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Case number:	138
Age:	64
Clinical presentation:	Postmenopausal woman with increased risk of developing breast cancer in view of family history of breast cancer presented for mammography screening.

Mammography:

Breast composition:	ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:
‣ Location of the lesion:	None
‣ Mass:
• Number:	0
• Size:	None
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	Round, fat necrosis
• Suspicious:	None
• Distribution:	Diffuse
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Ultrasound:

Ultrasound features: None
‣ Mass
• Location:	None
• Number:	0
• Size:	None
• Shape:	None
• Orientation:	None
• Margins:	None
• Echo pattern:	None
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

BI-RADS:

BI-RADS Category: 2 (benign)

Case summary:

Postmenopausal woman with increased risk of developing breast cancer presented for mammography screening. Diagnosed as typically benign calcifications in diffuse distribution in both breasts, BI-RADS 2 on imaging.

Learning points:

Mammography screening in high-risk women is recommended to start at an earlier age than in women with average risk. Some postmenopausal woman may have extremely dense breasts because of the unopposed estrogen influence, which lowers the sensitivity of mammography. They undergo supplementary breast ultrasound to look for small masses that may be obscured by the extremely dense breast parenchyma.