Having participated this lecture, the physicians should be

able to:

Learn the skills necessary for reading the mammograms of asympto-matic women.

Be familiar with the varying appearances of a normal mammogram.

Be able to guide the diagnostic workup using mammography, ultra-sound and interventional methods.

The breast can have five structurally different parenchymal patterns. These patterns can affect the detectability of small breast cancers.

Use of a systematic search method which emphasizes the regions on the mammogram where breast cancer is most likely to occur.

Detection of small breast cancers can be improved by understanding of the mammographie parenchymal patterns and how they influence lesion perception.

Thorough knowledge of the appearance of the various types of breast cancer.

Three biological factors can limit the efficacy of mammography screening:

-the more radiopaque breast tissue can obscure small breast cancers.

-some types of breast cancer can be difficult to perceive on the mammogram.

-if not detected early, cancer tends to dedifferentiate to a more mali-gnant grade.

Early detection of breast cancer with high quality mammography screening and treatment at an early stage has succeeded in lowering the death rate from breast cancer by nearly 50% among women who have attended screening regularly. The challenge of successful screening should be met with a commitment to master the complexities of image production, the variations in normal breast anatomy, the heterogeneity of breast diseases, and the progressive nature of breast cancer. In our experience, competence in breast image interpretation can be best achieved by direct comparison of mammogra-phic/ultrasound/MRI images with large-section histology and subgross, thick-section (3D) histology images of large, contiguous tissue samples containing the lésions. This lecture provides an overview of the variants of normal breast anatomy and a systematic viewing technique to find breast cancer at its earliest détectable phase. Comparison of the mammographie finding with large section and subgross histologic images facilitates understanding of the underlying patho-physiologie processes leading to the imaging findings. These compa-risons will enable the radiologist to better differentiate normal from pathologie, improving bofh the sensitivity and specificity of mammographie interpretation. Early detection is best achieved by special training of both radiologists and radiology technologists in breast imaging, ideally by subspecialization.