The breast, at the level of resolution of mammography, is a fairly stable organ that does not change dramatically from year to year except as a repository of fat with weight fluctuations. Among many women however, it begins to involute long before menopause. If there are any changes, fibrous connective tissue and glandular elements are replaced by fat as the individual ages. Even when exogenous hormones are used, the parenchymal densities of the breast remain relatively stable over time. New masses, focal areas of increased density, new calcifications, or architectural changes require careful evaluation.
A comparison study should be from at least 2 years prior to the present examination to reduce the likelihood of overlooking a subtle change.
Cysts are the most common masses that appear over time. They may come and go, but these are found in a minority of women. They are frequently multiple and bilateral. The greatest problem with cysts is that a significant abnormality may be more difficult to appreciate because the tissues are obscured by the cysts. As with other possible abnormalities, spot compression and varying the projection may help to determine if there is a superimposed problem. Ultrasound is helpful in distinguishing cysts from solid lesions, but ultrasound should be targeted to a specific area and not used to survey the breast.
Fibroadenomas can enlarge over time. Fibroadenomas likely originate when the breast is developing, and it is unusual for a fibroadenoma to suddenly appear, since the breast tissues of women from age 30 years and older are likely to be undergoing involutional changes. Therefore, a new, solid mass should be viewed with suspicion.
A small percentage of women who are on hormone replacement therapy (HRT) may develop new breast tissue densities, but even this is uncommon. For this reason, a new density on a mammogram should be viewed with suspicion, and unless the new density can be directly linked to the use of hormones, diagnostic evaluation is usually indicated.
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