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Case number:	023
Age:	68
Clinical presentation:	Postmenopausal woman presented with left axillary pain. She had an increased risk of developing breast cancer because of a family history of breast, ovarian, and rectal cancer.

Mammography:

Breast composition:	ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:
‣ Location of the lesion:	Left breast, lower outer quadrant at 4 o’clock, middle third
‣ Mass:
• Number:	0
• Size:	None
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	Round
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	Left breast, lower outer quadrant at 4 o’clock, middle third
‣ Mass:
• Number:	0
• Size:	None
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	Round
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

BI-RADS:

BI-RADS Category: 1 (negative)
BI-RADS Category (Follow-up): 1 (negative)

Case summary:

Postmenopausal woman with increased risk of developing breast cancer presented with left mastalgia. Diagnosed as BI-RADS 1 on imaging in 2001 and 2016.

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.