Mammography Flashcards
Breast cancer Statistics
- most common cancer among Canadian women (excluding non-melanoma skin cancers)
- 2nd leading cause of death from cancer for Canadian women
Mammography
used for DETECTION
diagnosis- confirmed by a pathologist
Anatomy of the breast
- fibrous, glandular, adipose
- Muscles – pectoralis major and serratus anterior
- Axillary tail
- Lobes 15-20
- Cooper’s Ligaments (fibrous)
- Lymphatic vessels
Breast tissue
- constantly changing with monthly and life cycles
Glandular
most sensitive to radiation, cancer arises from this type
Distribution changes with hormones, drugs, ageing
Somewhat determined by genetics
Fibrous
semi-elastic
Fat
atrophy of glandular tissue
Breast tissue categories
Three categories:
Fibro-glandular – young breast, pregnant or lactating
Fibro-fatty – more equal distribution of glandular and fat, usually 30-50 year olds
Fatty – post menopause 50+, males
Soft Tissue Radiography
mainly muscle and fat
very little subject contrast so we use a low kV to increase contrast
promote photoelectric effect
compress the breast to decrease the Compton effect
NS Breast Screening Guidelines
Age 40-49 annual screening recommended
Age 50-74 screening at two-year intervals (or annually if higher risk)
Age 75 and older – continue screening if in good health
May be referred for diagnostic imaging by a physician if symptomatic, regardless of age, sex
Breast imaging preparation
No deodorant or lotions Hospital gown No caffeine (could increase breast tenderness)
Breast Imaging: History
Scheduling of appointment Age Previous mammogram Screening or diagnostic # of pregnancies, breast feeding Hormone therapy First/last menstrual period Birth control
Compression
25-40 lbs of force Decreases part thickness Decreases scatter Decreases exposure Increases contrast Reduces motion Reduces superimposition Improves object/IR contact
Augmented Breast
The rate of cancer detection is lower Complications include: Increased fibrous tissue surrounding the implant Hardening Rupture Pain
Augmented breast: imaging
- Routine 2 images per breast is incomplete
- Suggested 4 images per breast
- CC, MLO demonstrates posterior and superior aspects
- Eklund technique CC and MLO will displace implant (extra views)
- Exposure factors will be significantly different (AEC not recommended)
- US and MRI are frequently used
Male Breast Mammography
- Incidence is about 1% of breast cancers
- Mammography often indicated by gynecomastia
- Routine CC and MLO or reverse projections, CC and LMO
Other Modalities
Ultrasound
- If there is a palpable mass and the mammo shows dense glandular tissue or smooth outline, non-palpable mass
- Can be used as a guide for biopsy
MRI
-when breast tissue is dense, fibrocystic or for implants
Nuclear Medicine Sentinel node studies PET metabolism of FDG, metastatic disease PET/CT or CT
Breast cancer- risk factors
Female Age Family/personal history Early menarche Late menopause No pregnancy, pregnancy after 30 BRCA1, BRCA2 Radiation exposure Dense breasts Oral contraceptives Alcohol consumption Obesity post-menopause
NO LINK TO BREAST CANCER: Deodorant/antiperspirants Abortion Breast implants Bras
