Mammogram – Breast

00:01 A common procedure for women is a mammogram and a mammogram can be used to kind of help us understand the various tissue elements that exist in the breast and how you might interpret the mammogram based on those tissue components. Here, we have a mammogram of a normal breast. A younger woman, 23 years of age. In younger women, adipose tissue is scarce and that means the breast is occupied by more fibroglandular components and those fibroglandular components are dense. And so, on mammography, the fibroglandular elements will form white condensations. The grayer areas here are made of up of less dense tissue such as adipose tissue. And as a woman ages, the relative abundance or proportions of these tissue elements will change. Older women will have more adipose tissue and less glandular tissue. And here we have an older woman. This is normal as well. She happens to be 47 years of age, but you can see in this image that while we still have some dense whitish regions within the breast, these aren't as numerous as are the grayer areas that we see outside of these whitish or brighter regions.

01:40 Now here, we're seeing another mammogram, but in this case, we're seeing breast cancer.

01:52 This is the most common cancer in women, excluding nonmelanoma skin cancers. And here, we can see a density or condensation. It has irregular borders to it and in an older woman with less fibroglandular tissue and more adipose tissue, it's easier to see the white condensations of a malignancy. If you think back to a younger woman, where you have greater density, the greater density can obscure and make it more difficult to identify breast cancer. But, in older women with breasts that are less dense, it is easier to see this irregular pattern on a mammogram. And you may also see, in a cancerous region of the breast, you may see some calcifications. Calcifications can also occur as a part of normal aging.

03:00 When we think about breast cancers, let's think about where breast cancers most frequently form. And in order to understand that, we'll have to divide the breast into quadrants.

03:13 Two lines will allow us to do that and these are going to be intersecting lines that occur at the nipple. We'll have a vertical line that would go down the nipple and then we'll run a horizontal line perpendicular to that vertical line, but also through the nipple.

03:32 By doing so, we'll have a lateral upper quadrant, a medial upper quadrant, a medial lower quadrant and a lateral lower quadrant. 50% of breast cancers are going to occur in the lateral upper quadrant. The other three quadrants, medial upper, medial lower and lateral lower, you're looking at a rate of about 10% in each of those. That brings us up to a total of 80%. 20% of the other breast cancers are going to be located in the more central location of the breast.