONG WITH THE NORMAL
BREASTS. THESE ARE MOSTLY
ASYMPTOMATIC, BUT CAN CAUSE
DISCOMFORT, AND IN SOME ARE SEEN
AS COSMETICALLY UNACCEPTABLE.
ACCESSORY BREAST TISSUE IS
SUSCEPTIBLE TO ALL THE NORMAL
CHANGES AND DISEASE SPECTRUM SEEN
IN THE NORMAL BREAST. BREAST
CONGENITAL ABNORMALITIES OF CANCER CASES HAVE BEEN REPORTED
THE BREAST IN ACCESSORY BREAST TISSUE.

PAGE
 TUBULAR BREASTS
TUBULAR BREASTS ARE CHARACTERIZED
BY NORMAL FUNCTION/PHYSIOLOGY OF
THE BREAST TISSUE, BUT ABNORMAL
ANATOMICAL SHAPE. IT CAN BE
UNILATERAL OR BILATERAL, AND THE
CLASSICAL FEATURES INCLUDE SOME
OR ALL OF: LACK OF BREAST SKIN;
BREAST HYPOPLASIA AND ASYMMETRY;
CONICAL BREASTS; HERNIATED
NIPPLE–AREOLAR COMPLEX; LARGE
AREOLA AND A CONSTRICTED BREAST
ABNORMALITIES OF THE SHAPE BASE.
OF THE BREAST

PAGE
 CONGENITAL CHEST WALL DEFORMITY

PAGE
 POLAND'S SYNDROME
UNILATERAL CHEST WALL HYPOPLASIA WITH IPSILATERAL UPPER LIMB
DEFORMITY IS CALLED POLAND'S SYNDROME. A PATIENT WITH SOME OF
THESE FEATURES WAS FIRST DESCRIBED BY ALFRED POLAND FROM GUYS
HOSPITAL LONDON IN 1841. IT WAS LATER NAMED POLAND'S SYNDROME BY
CLARKSON IN 1962

CLASSIFICATION OF POLAND'S SYNDROME

PAGE
 ANTERIOR THORACIC HYPOPLASIA

ANTERIOR THORACIC HYPOPLASIA IS RARE. IT INCLUDES POSTERIOR

DISPLACEMENT OF RIBS, ANTERIORLY SUNKEN CHEST WALL,
HYPOPLASIA OF THE IPSILATERAL BREAST (ALWAYS PRESENT), AND
A SUPERIORLY PLACED NIPPLE AND AREOLA.

PAGE
 ASYMMETRY
appearance of a part of the breast
in comparison to the remainder of
that breast and to the other breast.
Breast asymmetry is usually no cause
for cancer. However if there’s a
large variation in asymmetry or if
your breast density change this
could be an indication of cancer.

PAGE
 FOCAL ASYMMETRIES
TYPES OF
GLOBAL ASYMMETRIES
ASYMMETRIES DEVELOPING
ASYMMETRIES

PAGE
FOCAL ASYMMETRIES
Focal asymmetry is visible as a confined asymmetry with a similar shape
on two views but does not fit the criteria of a mass: that is, it lacks
convex outer borders and conspicuity

A. B.

PAGE
 C.

FIGURE; FOCAL ASYMMETRY SEEN IN (A) SCHEMATIC, (B) MLO VIEWS, AND (C)
CC VIEWS. 9 A FOCAL ASYMMETRY WITH A SIMILAR SHAPE (ARROWS), NOT
FITTING THE CRITERIA OF A MASS, IS SEEN ON TWO STANDARD VIEWS.

PAGE
 GLOBAL ASYMMETRIES
This asymmetric finding involves a greater volume of breast
tissue over a significant portion of the breast (at least a
quadrant), relative to the corresponding region in the
contralateral breast, without any associated mass, suspicious
calcifications, or architectural distortions

PAGE
 A. B. C.

FIGURE: GLOBAL ASYMMETRY SEEN IN (A) SCHEMATIC, (B) MLO VIEWS, AND (C)
CC VIEWS. A MUCH GREATER VOLUME OF BREAST TISSUE IS SEEN OVER A
SUBSTANTIAL PORTION OF THE LEFT BREAST RELATIVE TO THE CORRESPONDING
REGION IN THE RIGHT BREAST, BUT THERE IS NO ASSOCIATED MASS, SUSPICIOUS
CALCIFICATIONS, OR ARCHITECTURAL DISTORTION.

PAGE
DEVELOPING ASYMMETRY A.

THIS IS A FOCAL ASYMMETRY

THAT IS NEW, LARGER, OR
DENSER AT CURRENT
EXAMINATION THAN AT
PREVIOUS EXAMINATIONS.

FIGURE: DEVELOPING ASYMMETRY. (A) SCHEMATIC

SHOWS A DEVELOPING ASYMMETRY THAT IS LARGER
AND DENSER ON CURRENT EXAMINATION (RIGHT)
THAN ON PREVIOUS ONE. (B) A DEVELOPING
ASYMMETRY IS SEEN AS A NEW FOCAL ASYMMETRY
(ARROW) ON FOLLOW-UP MLO VIEW OBTAINED 2
YEARS AFTER BASELINE MAMMOGRAM (LEFT).
B.

PAGE
 GRADES OF NIPPLE INVERSION

INVERTED
NIPPLE INVERSION IS CLASSIFIED BY
GRADES, BASED ON HOW SERIOUS THE
CONDITION IS.

NIPPLES GRADE 1. THE NIPPLE CAN EASILY BE

PULLED OUTWARD, AND WILL SOMETIMES
INVERTED NIPPLES ARE NIPPLES STAND OUT ON ITS OWN WITH COLD OR
THAT POINT INWARD OR LIE FLAT, STIMULATION. YOU CAN STILL
RATHER THAN POINTING OUT BREASTFEED.
GRADE 2. THE NIPPLE CAN BE PULLED
OUTWARD, BUT IT QUICKLY GOES BACK TO
ITS ORIGINAL SHAPE. YOU MAY HAVE
TROUBLE BREASTFEEDING.
GRADE 3. THE CONDITION IS MOST
SEVERE. YOU MAY NOT BE ABLE TO PULL
THE NIPPLE OUT AT ALL OR BREASTFEED.

PAGE
 INVERTED
NIPPLES

PAGE
 ACCESSORY
BREAST TISSUE
GENERAL OVERVIEW CLINICAL PRESENTATION

ACCESSORY BREAST TISSUE, ALSO MOST WOMEN ARE UNAWARE OF THEIR

KNOWN AS POLYMASTIA, IS A ACCESSORY BREAST TISSUE AND IT IS
RELATIVELY COMMON CONGENITAL DETECTED INCIDENTALLY ON A
CONDITION IN WHICH ABNORMAL MAMMOGRAM. DISCOMFORT, PAIN, MILK
ACCESSORY BREAST TISSUE IS SEEN IN SECRETION, AXILLARY THICKENING, AND
ADDITION TO THE PRESENCE OF NORMAL LOCAL SKIN IRRITATION CAN OCCUR.
BREAST TISSUE. THIS NORMAL VARIANT ACCESSORY BREAST TISSUE RESPONDS TO
CAN PRESENT AS A MASS ANYWHERE HORMONAL STIMULATION AND MAY BECOME
ALONG THE COURSE OF THE MORE EVIDENT DURING MENARCHE,
EMBRYOLOGIC MAMMARY STREAK (AXILLA PREGNANCY, OR LACTATION. ON
TO THE INGUINAL REGION). EXAMINATION, SUPRANUMERARY NIPPLES
MAY ALSO BE SEEN.

PAGE
 LOCATION TREATMENT

ACCESSORY BREAST TISSUE CAN BE NO TREATMENT IS REQUIRED IN THE VAST

FOUND ANYWHERE ALONG THE MAJORITY OF CASES. THE TREATMENT OF
THORACOABDOMINAL REGION OF THE CHOICE FOR SYMPTOMATIC ACCESSORY
MILK LINE (THE EMBRYOLOGIC MAMMARY AXILLARY BREAST TISSUE IS SURGICAL
STREAK) BUT ARE MOST FREQUENTLY EXCISION AS REMOVAL OF THE TISSUE
FOUND IN THE AXILLA AND MAY OCCUR WILL RELIEVE PHYSICAL DISCOMFORT OR
BILATERALLY. THEY ARE VERY RARELY MECHANICAL DISCOMFORT IN THE CASE OF
SEEN IN THE FACE, BACK, AND THIGH. LARGE VOLUME ACCESSORY TISSUE.

PAGE
 WHAT ARE BREAST
CHANGES?
CLINICAL
BREAST
CHANGES

PAGE
 BREAST CHANGES DURING YOUR
LIFETIME THAT IS NOT CANCER
YOUNG WOMEN WHO HAVE NOT GONE THROUGH AS YOU APPROACH MENOPAUSE, YOUR MENSTRUAL
MENOPAUSE OFTEN HAVE MORE DENSE TISSUE IN PERIODS MAY COME LESS OFTEN. YOUR HORMONE
THEIR BREASTS. LEVELS ALSO CHANGE.
BEFORE OR DURING YOUR MENSTRUAL PERIODS, YOUR IF YOU ARE TAKING HORMONES (SUCH AS
BREASTS MAY FEEL SWOLLEN, TENDER, OR PAINFUL. MENOPAUSAL HORMONE THERAPY, BIRTH CONTROL
YOU MAY ALSO FEEL ONE OR MORE LUMPS DURING PILLS, OR INJECTIONS) YOUR BREASTS MAY BECOME
THIS TIME BECAUSE OF EXTRA FLUID IN YOUR DENSER
BREASTS. WHEN YOU STOP HAVING MENSTRUAL PERIODS
DURING PREGNANCY, YOUR BREASTS MAY FEEL (MENOPAUSE), YOUR HORMONE LEVELS DROP, AND
LUMPY. YOUR BREAST TISSUE BECOMES LESS DENSE AND
WHILE BREASTFEEDING, YOU MAY GET A CONDITION FATTIER.
CALLED MASTITIS. THIS HAPPENS WHEN A MILK
DUCT BECOMES BLOCKED. MASTITIS CAUSES THE
BREAST TO LOOK RED AND FEEL LUMPY, WARM, AND
TENDER

PAGE
 BREAST CHANGES TO SEE YOUR
HEALTH CARE PROVIDER ABOUT:
NIPPLE DISCHARGE OR
A LUMP (MASS) OR A CHANGES
FIRM FEELING SKIN CHANGES

A LUMP IN OR NEAR NIPPLE DISCHARGE

YOUR BREAST OR UNDER (FLUID THAT IS NOT ITCHING, REDNESS,
YOUR ARM. BREAST MILK) SCALING, DIMPLES,
THICK OR FIRM TISSUE NIPPLE CHANGES, SUCH OR PUCKERS ON YOUR
IN OR NEAR YOUR AS A NIPPLE THAT BREAST
BREAST OR UNDER YOUR POINTS OR FACES
ARM INWARD (INVERTED)
A CHANGE IN THE SIZE INTO THE BREAST
OR SHAPE OF YOUR
BREAST

PAGE
 LUMPS

POSSIBLE CAUSES OF
BREAST LUMPS INCLUDE:

ABSCESS OR
INFECTION
ADENOMA
A BREAST LUMP IS A CYSTS
LOCALIZED FAT NECROSIS
SWELLING, LIPOMA
PROTUBERANCE, BREAST CANCER
BULGE, OR BUMP IN
THE BREAST.

PAGE
 BREAST THICKENING
BREAST FIBROSIS MEANS THE THICKENING OF BREAST TISSUE.
FIBROSIS OF THE BREAST IS A BENIGN ENTITY

CLINICAL PRESENTATION
IT CAN PRESENT AS A PALPABLE BREAST MASS.

ETIOLOGY
THE ETIOLOGY OF FIBROSIS INCLUDES A HISTORY OF
TRAUMA WITH SCAR TISSUE, A SURGICAL HISTORY,
AND HISTORY OF INSULIN-DEPENDENT DIABETES
MELLITUS.
MANIFESTATIONS OF DISEASE
PALPABLE MASS OR MAY BE ASYMPTOMATIC
IT CAN BE DIFFUSE, PATCHY OR FOCAL AND CAN FORM A
WELL OR POORLY DEFINED MASS THAT CAN BE SEEN ON
MAMMOGRAPHY AS AN INCREASED DENSITY.

PAGE
 IMAGING TECHNIQUE AND FINDINGS
● MAMMOGRAPHY ● MAGNETIC RESONANCE IMAGING

PAGE
 IMAGING TECHNIQUE AND FINDINGS
● ULTRASONOGRAPHY

PAGE
 WHAT CAUSES BREAST
SWELLING?

BREAST
SWELLING

PAGE
 BREAST SWELLING CAN ALSO BE
A SYMPTOM OF BREAST CANCER.

OTHER POTENTIAL CAUSES OF BREAST SWELLING

INCLUDE:
FOODS AND DRINKS, SUCH AS THOSE WITH HIGH
AMOUNTS OF CAFFEINE OR SALT
CERTAIN MEDICATIONS, SUCH AS BIRTH CONTROL
PILLS, THAT CONTAIN ESTROGEN
CHANGES THAT OCCUR WHEN YOU’RE PREGNANT
POSTPARTUM-RELATED CHANGES THAT OCCUR AFTER
YOU’VE GIVEN BIRTH
MASTITIS, AN INFECTION OF YOUR MILK DUCTS THAT
CAN HAPPEN WITH BREASTFEEDING
FIBROCYSTIC BREAST DISEASE, A CONDITION IN
WHICH YOU DEVELOP NONCANCEROUS LUMPS IN YOUR
BREAST

PAGE
 DOES A SWOLLEN BREAST MEAN
CANCER?

IS SWELLING IN BREAST IS
NORMAL?

WHAT HAPPENS WHEN YOUR

BREAST SWELL?

WHAT DOES BREAST CANCER

SWELLING LOOK LIKE?

PAGE
 WHEN SHOULD YOU SEEK
MEDICAL ATTENTION?
CRACKING OF YOUR NIPPLE
CHANGES IN THE COLOR OF YOUR NIPPLE OR
THE SKIN ON YOUR BREAST
DIMPLING OR PUCKERING OF THE SKIN ON YOUR
BREAST
EXCESS BREAST SWELLING THAT PREVENTS
BREAST MILK FROM COMING OUT AFTER YOU
GIVE BIRTH
A HARDENED LUMP IN YOUR BREAST TISSUE
THAT DOESN’T CHANGE DURING YOUR MENSTRUAL
CYCLE
A SORE ON YOUR BREAST THAT DOESN’T HEAL
UNEXPECTED DISCHARGE FROM YOUR NIPPLE

PAGE
 HOW ARE THE CAUSES OF
BREAST SWELLING DIAGNOSED?
THEY MAY RECOMMEND IMAGING TESTS SUCH AS A
MAMMOGRAM OR BREAST ULTRASOUND TO VIEW THE
INTERNAL STRUCTURES OF YOUR BREAST.

HOW IS BREAST SWELLING TREATED?

HERE ARE A FEW TIPS FOR RELIEVING DISCOMFORT
ASSOCIATED WITH BREAST SWELLING.
WEAR A SUPPORTIVE BRA OR MAKE SURE YOUR
BRA FITS PROPERLY.
APPLY A CLOTH-COVERED HEAT PACK OR ICE
PACK TO YOUR BREASTS FOR UP TO 10 MINUTES
AT A TIME.
USE OVER-THE-COUNTER PAIN RELIEVERS, SUCH
AS IBUPROFEN (ADVIL).

PAGE 11
 DIMPLING
DIMPLING OF THE BREAST TISSUE CAN BE A SIGN OF A SERIOUS FORM OF
CANCER KNOWN AS INFLAMMATORY BREAST CANCER. ALSO KNOWN AS PEAU
D'ORANGE, DIMPLING OF THE BREAST CAUSES THE SKIN TO LOOK LIKE
THE PITTING AND UNEVEN SKIN OF AN ORANGE. SOMETIMES, THE SKIN
CAN ALSO BE RED AND INFLAMED.
 The following Causes
changes may also
occur: THERE ARE TWO MAIN
REASONS FOR BREAST
Skin changes DIMPLING. ONE IS FAT
NECROSIS, AND THE OTHER
Thickening of IS INFLAMMATORY BREAST
tissue CANCER.

1 INFLAMMATORY BREAST CANCER

INFLAMMATORY BREAST CANCER IS A RARE BUT AGGRESSIVE

TYPE OF BREAST CANCER IN WHICH CANCEROUS CELLS AFFECT
THE LYMPH VESSELS AND THE SKIN, ACCORDING TO THE
NATIONAL BREAST CANCER FOUNDATION.

PAGE 5
 IT OFTEN PRODUCES NO SYMPTOMS UNTIL STAGE III OR STAGE IV.
UNLIKE OTHER TYPES OF BREAST CANCER, THERE IS NO DISTINCT
MASS OR TUMOR.
INSTEAD, CANCER CELLS BLOCK THE LYMPHATIC DRAINAGE IN THE
BREAST TISSUE.
IT TENDS TO DEVELOP IN THE MILK DUCTS WITHIN THE BREAST.
EARLY SYMPTOMS OF INFLAMMATORY BREAST CANCER MAY INCLUDE
ITCHING AND A RASH OR SMALL, IRRITATED BUMP, SIMILAR TO A BUG
BITE.
AS THE SYMPTOMS PROGRESS, THE PERSON MAY NOTICE:
TENDERNESS
PAIN OR A BURNING SENSATION
SWELLING
REDNESS
DIMPLING OF THE SKIN

PAGE 5
 2 FAT NECROSIS
Dimpling can also be a symptom of fat necrosis, a
condition where the fatty tissue in the breast dies. It
can happen for various reasons, including breast surgery,
a bruise or injury, or as a side effect of a biopsy.

HOW TO FIND DIMPLING?

THE BEST TIME TO DO IT IS TO TAKE A FEW MINUTES WHEN GETTING

DRESSED OR CHANGING CLOTHES.

TO SCREEN FOR DIMPLING:

CHECK OUT THE TISSUE COVERING THE BREASTS AND UNDERARM AREAS.
NOTE ANY CHANGES IN THE SKIN, INCLUDING LUMPS OR CHANGES IN TEXTURE.
FEEL THE BREASTS TO CHECK FOR LUMPS, AREAS OF TENDERNESS, OR THICKENING
IN THE BREAST OR UNDER THE ARMS.

PAGE 5
 DIAGNOSIS
To find out why the dimpling is there, the doctor:

will perform a clinical breast exam

may order further testing, such as a mammogram or ultrasound
may recommend a biopsy, depending on the results of the
imaging tests

DIAGNOSTIC CRITERIA
redness, swelling, and ridged or pitted skin that appears
suddenly.
warmth in the breast that starts suddenly, either with or without
a lump and with or without the redness, swelling, and dimpling.
these symptoms must have been there for 6 months or less.
the redness affects at least one third of the breast.
a biopsy shows that invasive cancer cells are present

PAGE 5
 TREATMENT:

Surgery
Chemotherapy
Radiation
Hormonal
therapy

PAGE 5
 SKIN IRRITATION
YOUR NIPPLES, AND THE SURROUNDING SKIN OF YOUR CHEST, CAN ITCH FOR
PLENTY OF REASONS.

THIS ITCHING MIGHT SEEM MORE INTENSE AT CERTAIN TIMES:

• DURING YOUR PERIOD
• POST-WORKOUT AFTER A SHOWER
• THROUGHOUT PREGNANCY

OCCASIONAL ITCHING USUALLY ISN’T ANYTHING TO FEEL CONCERNED ABOUT,

ESPECIALLY IF YOU DON’T NOTICE ANY INFLAMED OR PEELING SKIN. JUST AS
OTHER PARTS OF YOUR BODY MIGHT FEEL ITCHY FROM TIME TO TIME, YOUR
NIPPLES CAN GET ITCHY, TOO — ESPECIALLY IF YOU HAVE DRY SKIN OR
SENSITIVITY TO A CERTAIN CHEMICAL.
BREAST PAIN
BREAST PAIN (MASTALGIA) CAN BE DESCRIBED AS TENDERNESS, THROBBING,
SHARP, STABBING, BURNING PAIN OR TIGHTNESS IN THE BREAST TISSUE. THE
PAIN MAY BE CONSTANT OR IT MAY OCCUR ONLY OCCASIONALLY, AND IT CAN
OCCUR IN MEN, WOMEN AND TRANSGENDER PEOPLE.

TYPES OF BREAST PAIN

THE FIRST TYPE IS CYCLICAL AND

CHANGES WITH HORMONAL CHANGES IN
YOUR BODY.

NONCYCLIC BREAST PAIN

 SYMPTOMS BREAST PAIN CAN BE CYCLIC OR NONCYCLIC

BREAST PAIN
CHARACTERISTICS

CYCLIC BREAST PAIN NONCYCLIC BREAST PAIN

CLEARLY RELATED TO THE MENSTRUAL UNRELATED TO THE MENSTRUAL CYCLE
CYCLE AND CHANGING HORMONE LEVELS DESCRIBED AS TIGHT, BURNING,
DESCRIBED AS DULL, HEAVY OR ACHING STABBING OR ACHING SENSATION
OFTEN ACCOMPANIED BY BREAST CONSTANT OR INTERMITTENT
SWELLING, FULLNESS OR LUMPINESS USUALLY AFFECTS ONE BREAST, IN A
USUALLY AFFECTS BOTH BREASTS, LOCALIZED AREA, BUT MAY SPREAD MORE
PARTICULARLY THE UPPER, OUTER DIFFUSELY ACROSS THE BREAST
PORTIONS, AND CAN RADIATE TO THE IN WOMEN, MOST LIKELY TO OCCUR
UNDERARM AFTER MENOPAUSE
 EXTRAMAMMARY BREAST PAIN
The term "extramammary" means
"outside the breast."

WHAT CAUSES PAIN IN THE

BREAST?
hormonal changes, an incorrect
bra fit, and infections.

WHY IS MY LEFT BREAST

PAINFUL?
injuries, surgery, problems
with milk ducts, hormonal
fluctuations, and benign lumps.

PAGE
 CAN PAIN IN LEFT BREAST BE
HEART RELATED?
When the heart muscle does not
receive enough oxygen in the
coronary artery blood supply, the
DOES MASSAGING BREASTS
resulting pain under the left
HELP PAIN?
breast or in the center of the
chest is known as angina.
breast massage can also help
HOW CAN I RELIEVE BREAST ease the tension in your
PAIN? chest muscles

Use hot or cold compresses on your

breasts. Wear a firm support bra,
fitted by a professional if
possible. Wear a sports bra during
exercise

PAGE
Welcome to A A A
WEEK 8 REPORTING

GROUP 2
Start
 DISCHARGE
Nipple discharge refers to any fluid that
seeps out of the nipple of the breast.

Nipple discharge during pregnancy and breast-

feeding is normal. Nipple discharge happens
less commonly in women who aren't pregnant or
breast-feeding. It may not be cause for
concern, but it's wise to have it evaluated by
a doctor to be sure. Men who experience nipple
discharge under any circumstances should be
evaluated.
DISCHARGE
 DISCHARGE
Mammary duct ectasia -
Galactorrhea - is a milky nipple
Duct ectasia, also known as
discharge unrelated to the
mammary duct ectasia, is a
normal milk production of
benign (non-cancerous) breast
breast-feeding. Galactorrhea
condition that occurs when a
itself isn't a disease, but it could
milk duct in the breast widens
be a sign of an underlying
and its walls thicken. This can
problem. It usually occurs in
cause the duct to become
women, even those who have
blocked and lead to fluid build-
never had children or after
up. It's more common in
menopause.
women who are getting close
to menopause
 DISCHARGE
Fibrocystic breasts Disease -
Intraductal papillomas - are
are painful, lumpy breasts.
benign (non-cancerous), wart-
Formerly called fibrocystic
like tumors that grow within the
breast disease, this common
milk ducts of the breast. They
condition is, in fact, not a
are made up of gland tissue
disease. Many women
along with fibrous tissue and
experience these normal
blood vessels (called
breast changes, usually around
fibrovascular tissue).
their period. The female breast
is either of two mammary
glands (organs of milk
secretion) on the chest.
NIPPLE RETRACTION AND AREOLA CHANGES

Many factors can alter the appearance, shape, or

texture of your nipple and areola. Sometimes
these changes are temporary and due to hormonal
shifts, pregnancy, or breastfeeding. Permanent
changes of the nipple or areola are often seen
with breast surgeries, weight loss, and aging.
It's important to be familiar with what is normal
for your breasts and report any changes to your
medical provider.
NIPPLE RETRACTION AND AREOLA CHANGES
 NIPPLE RETRACTION AND AREOLA CHANGES

Abnormal Nipple discharge - is a Changes in nipple and areola size -

typical part of breast function during Nipples and areolas vary in size. The
pregnancy or breast-feeding. It may also areola is a pigmented circular area
be associated with menstrual hormone around the nipple, usually between 3
changes and fibrocystic changes. centimeters and 6 centimeters (1.2
inches to 2.4 inches) across. The size of
Inverted or retracted nipple - When nipples and areolas can sometimes
the nipple is pulled in and points inward correlate to breast size, but genes can
instead of out, it is termed nipple also play a role. It's normal for nipples
inversion or retraction. Nipple inversion and areolas to change in size during
can affect one breast or both and can puberty, certain stages of your
be congenital or acquired. Acquired menstrual cycle, pregnancy, and
nipple inversion can be due to benign breastfeeding.
or malignant causes.
 NIPPLE RETRACTION AND AREOLA CHANGES

persistent lump and bump of persistent nipple pain or

breast - They're often caused by itchiness - Just as other parts of
something harmless like a non- your body might feel itchy from
cancerous tissue growth time to time, your nipples can get
(fibroadenoma) or a build-up of itchy, too — especially if you have
fluid (breast cyst). Breast Cancer dry skin or a sensitivity to a certain
Now has more information about chemical. Persistent nipple itching,
fibroadenoma and breast cysts. on the other hand, might have a
Sometimes, a breast lump can be more serious cause, such as
a sign of something serious like eczema, yeast infection of the
breast cancer. breast, or mastitis.
NIPPLE RETRACTION AND AREOLA CHANGES

Changes in skin texture

TEXTURE: The skin texture
and color
of the nipple is normally
smooth, whereas the
COLOR: The areola is areola can be bumpy and
often darker than the pimple-like.
nipple itself.
BREAST EDEMA
Is characterized by
skin changes,
hardness of the
breast and pain, but
can also be present
without visible
swelling, whilst the
main property of
lymphedema of the
extremities is
swelling. Irradiation
causes hardening of
the fat tissue.
 ERYTHEMA OF BREAST
Extensive erythema of
the breast skin is a
benign disease, for
which there is still
no known effective
therapy. The lack of
mammographic evidence
and, especially, of
positive palpatory
findings make breast
cancer highly
improbable as the
underlying cause.
IMPLANTS OF BREAST

TWO MAIN TYPES

BREAST IMPLANTS

1. SALINE-FILLED IMPLANTS
2. SILICO NE-GEL FILLED IMPLANTS

FAT TRANSFER AUGMENTATIO N

 BREAST REDUCTION

Breast reduction surgery is an operation to

remove extra fat, tissue, and skin from your
breasts. If you have large breasts that are out
of proportion to the rest of your body and
causing neck pain, back pain, or other symptoms,
you may be considering breast reduction surgery.

Most women who get breast reduction are very

satisfied with the results. Men with conditions
such as gynecomastia (in which male breasts are
abnormally enlarged) may also have it.
BREAST REDUCTION
POST-SURGICAL EXCISION OF BREAST
Acute postsurgical changes are most prominent in the
immediate postoperative period (as long as 1-2 wk)
and are related to hematoma, edema, and tissue
disruption. Mammographic images may show an ill-
defined mass, area of increased density, skin
thickening, and/or distortion.
An open breast biopsy is surgery to remove abnormal
breast tissue. The breast tissue will be sent to a
lab, where a doctor will look at the tissue under a
microscope to check for breast cancer.
Your doctor may have some answers right away. But it
can take up to 1 to 2 weeks to get the final
results. Your doctor will discuss the results with
you.
 RADIATION CHANGES IN BREAST
The main short-term side effects of external beam radiation therapy to the
breast are: Swelling in the breast. Skin changes in the treated area similar
to a sunburn (redness, skin peeling, darkening of the skin) Fatigue.

Radiation therapy for breast cancer uses high-energy X-rays, protons or other
particles to kill cancer cells. Rapidly growing cells, such as cancer cells,
are more susceptible to the effects of radiation therapy than are normal
cells.
The X-rays or particles are painless and invisible. You are not radioactive
after treatment, so it is safe to be around other people, including children.
Radiation therapy for breast cancer may be delivered through:
External radiation. A machine delivers radiation from outside your body to
the breast. This is the most common type of radiation therapy used for breast
cancer.
Internal radiation (brachytherapy). After you have surgery to remove the
cancer, your doctor temporarily places a radiation-delivery device in your
breast in the area where the cancer once was. A radioactive source is placed
into the device for short periods of time over the course of your treatment.
 RADIATION CHANGES IN BREAST
Radiation therapy may be used to treat breast
cancer at almost every stage. Radiation therapy is
an effective way to reduce your risk of breast
cancer recurring after surgery. In addition, it is
commonly used to ease the symptoms caused by cancer
that has spread to other parts of the body
(metastatic breast cancer).

Radiation therapy kills cancer cells. It's often

used after surgery to reduce the risk that the
cancer will come back. It can also be used to
provide relief from pain and other symptoms of
advanced breast cancer.
THANK YOU
FOR
LISTENING!!!

GROUP 2
MAMMOGRAPHIC
APPEARANCES OF
PATHOLOGY
MASSES
 MASSES
• In mammography, a mass is
defined as a space-occupying
lesion, visible in two different
projections, characteristic by its
shape and contour.
• A mass might be seen with or
without calcifications.

3
 Masses can be many things,
including;
• Cysts - are fluid-filled sacs
and non cancerous.
• Solid masses (tumors) - can
be more concerning. It may
be benign (not cancer), or
malignant (cancer).

4
According to the BI-RADS system (Breast Imaging Reporting and
Data System) by the American College of Radiology (ACR), a mass
is characterized by:

• the shape: round, oval, lobulate or irregular;

• the contour: circumscribed, microlobulated, masked, indistinct,
spiculated;
• the density with respect to normal fibroglandular tissue: high,
medium or low density or containing fat;
• the association with other anomalies: micro or macrocalcifications,
skin retraction, skin thickening, architectural distortion, etc.;

5
 1.
TRANSITION HEADLINE
Let’s start with the first set of slides
 Here, multiple round The image shows a hyperdense
circumscribed low density masses mass with an irregular shape and
in the right breast. speculated margin.

7
MARGINS
CATEGORIES OF ASSESSMENT:
• CIRCUMSCRIBED

• OBSCURED

• MICROLOBULATED

• INDISTINCT

• SPICULATED

9
 1.
TRANSITION HEADLINE
Let’s start with the first set of slides
 CIRCUMSCRIBED
• Historically well-defined.
• This is a benign finding
• Examples of benign circumscribed masses:
cysts and fibroadenomas

11
 OBSCURED

• When the margin is hidden by superimposed

fibroglandular tissue. Ultrasound can be helpful
to define the margin better.

13
 MICROLOBULATED

• This implies a suspicious finding.

• Non-circumscribed margins

15
 INDISTINCT

• Historically ill-defined
• This is also a suspicious finding.

17
 SPICULATED
• Characterized by lines radiating from the mass
• Irregular Margin
• Spiculated with radiating lines from the mass is
a very suspicious finding.

19
ASYMMETRY
DENSITY
• Findings that represent unilateral deposits of
fibroglandulair tissue not conforming to the
definition of a mass.
• Fibroglandular tissue is a mixture of fibrous
connective tissue (the stroma) and the
functional (or glandular) epithelial cells that
line the ducts of the breast (the parenchyma).
The remainder of the breast is fat.
• Asymmetries appear similar to other discrete
areas of fibroglandulair tissue except that they
are unitaleral, with no mirror-image correlate
in the opposite breast.

21
• Asymmetry as an area of fibroglandulair tissue visible on
only one mammographic projection, mostly caused by
superimposition of normal breast tissue.
• Global asymmetry consisting of an asymmetry over at least
one quarter of the breast and is usually a normal variant.
• Developing asymmetry new, larger and more conspicuous
than on a previous examination.
• Focal asymmetry

23
 ASYMMETRY VERSUS MASS
• All types of asymmmetry have different border contours than true masses and also
lack the conspicuity of masses.
Asymmetries appear similar to other discrete areas of fibroglandulair tissue except
that they are unitaleral, with no mirror-image correlate in the opposite breast.
• An asymmetry demonstrates concave outward borders and usually is interspersed
with fat, whereas a mass demonstrates convex outward borders and appears
denser in the center than at the periphery.
The use of the term "density" is confusing, as the term "density" should only be
used to describe the x-ray attenuation of a mass compared to an equal volume of
fibroglandular tissue.

24
 FOCAL
ASYMMETRY
• FOCAL ASYMMETRY
Visible in two projections, real finding rather
than super imposition. Differentiated from a
mass seen in two views and may be benign or
malignant

• Figure 4: Focal asymmetry seen in (a)

schematic, (b) MLO views, and (c) CC views

26
MAMMOGRAPHIC
APPEARANCE OF
FOCAL
ASYMMETRY
CASE 1
Mammography
Figure 1. Mediolateral oblique (MLO) and
craniocaudal (CC) views. (A) Right MLO, (B) right
CC, (C) right MLO spot compression, and (D) right
CC spot compression views. There is an ill-defined
oval focal asymmetry (square) in the inferior inner
breast.

28
 CASE 1

Ultrasonography
Figure 1. (E) Right breast sonogram. The mammographic asymmetry
corresponds to an oval solid hypoechoic mass.

29
CASE 2
Mammography
Figure 2. Mediolateral oblique (MLO)
and craniocaudal (CC) views. (A) Left
MLO and (B) left CC mammograms. In
the MLO view, there is a focal
asymmetry with architectural distortion
(square).

30
 CASE 2

Magnetic Resonance Imaging

Figure 2. (C) Bilateral breast MRI (subtraction series: 2 minutes after injection of contrast). Initial
ultrasound examination is negative, so an MRI is performed. In the left breast, there is a small
enhancing lesion in the 12 o’clock position that corresponds to the mammographic asymmetry.

31
 CASE 2

Ultrasonography
Figure 2. (D) Left breast sonogram. After magnetic resonance imaging (MRI),the
sonographic exam identified a spiculated solid mass that corresponds to both the
MRI and the mammogram.

32
 CASE 3

Mammography
Figure 3. Mediolateral oblique (MLO) and craniocaudal (CC) views. (A) Right MLO, (B) left MLO, (C) right CC,
and (D) left CC mammograms. Radiopaque marker denotes location of palpable lump. There is a focal
asymmetry in the 6 o’clock position (square). On the screening images, the margins are only visible on the
CC view.

33
CASE 3

Ultrasonography
Figure 3. (E) Left breast sonogram. The palpable asymmetry at 6 o’clock
corresponds to a hypoechoic oval solid mass with mildly indistinct margins.

34
 CASE 3

MRI
Figure 3. (F) Bilateral breast MRI (subtraction series: 2 minutes after injection of contrast). Left
breast has an oval, rapidly enhancing mass at 6 o’clock that corresponds to the sonographic
mass. No other masses or suspicious adenopathy are identified.

35
CALCIFICATION
 TWO TYPES OF BREAST
CALCIFICATIONS
1. Macrocalcification – Looks like large white dots on a
mammogram and are often dispersed randomly within the
breast.
2. Microcalcifications - are small calcium deposits that look

like white specks on a mammogram.

37
 In the 2003 atlas, calcifications were classified by
morphology and distribution either as benign,
intermediate concern or high probability of malignancy.

In the 2013 version, the approach has changed. Since

calcifications of intermediate concern and high
probability of malignancy are all being treated the same
way.
Note: Calcifications are now either typically benign or of
suspicious morphology.

38
 TYPICALLY BENIGN
• Skin Calcification
• Milk of calcium
• Rod-like
• Dystrophic
• Coarse/popcorn like
• Rim calcification
• Vascular calcification
• Round
• Punctate

39
 SUSPICIOUS MORPHOLOGY
• Amorphous

• Fine pleomorphic

• Coarse

heterogeneous
• Fine linear/fine linear

branching

40
DISTRIBUTION OF CALCIFICATIONS

1. Diffuse
2. Regional
3. Grouped
4. Linear
5. Segmental

41
THANK YOU
FOR
LISTENING!
Diagnosis for
Breast cancer
Bu n say, K at h l een
C ayet an o, R alph
Eu g en e
F ran ci sco , M a. I v et
M an i au l , Jan el l a
Pad l an , C h ri st i n e
Vel asco , R u b ilyn
 CONTENTS

1 Fine - Needle Aspiration 2 C o r e B i o p s y

3 Vacuum Assisted Breast Biopsy 4 Correlation to Mammographic Findings

Fine- Needle Aspiration
(Velasco, Rubilyn)
What is an FNA of the breast?

In an Fine needle aspiration (FNA) the doctor uses a very

thin, hollow needle attached to a syringe to withdraw
(aspirate) a small amount of breast tissue or fluid from a
suspicious area.

FNA is most often done if the suspicious area is likely to

be a fluid-filled sac (a cyst).
 What should you expect if you have an FNA?

During an FNA

You’ll lie on your back for the FNA, and you will have to be still while
it’s being done.

If ultrasound is used, you may feel some pressure from the

ultrasound wand and as the needle is put in. Once the needle is in the
right place, the doctor will use the syringe to pull out a small amount
of tissue and/or fluid.
A f t er a n F N A

Your doctor or nurse will tell you how to care for the area
where the biopsy was done and what you can and can’t do while
it heals. You might be told to limit strenuous activity for a day or
so, but you should be able to go back to your usual activities
after that.
W h at d o es a n F N A s h ow?

A doctor called a pathologist will look at the biopsy tissue or fluid to find out if
there are cancer cells in it.

The main advantages of FNA are that it is fairly quick, it often doesn't require
anesthesia, and the skin doesn’t have to be cut, so no stitches are needed and
there is usually no scar. Also, in some cases it’s possible to get the results the
same day.

If the results of the FNA biopsy do not give a clear diagnosis, or if your doctor
still has concerns, you might need a more extensive type of biopsy, such as
a core needle biopsy or a surgical (open) biopsy.
Core Biopsy
(Maniaul, Janella)
If exams or imaging tests show you might have breast cancer, your doctor might refer you for a core
needle biopsy (CNB) tohelp find out for sure

During this procedure, the doctor uses a hollow needle to take out pieces of breast tissue from the
area of concern. This can be done with the doctor either feeling the area or using an imaging test to
guide the needle.

The needle may be attached to a spring-loaded tool that moves the needle in and out of the tissue
quickly, or it may be attached to a suction device that helps pull breast tissue into the needle (known
as a vacuum-assisted core biopsy).

A small cylinder (core) of tissue is taken out in the needle.

I m aging t e st a D o c tor m ay u s e:
*Mammogram (or breast * Ultrasound
tomosynthesis) (known as
a stereotactic biopsy)
MRI
D U RING C NB

Fo r any type o f CNB, a thin ne e dle will be use d f ir st to put numbing me dicine ( lo cal
anesthesia) into the ar ea to be bio psied.

So metimes a small cut ( abo ut ¼ inch) is then made in the br east. T he bio psy needle
is put into the br east tissue to r emo ve the tissue sample thr o ugh this cut.

A tiny tissue mar ke r ( also called a clip) is put into the ar e a whe r e the bio psy is
do ne. T his mar ker will sho w up o n mammo gr ams o r o ther imaging tests so the exact
ar ea can be lo cated f o r f ur ther tr eatment ( if needed) o r f o llo w - up.

O nce the tissue is r emo ved, the needle is taken o ut. Stitches ar en't usually needed,
but pr essur e may be applied f o r a sho r t time to help limit bleeding. T he ar ea is then
co ver ed with a ster ile dr essing.
A F TER C NB

Limit strenuous activity

A CNB can cause some bleeding, bruising, or swelling. This can make it seem like
the breast lump is larger after the biopsy

T h ere a re 3 m a in t ypes of i m age-guided b i opsies:

•Stereotactic (mammogram- or tomosynthesis-guided)

•Ultrasound-guided

•MRI-guided
S t e r eot a c tic ( m a m m og ra m o r t o m os y nt hes is-g u ide d) c o r e n e e dl e
b i o p sy
A doctor uses mammogram pictures taken from different angles to pinpoint the biopsy site. A
computer analyzes the breast x-rays and shows where the needle tip needs to go in the abnormal
area. This type of biopsy is often used to check suspicious microcalcifications (tiny calcium
deposits) or small masses or other abnormal areas that can’t be seen clearly on an ultrasound.
The breast will be positioned in the mammography machine and compressed, and an image will be
taken to make sure the area in question can still be seen. The breast is then cleaned, and
numbing medicine (local anesthesia) is given. The biopsy device is placed into the breast, and
more images are taken to confirm that the device is in the correct spot to take samples. Several
biopsy samples are then taken.
Afterwards, the device is removed from the breast, and a biopsy marker (clip) is placed in the
area. Another mammogram is then done to confirm the marker is in the right place.
Mammography guided (stereotactic)
Vacuum assisted biopsy
Ul t rasound- g uided c ore n eedle b iopsy

An ultrasound is done first to view the area. Then the

skin is cleaned and numbing medicine (local
anesthesia) is injected. Ultrasound is then used to
guide the needle into the correct area. You might feel
pressure as the needle goes in. Several biopsy
samples are usually taken.

A biopsy marker (clip) is placed in the area of the

biopsy. Most often, a mammogram is done after the
biopsy to confirm the clip is in the right place.
M R I- gui ded co re n eedle bi opsy

Most often done when something is seen on breast MRI that is unlikely to be seen on
mammogram or ultrasound.
The table will slide into the MRI scanner and images will be taken. Then you’ll be given
contrast through an IV line
Once the suspicious area has been located, the skin is cleaned and numbing medicine
(local anesthesia) is injected into the area. The biopsy device is then gently inserted
into the breast. It’s normal to feel pressure while this is being done.
More MRI images will then be taken to confirm to that the device is in the correct spot
to take samples. Several biopsy samples are then taken, and the device is removed
from the breast.
A biopsy marker (clip) is then placed in the area of the biopsy. Most often, a mammogram
is done after the biopsy to confirm the clip is in the right place.

What does a CNB show?

A doctor called a pathologist will look at the biopsy tissue and/or fluid to check if there
are cancer cells in it

If the doctor still has concerns, the doctor may recommend the patient to have a second
CNB or a more extensive type of biopsy.
Vacuum Assisted Breast Biopsy
(Bunsay, Kathleen)
A p r o c e d ur e i n w h i c h a s m a ll s a m p le o f t i s s ue i s
r e m o v e d f ro m t h e b re a s t .

A n i m a g i n g d e v i c e i s us e d t o g ui d e a h o llo w p r o b e
c o n n e ct ed t o a v a c uum d e v i c e c a lle d t h e
M a m m o t ome b i o p s y d e v i c e . T h r o ug h t h e us e o f
c o m p ut e r i m a g i n g ( x - r a y, u l t r a s o u n d o r M R I ) , a
b r e a s t a b n o r m a li t y c a n b e c le a r ly i d e n t i f i e d a n d
m a p p e d , e v e n i n i t s e a r li e s t s t a g e s . D i g i t a l i m a g i n g
e n a b le s a p h ys i c i a n t o g ui d e t h e M a m m o t om e p r o b e
i n t o t h e b re a s t t o g e n t ly c o lle c t t i s s ue s a m p le s
t h r o ug h o n e s m a ll ¼ - i n c h i n c i s i o n .
A d van tages

A breast biopsy usin g a Mammotome breast biopsy device can h elp a

do cto r m ake a h igh ly accurate diagn osis of a breast abn o rm ality
with out th e n eed for open surgery . Th e devices can also be used for
a n o n -can cerous breast lum p such as a fibro adeno ma. A lum p m ay
be reduced in siz e at th e sam e tim e it is bio psied, often to th e po in t
wh ere th e lum p may n o lon ger be seen un der ultrasoun d or felt
durin g self-ex amin ation.
R i sks

S om e patien ts m ay ex perience discom fort, alth ough th is can be easily

m an aged with over -th e -coun ter pain killers. O th er risks in clude ex cessive
bleedin g an d in fection at th e site of th e biopsy , alth ough th ese rarely occur.
https://youtu.be/ebZqB3Ai8V8
Correlation to Mammographic
Findings
(Cayetano, Ralph Eugene)
A benign mass: a fibroadenoma with well-
defined edges and a halo sign.

Benign microcalcifications: secretory change

Traumatic fat necrosis: fallowing a
removal of lesion. The stellate lesion has
a halo center
Early Detection of Breast Cancer
Screening Mammograms
(Padlan,Christine)
DIFFERENT TYPES OF MAMMOGRAMS
• SCREENING MAMMOGRAMS
• DIAGNOSTIC MAMMOGRAMS

Screening mammograms are performed for women

who have no symptoms or signs of breast cancer and
are considered at average risk for breast
cancer.Your first mammograms is considered a
baseline mammogram againts which all future test
will be compared to look for changes in your breast
tissue.
•Sc re e ni ng Ma mmo gra ms i s us e d t o de t e c t bre a s t c ha nge s t ha t c o uld be c a nc e ro us i n pe o ple who
ha v e no s i gns o r s y mpt o ms .

•The go a l i s t o de t e c t c a nc e r whe n i t 's s ma ll a nd t re a t me nt ma y be le s s i nv a s i v e .

•A s c re e ni ng ma mmo gra m o nly t a ke s a bo ut 1 0 t o 2 0 mi nut e s

• Sho uld be pe rf o rme d a nnua lly a t a ge 4 0 a nd o lde r

• Af t e r t he t e s t , a ra di o lo gi s t i nt e rpre t s t he i ma ge s a nd i nf o rms t he pa t i e nt s o f t he re s ult s wi t hi n

3 0 da y s .

•The c urre nt t e s t i s c o mpa re d t o pre v i o us o ne s t o f i nd t i ny a bno rma li t i e s

•Mo s t o f t he t i me , re s ult s a re no rma l

B e n e fi t s a n d R i sk s o f S c r ee n i ng

•Eve r y scr e e ni ng te st ha s be ne fi ts a nd r i sk s, whi ch i s why i t’s i m po r ta nt to ta lk to yo ur do cto r be fo r e ge tti ng a ny

scr e e ni ng te st, li k e a m a m m o gr a m .

B e n e fi t o f S c r e en i ng

• F i nd i ng ca nce r e a r ly, whe n i t’s e a si e r to tr e a t.

•R e d uce s the r i sk o f dyi ng fr o m br e a st ca nce r

•R e d uce the r i sk o f ha vi ng to unde r go che m o the r a py

•Allo ws wo m e n to k no w the he a lth o f the i r br e a st

R i s k s o f S cr e e ni n g

•Scr e e ni ng m a m m o gr a phy ca n't de te ct a ll ca nce r

•No t a ll o f the ca nce r s fo und by m a m m o gr a phy ca n be cur e d.

• F a l s e p o si t i ve t e s t r e su lt s , whe n a do cto r se e s so m e thi ng that lo o k s li k e cance r but i s no t. T hi s can le ad to m o r e

te sts, whi ch ca n be e x pe nsi ve , i nva si ve , ti m e - co nsum i ng, and m ay cause anx i e ty.

•Po ssi ble o ve r di a gno si s

Diagnostic Mammograms
(Bunsay,
Kathleen)
A diagnostic mammogram is an X-ray
examination of the breasts. This is carried
out when a person, their doctor or another
health professional discovers unusual
signs or symptoms in one or both breasts;
that is, a lump, tenderness, nipple discharge
or skin changes.
PR E PARATION

●If you have menstrual or monthly periods, it is best to have your diagnostic mammogram
appointment 1 week after the start of your period.

●If you have breast implants, please let the hospital, clinic or radiology practice know, so they
can schedule a longer appointment. The presence of implants needs more time to make sure
clear images are taken.

●When you make the diagnostic mammogram appointment, you will be told not to wear any
deodorant, perfume, lotion or talcum powder on the day of your appointment, because these
substances may show up as shadows on your mammogram.
PR OCEDURE
● When you have u ndres s ed, a radiographer will explain the mammography proc edu re to you and as k
a few qu es tions ; for example, ‘have you had a prior mammogram?’, ‘do you have a his tory of prior
breas t proc edu res ’, ‘do you have a family his tory of breas t dis eas e?’.

● Your breas ts will then be pu t, one at a time, between two s pec ial plates and c ompres s ed (pres s ed
down) between the plates by the X -ray mac hine for a few s ec onds while X -rays are taken. Two views
of eac h breas t are taken as a minimu m.

● The mammography and the c ompres s ion are c arried ou t by a s pec ially trained radiographer
(medic al imaging tec hnologis t). While the c ompres s ion may be u nc omfortable and perhaps painfu l, it
las ts only s ec onds . Withou t c ompres s ion, the X -rays wou ld be blu rry, whic h makes it hard to s ee any
abnormality. Compres s ion als o redu c es the amou nt of radiation requ ired for the mammogram.
E F FECTS
• Afte r e ffe cts ar e r ar e . Yo u m ay e x pe r i e nce br e ast te nde r ne ss, br ui si ng o r , ve r y o ccasi o nally, m i no r spli tti ng
o f the sk i n i f yo ur sk i n i s fr agi le . Ple ase te ll the r adi o gr aphe r who i s do i ng the te st i f yo u te nd to br ui se o r have
sk i n tha t br e ak s e asi ly.

R IS K
● L i k e a ll X- r ays, havi ng a m am m o gr am e x po se s yo u to so m e r adi ati o n, but o nly a sm all am o unt. Sci e nti sts
e sti m a te that the r e i s le ss than a 1 i n 2 5,000 r i sk o f a m am m o gr am causi ng br e ast cance r

● . T he H e a lth Pr o te cti o n Age ncy o f the Uni te d Ki ngdo m e sti m a te s the r i sk o f a n a ddi ti o na l ca nce r i n a li fe ti m e
fr o m a si ngle m am m o gr aphi c e x am i nati o n to be i n the lo w - r i sk r ange : 1 i n 100,000 to 1 i n 10,000.1 T he r i sk o f
de ve lo pi ng cance r fr o m a m am m o gr am i s no gr e ate r than de ve lo pi ng cance r fr o m e x po sur e to the natur al
ba ck gr o und r adi ati o n accum ulate d fr o m the no r m al e nvi r o nm e nt i n 1 ye ar .

● I f yo u ha ve br e a st i m pla nts, the r e i s a n e x tr e m e ly sm a ll r i sk o f da m a ge to the i m pla nt.

BE NEFITS
• Ea r ly de te cti o n i ncr e a se s the li k e li ho o d o f a ca nce r be i ng succe ssfully tr e a te d a nd o fte n a llo ws fo r gr e a te r
tr e a tm e nt o pti o ns.
Clinical Examination
(Padlan, Christine)
•C l i n i c a l e x a m i n at ion A p h y s i cal e xa m of t h e b r e a s t p e r f or med b y a h e a l t h c a r e p r ov ider
t o c h e c k f or l u m p s or ot h e r c h a n g es. A l s o c a l l e d C BE .

•Pe r f or m ed b y a t r a i n ed p h y s i ci an, c b e i s i m p or t a n t f or d e t ec ti n g b r e a st c a n c e rs .
C l i n i c a l b r e a st e x a m i n ati on i s a v e r y l ow - c os t t e s t t h a t c ou l d i m p r ov e t h e d e t e ct ion of
b r e a st c a n c er . F or p a t i en ts w i t h b r e a st s y m p tom s, a c b e h a s t o b e p e r f orm ed.
A Manual Check f or Unus ual Text ure or L umps

• Usi ng t he pad s of t he f in gers , y ou r he al th care pr ov ider che cks y our en ti re b reas t ,

u nde rar m , an d c ol la rb one area f or an y l ump s or ab n orm al it ies .

•A s us pi ci ous lu mp –t he t ype y ou r p hys ic ia n is c heck i ng f or – is ge ner al ly a b ou t t he s i ze

of a pea bef ore a ny one ca n fee l it i n t he b reas t t is sue . T he ma nu al e xa m is d one on one
s ide a nd t hen t he ot her . Y our hea lt hc are p r ov ide r w i ll al s o c heck the ly mp h n odes nea r
t h e b r e a st t o s e e i f t h e y a r e e n l a r ged
A Change In How The Breast Or Nipple Looks Or Feels

A Change In The Breast Or Nipple Appearance

Any Nipple Discharge Particularly Clear Discharge Or Bloody Discharge

Breast Self- Examination
(Francisco, Ma. Ivet)
- Che ck bo th si de s fo r lum ps o r thi ck e ni ngs abo ve and be lo w yo ur co llar bo ne . W i th hands so apy, r ai se o ne ar m
be hi nd yo ur he ad to spr e ad o ut the br e ast ti ssue . Use the flat par t o f yo ur fi nge r s fr o m the o the r hand to pr e ss
ge ntly i nto the br e ast. F o llo w an up - and - do wn patte r n, m o vi ng fr o m br a li ne to co llar bo ne

- A br e a st se lf - e x a m i s a ste p - by- ste p m e tho d wo m e n can use to e x am i ne the i r br e asts. By lo o k i ng at and fe e li ng

yo ur br e a sts r e gular ly, yo u can no ti ce anythi ng that se e m s abno r m al.Mo st lum ps and abno r m ali ti e s ar e n’t
ca nce r , but yo u sho uld sti ll r e po r t change s to yo ur do cto r .
W h at a r e t h e s t eps o f a b r east s e lf -ex am?

1.Visual inspection:

2. Manual inspection while standing up:

3.Manual inspection while lying down:
 H o w l o n g d o es a b r east e x am t a ke?
A br e a st se lf - e x am tak e s o nly a fe w m i nute s and can e asi ly be bui lt i nto yo ur dai ly sche dule . Yo u can do a br e ast
e x a m whe n yo u’r e :

•Dr e ssi ng fo r the day o r undr e ssi ng at ni ght.

•Lyi ng i n be d i n the m o r ni ng o r at be dti m e .

•T a k i ng a sho we r .

R i s k s o f a b r e ast s e l f - e xam

~ F i ndi ng a lum p i n yo ur br e ast can be alar m i ng, but a m ajo r i ty o f br e ast lum ps a r e n’t m a li gna nt, o r ca nce r o us.

~ Br e a st se lf - e x am s have also be e n asso ci ate d wi th an i ncr e ase i n unne ce ssar y br e ast bi o psi e s, whi ch ar e
pr o ce dur e s that i nvo lve the sur gi cal r e m o val o f br e ast ti ssue .

N o te:

Pe r fo r m i ng a m o nthly br e ast se lf - e x am wi ll he lp yo u m ai ntai n br e ast he alth and de te ct e ar ly si gns o f di se ase . Yo u

ca n i nco r po r ate the ste ps o f a br e ast e x am i nto yo ur r e gular r o uti ne , such as whe n yo u ge t r e ady fo r be d o r tak e a
sho we r . W i th e ach br e ast se lf - e x am , yo u wi ll be co m e m o r e fam i li a r wi th yo ur bo dy. W he n yo u k no w wha t’s no r m a l
fo r yo u, yo u wi ll be m o r e awar e whe n change s o ccur .
Thank you for
listening!
 Patient
Communication &
Preparation and
Infection Control
RAD 123 Mammography

Group 5
RAD 123 MAMMOGRAPHY GROUP 5

Patient
Communication
Aside from the performance of high quality imaging,

the most important service that a technologist can

provide for their patient is effective communication.

Effective, concise and accurate communication (and

education) of the patient can significantly lessen her

anxiety and improve her experience.

RAD 123 MAMMOGRAPHY GROUP 5

A screening patient should be asymptomatic or have

symptoms that are longstanding or have been worked
up previously and found to be benign.

Part of Diagnostic patients may be diagnostic based on

symptoms that the patient perceives, physical findings
effective that the referring clinician perceives, or based on a
past history that warrants a problem solving evaluation
communication (such as lumpectomy for malignancy).

involves
thorough and
accurate Accurate and detailed history taking in this instance ensures
that the correct examination(s) are performed for that

history taking. particular patient making the likelihood of a correct

diagnosis more likely. The technologist’s familiarity with the
specifics of these criteria is crucial to the accuracy of the
information.
RAD 123 MAMMOGRAPHY GROUP 5

Speaking the same This step is necessary to ensure that all

language avoids
data that would affect the outcome of

the examination (the radiologist’s

pitfalls in assessment as to the benignancy or

understanding suspicious nature of the evaluation) is

communicated to the radiologist.

Now that the technologist has

In this instance, speaking the “same
acquired the appropriate history
language” is important so that the
from the patient, the next step is to
information conveyed is interpreted with
accurately document and
the same level of understanding between
communicate the relevant
the two parties that are communicating.
information to the radiologist.
 Translating what patients say
into what they mean
An example of this would be the terms excisional biopsy versus lumpectomy. It is the

responsibility on the technologist to clarify with the patient what she means by

“lumpectomy” - which is a common description by patients who have had both

benign and malignant surgical procedures. Whether the patient has had a previously

documented cancer will affect the radiologist’s interpretation and may explain

other findings such as thickened skin or trabecular thickening that can be seen in

lumpectomy patient’s who have also had radiation therapy.

RAD 123 MAMMOGRAPHY GROUP 5

Visual communication with skin markers

assists with interpretation and clinical efficacy

Skin markers aid the If specific protocols THE TOP REASONS FOR
USING SKIN MARKERS
radiologist by for skin markers are
ARE:
providing a visual form consistently used 1. To clearly identify skin
of communication. By within a practice, the lesions and skin surface
abnormalities
following a consistent image interpretation
2. To provide an accurate
protocol for the use of for the radiologist
method of
skin markers, it can becomes more communication to the

effectively accurate and radiologist

3. To aid the radiologist in
communicate: nipples efficient; which is of
diagnosis
in profile, moles or course better patient
4. To highlight nipples,
raised skin lesions, care. moles, scars and masses

scars, palpable 5. To avoid unnecessary

callbacks and to reduce
masses and areas of
recall rates
concern.
RAD 123 MAMMOGRAPHY GROUP 5

Channeling what you do every day to

improve communication results in better
patient care.
Mammography technologists are uniquely positioned to act as the conduit of

communication and transference of knowledge between patient and radiologist.

Patients are often anxious at their exam due to the prospect of "something" being found

on their mammogram.

The fact remains that the majority of women undergoing breast evaluations will not be

diagnosed with cancer. However, symptoms of benign breast abnormalities are quite

common and impact many more lives. Accurately diagnosing and explaining these non-

cancerous conditions can alleviate much anxiety, in addition to helping patients towards a

correct treatment plan.

RAD 123 MAMMOGRAPHY GROUP 5

Patient Preparation
The following are the interventions and care considerations for a

patient indicated for mammography.

RAD 123 MAMMOGRAPHY GROUP 5

Before the Procedure

Explain the procedure and

what to expect after. Tell
the patient who will
perform the test and Allow the patient to
where it will take place. express concerns and
Remove interfering
Inform the patient that fears about the
factors. Instruct the
although the test takes procedure. Assess the
patient to avoid using
only about 15 minutes to patient’s understanding
underarm deodorant or
perform, she may be of the procedure, answer
powder on the day of the
asked to wait while the any questions, and
examination
films are checked to make correct any
sure they are readable. misconceptions.
Advise her that there’s a
high rate of false-positive
results.
RAD 123 MAMMOGRAPHY GROUP 5

Before the Procedure

Schedule a senior
technologist on a patient Prepare the patient. Just
with breast implants. If the before the test, give the
patient has breast patient a gown to wear
implants, notify him/her to
that opens in the front,
inform the staff when
and ask her to remove all
he/she schedules the
jewelry and clothing
mammogram so that a
above the waist.
technologist familiar with
imaging implants is on
duty.
RAD 123 MAMMOGRAPHY GROUP 5

Assist with patient positioning. Place patient in a standing

or sitting position in front of the X-ray machine, which is
adjusted to the level of the breast. Place the patient’s arms
out of the range of the area to be imaged.

During Tell the patient that some discomfort may be felt.

Pain/discomfort may be caused by the pressure required to

the compress the breast tissue against the X-ray plate.

Procedure
Advise the patient to cooperate completely and follow
directions. Instruct patient to remain still throughout the
procedure since movement produces unreliable results. Ask
the patient to hold breath while the x-ray films are being
taken.
RAD 123 MAMMOGRAPHY GROUP 5

After the procedure

Provide information Assist the patient in

about the availability
arranging an
of the results. Inform
Reinforce the information
the patient a report additional test,
given by the patient’s
of the findings will be
HCP. therapy, or referral to
given to the
requesting physician, another HCP if an

who will discuss the

abnormality is found.
results with the
patient.
RAD 123 MAMMOGRAPHY GROUP 5

Infection control procedures of the health

Disinfection/
system should be followed, including hand infection
prevention and
washing and cleaning the unit, the

compression paddle and the room.

control:
Special consideration should be given to

appropriate sanitizing processes after the

exposure of equipment to bloody or bodily

fluid, for potential contamination of the

machine and to avoid the transmission of

infections.

Countries with no infection control

guidelines can follow those issued by the

WHO.
RAD 123 MAMMOGRAPHY GROUP 5

The End.
Thank you for listening!
PATIENT COMMUNICATION AND
PREPARATION

MAMMOGRAPHY EQUIPMENT
Mammography is a radiographic (X ray) procedure optimized for
examination of the breast

Highly effective means of detecting early-stage breast cancer

Mammography is used both for

• Investigating symptomatic patients (diagnostic mammography)

• Screening of asymptomatic women (selected age groups)

How should I prepare for the
mammogram?
✓Do not wear deodorant, talcum powder or lotion under your
arms or on your breasts on the day of the exam. These can
appear on the mammogram as calcium spots.
✓Describe any breast symptoms or problems to the technologist
performing the exam.
✓Obtain your prior mammograms and make them available to the
radiologist if they were done at a different location. This is
needed for comparison with your current exam and can often be
obtained on a CD.
✓Ask when your results will be available; do not assume the
results are normal if you do not hear from your doctor or the
mammography facility.
What does the mammography
equipment look like?
A mammography unit is a rectangular
box that houses the tube in which x-
rays are produced. The unit is used
exclusively for x-ray exams of the
breast, with special accessories that
allow only the breast to be exposed to
the x-rays. Attached to the unit is a
device that holds and compresses the
breast and positions it so images can
be obtained at different angles.
 How does the procedure work?

X-rays are a form of radiation like light

or radio waves. X-rays pass through
most objects, including the body. Once
it is carefully aimed at the part of the
body being examined, an x-ray machine
produces a small burst of radiation that
passes through the body, recording an
image on photographic film or a special
detector.
How is the procedure performed?
During mammography, a specially qualified radiologic technologist will position
your breast in the mammography unit. Your breast will be placed on a special
platform and compressed with a clear plastic paddle. The technologist will
gradually compress your breast.

Breast compression is necessary in order to:

• Even out the breast thickness so that all of the tissue can be visualized.
• Spread out the tissue so that small abnormalities are less likely to be hidden
by overlying breast tissue.
• Allow the use of a lower x-ray dose since a thinner amount of breast tissue is
being imaged.
• Hold the breast still in order to minimize blurring of the image caused by
motion.
• Reduce x-ray scatter to increase sharpness of picture.
What will I experience during and after
the procedure?
You will feel pressure on your breast as it is squeezed by the
compression paddle. Some women with sensitive breasts may
experience discomfort. If this is the case, schedule the
procedure when your breasts are least tender.
Who interprets the results?
A radiologist a physician
specifically trained to supervise
and interpret radiology
examinations, will analyze the
images and send a signed report
to your primary care or referring
physician, who will discuss the
results with you.
What are the benefits vs. risks?
Benefits
• Screening mammography reduces the risk of death due to breast
cancer. It is useful for detecting all types of breast cancer,
including invasive ductal and invasive lobular cancer.
• Screening mammography improves a physician's ability to detect
small tumors. When cancers are small, the woman has more
treatment options.
• The use of screening mammography increases the detection of
small abnormal tissue growths confined to the milk ducts in the
breast, called ductal carcinoma in situ (DCIS).
• No radiation remains in a patient's body after an x-ray
examination.
• X-rays usually have no side effects in the typical diagnostic range
for this exam.
Risks

• There is always a slight chance of cancer from excessive

exposure to radiation. However, the benefit of an accurate
diagnosis far outweighs the risk.
• False Positive Mammograms. Five percent to 15 percent of
screening mammograms require more testing such as additional
mammograms or ultrasound. Most of these tests turn out to be
normal. If there is an abnormal finding, a follow-up or biopsy
may have to be performed.
• Women should always inform their physician or x-ray
technologist if there is any possibility that they are pregnant.
X-RAY EQUIPMENT
Specialized gantry to accommodate the breast
• Rotation and vertical movement
Specialized beam geometry
• Improves visualization of chest wall edge
INDICATIONS
✓Screening of asymptomatic women
✓Screening of high risk women.
✓Follow up of patients after mastectomy of same and opposite
breast / same breast with implant .
✓Investigations of benign breast diseases with eczematous skin,
nipple discharge , skin thickening .
✓Investigation of a breast lump
✓Male breast evaluation .
MAMMOGRAPHY EQUIPMENT
• Generator
• Xray tube – fine focus of 0.2-0.5 mm with an additional 0.1 mm
focus for magnification .
• Target – Molybdenum and Rhodium
• Beryllium window – Minimizes absorption of radiation within the
tube .
• Molybdenum filter – By transmitting only characteristic radiation
,absorbs unwanted radiation and forms a monoenergetic beam.
Compression device : 1-4 mm thick plastic plate
TARGET
The xray tubes are designed with Tungsten ,Molybdenum, Rhodium
targets .

Tungsten target is operated under 30 kVp with a 0.5 mm Al filter –

Brehmsstrahlung and 12 keV L-shell characteristic xrays .

Molybdenum target with Mo/Rh filter is more suitable for

mammography .

Rhodium target filtered with Rh filter gives a similar spectrum as

molybdenum .
FILAMENT
Positioned within a focusing cup with two focal spot sizes .
Filament types are either double wound/flat ribbon/circular
filament .
Focal spot size is very critical in mammography where high
spatial resolution is required .
Small focal spot is used with small anode angle , which permits
the use of high mA factors .
Usually the cathode is positioned towards the chest wall , which
makes patient positioning east and takes care of the heel effect .
FILTERS
Thin beryllium window or borosilicate glass window is used to
reduce inherent filtration , since it offers low attenuation .

For a tungsten target Xray tube , Mo or Rh filter is recommended

In case of Rhodium target Xray tube , Rhodium filter of 0.025 mm

is used which gives high quality xrays with higher penetration .

Combination is suitable for thicker and dense breast imaging .

GRIDS
Oscillating grids are used
Grid ratio of 4:1 or 5:1
The grid lines are eliminated by the motion of the grid .

Grids improve the image quality

COMPRESSION PADDLE
• Decreases the thickness of the breast , thus reduces the
scattered radiation –improves the contrast .
• Decreases the kinetic blur .
• Reduces geometric unsharpness by homogenously bringing the
object close to the film .
• Makes breast thickness uniform in film density.
• Differentiates the easily compressible cysts and fibro- glandular
tissue from the more rigid carcinomas
• Separates the super imposed breast lesions .
• Reduces radiation dose to the breast tissue .
The compression device is parallel to the receptor surface .
Radiolucent plate that is flat and parallel to the support table .
Should match the cassette size
CRANIO-CAUDAL VIEW
CRANIO-CAUDAL VIEW

The casette is placed under the breast at

the level of the inframammary fold .
The breast is then pulled until the
inframammary fold is taut .
Compression is applied and Xray beam is
directed vertically from above .
Postero medial aspect should also be
included .
 MEDIOLATERAL OBLIQUE VIEW
Best view to image all of the breast tissue and the
pectoral muscle .
The C-arm of the mammographic unit is rotated to
45 degree so that the cassette is parallel to the
pectoral muscle .
The film holder is kept high up in the axillary fossa
and the patient’s arm is abducted at the elbow by
80degrees.
The xray beam enters the breast from the medial
side
compression is applied to the pectoralis major
muscle .
SUPPLEMENTARY VIEWS
Lateral projections (mediolateral/lateromedial)
2. Extended craniocaudal projection
3. Cone down compression view 4. 90 degrees lateral view and
angled craniocaudal views
5. Tangential views in palpable masses
6. Spot and magnification views
7. Cleavage view
8. Modified compression technique .
MAMMOGRAPHY
FINALS
It is now widely recognized that high quality mammography coupled
with careful physical examination can lead to detection of breast cancer
at an early stage when its is most curable.
Cancer is the abnormal, uncontrollable , continuous replication of cells
which will inevitably lead to the formation of a tumor.
BREAST CANCER
✓Forms in the tissues of the breast.

✓Spreads mainly through the Lymphatic system

BREAST TUMORS
Malignant
Cancerous

Benign Cancerous
Not - Cancerous
BREAST CANCER
Invasive
✓ Cancerous
✓ Malignant
✓Spreads to other organs (metastasis)
Non - Invasive
✓Pre – Cancerous
✓Still in its original position
✓ Eventually develops into invasive breast cancer.
TYPES OF BREAST CANCER
• Ductal Carcinoma
• Inflammatory Breast Cancer (IBC)
• Lobular Carcinoma
Inflammatory Breast Cancer (IBC)
Uncommon (1% to 3% of all breast cancers)
Invasive Brest Cancer.
No lump or tumor.
Mistaken for infection in its early stages.
IBC makes the skin of the breast look red and feel warm.
It also may make the skin look thick and pitted and may have an orange
peel feel.
The breast may get bigger, hard, tender, or itchy
DUCTAL CARCINOMA IN SITU
Non – invasive contained within the milk ducts
May become invasive (pre – cancer).
INVASIVE DUCTAL CARCINOMA
Most common breast cancer.
Accounts for about 8 out of 10 invasive breast cancers.
Lining of the ducts
Grows /invades the breast tissues Spreads to lymph nodes Other
organs
Lobular Carcinoma In Situ
Non – Invasive
Contained in the lobules and does not spread to the tissues of the
breast.
Invasive lobular carcinoma
May become malignant .
About 1 in 10 Invasive breast cancers are ILC.
Formed in the lobules.
Grows through the wall of the lobules.
Spreads
Risk factors increases your chances of having breast cancer but does
not causes it. Breast cancer results from the abnormal, uncontrollable
replication of cells of the breast.
Diagnostic tests and procedures for breast cancer include:

Breast exam
Mammograms
Breast ultrasound
Breast MRI scan
Biopsy
Mammogram
An x-ray of the breast. It uses a very small amount of radiation.

A technologist will position your breast for the test. The breast is
pressed between 2 plates to flatten and spread the tissue. The pressure
lasts only a few seconds while the picture is taken. The breast and
plates are repositioned and then another picture is taken. The whole
process takes about 20 minutes.
ULTRASOUND
Uses sound waves to outline a part of the body.
The sound wave echoes are picked up by a computer to create a
picture on a computer screen.
Used to investigate areas of concerns found by a mammogram.
MAMMOGRAM
Use magnets and radio waves.
Cross-sectional images of the body.
MRI scans can take a long time. Used if view areas of concern found on
a mammogram.
BIOPSY
A biopsy is done when other tests show that you might have breast
cancer. It confirms if a mass is cancerous or not. Mass is removed and
studied.

• Fine needle aspiration (FNA) biopsy

• Core needle biopsy
• Vacuum-assisted biopsies
• Surgical (open) biopsy
• Lymph node biopsy
Fine needle aspiration (FNA) biopsy
Very fine needle is used.
Extracts fluid from the lump.
Guided by ultrasound.
Simple but is not 100% accurate.
Core needle biopsy
Needle is larger than in fine
needle biopsy.
Removes more tissues.
Clearer results.
Vacuum-assisted biopsies

The skin is numbed and a small cut

(incision) is made.
A hollow probe is put through the
cut into the breast tissue.
A piece of tissue is sucked out.
Surgical biopsy
Anesthesia is administered.
Incision is made.
Part or whole lump is extracted
and studies.
STAGING OF BREAST CANCER
The TNM staging system

This system takes into account:

the tumor size and spread (T), whether the cancer has spread to lymph
nodes (N) and whether it has spread to distant organs (M) for
metastasis
STAGING OF BREAST CANCER

Stage 0 : Non – Invasive breast cancer. Has not spread to breast tissues.
Stage l : ≤ 2cm and has not spread to lymph nodes.
Stage ll Stage llA: ≤ 2 cm and has spread to lymph nodes or 2-5 cm and has spread to lymph nodes.
Stage llB: 2-5 cm and has spread to lymph nodes or > 5 cm and has not spread to lymph nodes.
· Stage lll Stage lllA: ≤ 5cm and spread to lymph nodes forming clumps or >5 cm and spread to
lymph nodes without forming clumps.
Stage lllB: Any size and spread to the skin or chest wall. Swelling.
Stage lllC: Any size , spread to lymph nodes, skin and chest wall.
Stage lV: Metastasized
SURVIVAL RATES
Various factors of breast cancer treatment
The type of breast cancer
The stage and grade of the breast cancer
How large the tumor is, whether or not it has spread
Whether or not the cancer cells are sensitive to hormones
The patient's overall health
The age of the patient
The patient's own preferences
Treatment options
Surgery
Radiation therapy
Biological therapy (targeted drug therapy)
Hormone therapy
Chemotherapy