Mammography Study Notes

Presentation by Louise McKendrick
Focus on breast health, anatomy, imaging techniques, pathology, and breast cancer management.

The breast is composed of three types of tissue:
  - Fibrous Tissue:
    - Includes ligaments and connective tissues.
  - Glandular Tissue:
    - Comprises lobes, lobules, and milk ducts.
  - Fatty Tissue:
    - Also referred to as adipose tissue.
Structural components visible in imaging:
  - Connective Tissue: Appears as white lines.
  - Glandular Tissue: Appears as white areas.
  - Fat: Appears as dark areas.
Pectoralis Major Muscle: Identified in images as a white triangle.

Crucial for effective imaging.
Key features:
- Shows tissue adjacent to the chest wall and the axillary tail.
- The inferiomedial aspect of the breast often excluded.
Quality Assessment Criteria:
  - Medial border imaged per local protocols.
  - Inclusion of some axillary tail.
  - Nipple appears in profile.
  - Appropriate exposure settings used.
  - Adequate compression applied.
  - Skin fold free images ensured.

Views:
- Left Mediolateral Oblique (LMLO)
- Right Mediolateral Oblique (RMLO)

Benefits of Compression:
  - Spreads out dense fibroglandular tissue making it easier for radiologists to visualize abnormalities.
  - Minimizes the risk of overlapping tissue that may mimic masses or abnormalities.   - Reduces motion artifacts caused by patient movement or breathing, leading to clearer images.
  - Improves visualization of calcifications, which can indicate early breast cancer.
  - Less radiation exposure required with enhanced image quality through adequate compression.

Features:
  - Ill-defined edges.
  - Spiculated appearance.
  - Stellate shapes.
  - High density.
  - Presence of microcalcifications, which may indicate early breast cancer.

Target Population:
- All women invited within three years of their 50th birthday.
- Utilizes static centers and mobile units.
Screening intervals:
- Every three years until age 70 (self-referral possible afterwards).
Patient Expectations:
- Low likelihood of sinister findings.
- Patients may exhibit less anxiety and cooperativeness.
Action on Suspicious Findings:
- Further investigations initiated upon detection of abnormal results.

Patient Initiative:
- Patients self-identify lumps and visit a GP for referral.
- Imaging (ultrasound or mammogram) is prescribed based on age characteristics (ultrasound preferred for younger, denser breasts).
Patient Awareness:
- Aware of the potential for sinister findings, leading to higher anxiety levels.
- Typically very cooperative.
Follow-up Procedures:
  - Post-imaging biopsy may be conducted; results scrutinized for confirmation of cancer.
  - If cancer is confirmed, further imaging and sentinel lymph node biopsy planned.
  - The patient will undergo appropriate treatment options.

Treatment Options:
  - Combination therapies including:
    - Chemotherapy (FEC-T).
    - Radiotherapy.
    - Mastectomy or lumpectomy.
    - Herceptin therapy.
    - Hormone therapy for 10 years post-cancer (e.g., Letrozole, Tamoxifen).
Follow-Up Protocol:
- Imaging is conducted following a local protocol: every 3 months, then 6 months, and subsequently yearly.