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Case number:	030
Age:	55
Clinical presentation:	Postmenopausal woman presented for mammography screening with increased risk of developing breast cancer in view of family history of breast cancer.

Mammography:

Breast composition:	ACR category d (the breasts are extremely dense, which lowers the sensitivity of mammography)
Mammography features:
‣ Location of the lesion:	Mammography features - at age 40 years
‣ 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:	None

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	Mammography features - at age 55 years
‣ 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:	None

BI-RADS:

BI-RADS Category: 1 (negative)

Case summary:

Postmenopausal woman with increased risk of developing breast cancer presented for mammography screening. Diagnosed as BI-RADS 1 on imaging.

Learning points:

Follow-up mammogram in view of family risk show the physiological changes of breast parenchyma. Breast involution begins many years before menopause and continues into the postmenopausal years. Glandular atrophy through involution changes the breast density from extremely dense glandular tissue to predominantly fatty breasts, as is seen in the follow-up mammogram.