Project Objective

This site is designed to instruct medical students in the rudiments of mammogram analysis.  This site is also designed to be interactive.  Mammogram images are presented on-line and the viewer is asked to intepret the images for possible abnormalities.  In addition to web-based images for user analysis, teaching modules are available which hopefully will foster in the user a basic understanding of mammograms and how to approach its interpretation in a systematic manner.

This project is sponsored by the   Molson Informatics Project   of   McGill Faculty of Medicine.

The Importance of Mammography in the Early Detection of Breast Cancer and Guidelines

In the year 2000, an estimated 182,800 new cases of breast cancer were diagnosed in American women with approximately 40,800 deaths.¹. As the second leading cause of cancer-related mortality in American women, it is crucial that breast cancer be detected in its earlier and more curable stages of development. 

Mammography has been used as a screening and diagnostic tool for the early detection of breast cancer.  As a screening tool, mammography has proven to be effective for women 50 to 75 years of age.² For women in the age group 40 to 49, its effectivess as a screening test³ is more controversial.⁴ Earlier studies showed no improved survival rates in women aged 40-49 with screening mammograms,⁵ but recent studies now show a significant reduction in mortality rates within this age group.⁶ A recent meta-analyses concluded that screening mammography in women aged 40-49 years reduces breast cancer mortality by 16-18%. ⁷

AAFP	Every 1 to 2 years, ages 50-69; counsel women ages 40-49 about potential risks and benefits of mammography and clinical breast examination.
ACOG	Every 1 to 2 years starting at age 40, yearly after age 50.
ACS	Annually after age 40.
AMA	Every 1 to 2 years in women ages 40 to 49; annually beginning at age 50.
CTFPHC	Every 1 to 2 years, ages 50 to 59.
NIH	Data currently available do not warrant a universal recommendation for mammography for women in their 40s; each women should decide for herself whether to undergo mammography.
USPSTF	Every 1 to 2 years, ages 50 to 69.

AAFP = American Academy of Family Physicians; ACOG = American College of Obstetricians and Gynecologists; ACS = American Cancer Society; AMA = American Medical Association; CTFPHC = Canadian Task Force on Preventive Health Care; NIH = National Institutes of Health; USPSTF = U.S. Preventive Services Task Force.

Organizations that Recommend Routine Screening	Organizations that Do Not Recommend Routine Screening
National Cancer Institute American Cancer Society American College of Radiology American College of Obstetricians      and Gynecologists American College of Surgeons	American College of Physicians US Preventive Services Task Force American Academy of Family Physicians Canadian Task Force on Periodic Health Exams National Institutes of Health Consensus Panel

80 - 85% of breast cancers can be seen on a mammogram as a mass, calcification, or a combination of both.¹⁰ The specificity of distinguishing benign from malignant lesions on mammography is 50 - 60%.¹⁰ A false negative result has been reported in 10 - 15% of patients with palpable masses.¹¹ A false negative rate of 8.6% has been reported in patients who subsequently were diagnosed with cancer at an average delay of 45 weeks.¹²

How To Use This Website

Start with the TUTORIAL & CASES Page. From there one can access the individual tutorial topics on how approach in a systematic manner the interpretation of a mammogram. An index of cases can also be accessed from this page whereby mammogram images are presented. Upon choosing a case the user will be presented with mammogram images from a hypothetical patient. The user will have the ability to increase the mammogram images to its original size. After analysis of the images, the user will be able to check a number of choices which correlate with the interpretation of the images.  The user must note the location of the possible abnormality, and upon submitting his or her choices, he or she will be presented with the results of his or her interpretations.

To begin, click on the link to the TUTORIAL & CASES page below. There, the user can access the available cases as well as the brief tutorials on how to view and what to look for in a mammogram.

TUTORIAL & CASES PAGE

This Site Is Under Continual Revision and Construction

We have tried to make this web-site as realistic as possible to actually reading a mammogram in a clinical setting.  However, the limitations of the internet cannot be discounted in presenting a subject matter of this magnitude.  We have tried to select the best images that may be viewed in the size that it is presented, and the larger images may take some time to download.  Furthermore, it is not possible to select every possible cases that may arise clinically; but we have tried to select cases with the intention of providing an introduction to mammogram analysis.  Needless to say, it is not possible to present or to learn everything that one needs to know about mammography interpretation from this website. However, in scratching the surface of this important subject matter, we hope that the user will attain the working basics in analyzing a mammogram.

We welcome any and all suggestions and comments about our site.