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Atlas of breast cancer early detection

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Case number:022
Clinical presentation:Postmenopausal woman presented with left nipple inversion that she had had for many years.


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Left inverted nipple
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Inverted nipple


BI-RADS Category: 1 (negative)

Case summary:

Postmenopausal woman with inverted nipple presented for mammography screening. Diagnosed as BI-RADS 1 on imaging.

Learning points:

  • Screening mammography every 2–3 years helps in the early detection of breast cancer and reduces breast cancer mortality. Serial follow-up mammograms reveal the age-related physiological and morphological changes in breast parenchyma.
  • Comparison with earlier mammograms shows involuting breast parenchyma. Breast involution begins many years before menopause and continues into the postmenopausal stage. Glandular atrophy through involution changes the breast density from heterogeneous dense glandular tissue to predominantly fatty breasts as is seen in the follow-up mammogram.

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