2. In The Name of God BREAST IMAGING N. Ahmadinejad Medical Imaging Center TUMS

3. BREAST IMAGING Screening Screening Diagnostic Diagnostic

4. Mammography An excellent detection technique

5. Mammography is early detection Not prevention WHO Principles of Screening Disease is serious and prevalent; Test is sensitive, specific, well tolerated, cheap, changes therapy or outcome The goal of screening for breast cancer is not to detect all breast abnormalities; the goal is to prevent deaths from breast cancer

6. Minimal Carcinomas All invasive carcinomas measuring less than 1cm. All invasive carcinomas measuring less than 1cm. All in situ carcinoma All in situ carcinoma

10. Lead time for mammographic detection range from2 to 4 or more years before a lesion becomes clinically evident Lead time for mammographic detection range from2 to 4 or more years before a lesion becomes clinically evident

11. Screening Guidelines ACS  Women at average risk: Ages 20 to 39 Ages 20 to 39 ○ clinical breast examination at least every three years Age 40 and over Age 40 and over ○ annual screening mammography and clinical breast exam Breast self-exam (BSE) is an option for women starting in their 20s Breast self-exam (BSE) is an option for women starting in their 20s Elderly women Elderly women ○ continue screening as long as woman is in reasonably good health and would be a candidate for cancer treatment 6/4/201610

12. BC Screening Interval US: American Cancer Society, American Medical Association: annual screening by the age of 40 Y US: American Cancer Society, American Medical Association: annual screening by the age of 40 Y National cancer institute: every 1-2 Y National cancer institute: every 1-2 Y Biennale screening in Canada, Australia and much Europe Biennale screening in Canada, Australia and much Europe Sweden: 18 mo. 40-49 and 24 mo. Sweden: 18 mo. 40-49 and 24 mo. grater than 50 grater than 50 UK: every 3 Y UK: every 3 Y

13. Screening Guidelines ACS High Risk Patients  Known BRCA1 or BRCA2 mutation  First degree relative with BRCA1 or 2 and no testing themselves  Radiation therapy to the chest between the ages of 10 and 30 yrs  Have Li-Fraumeni, Cowden, or hereditary diffuse gastric syndromes, or a first degree relative with one of these syndromes  Risk assessment tools> 20% lifetime 6/4/201612

14. Women who have a mother or sister with premenopausal BC being screening 5-10 Y earlier than the age at which the immediate relative was diagnosed Women who have a mother or sister with premenopausal BC being screening 5-10 Y earlier than the age at which the immediate relative was diagnosed

15. Mammography: Pros *7 randomized trials demonstrate that there is a relative risk reduction in BCM by 20-30%, depending on age *Smaller cancers are less likely to metastasize, thus prognosis for a small tumor is better *Smaller cancers are amenable to breast conservation, and more cosmetic *Smaller cancers are amenable to breast conservation, and more cosmetic outcome than if tumors are larger

16. It is not diagnostic unless The lesion has the typical characteristics of a malignant or benign mass

18. spiculated

20. MAMMOGRAPHIC PROJECTION STANDARD VIEWS STANDARD VIEWS Medio Lateral Obliqe (M.L.O) Medio Lateral Obliqe (M.L.O) CranioCaudal(cc) CranioCaudal(cc) ADDITIONAL VIEW ADDITIONAL VIEW 90-Degree lateral 90-Degree lateral Spot Compression Spot Compression Magnification Magnification Exaggerated Cranio Caudal Exaggerated Cranio Caudal Cleavage Cleavage Axilary Tail Axilary Tail Tangenital Tangenital Roll Roll

21. Techniqual aspect Techniqual aspect Positioning Positioning Evaluation Evaluation Interpretation Interpretation

22. Digital Mammography Improved breast cancer detection over analog (film-screen) mammography for: Improved breast cancer detection over analog (film-screen) mammography for: Women with dense breasts Women with dense breasts Women under 50 Women under 50 Premenopausal women Premenopausal women Lower radiation dose Lower radiation dose No increase in false positive rate No increase in false positive rate Expensive Expensive