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Early-detection demo · Breast cancer

DCIS caught at BI-RADS 4B from screening mammography

Pleomorphic microcalcifications in a linear-branching distribution — high-grade DCIS suspected.

Patient: Maya · 47 · BRCA1 carrierModality: MMGRisk: high · 78/100
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01

Risk profile

What OCTON knew before the scan
Risk
78
high
Tier
high
Premenopausal · dense breasts (BI-RADS C) · paternal aunt with breast cancer at 52 · BRCA1 c.5266dupC pathogenic variant.
Contributing factors
  • BRCA1 pathogenic variant+35
  • Family history (first-degree)+18
  • Dense breasts (Type C)+12
  • Age 47+8
  • Nulliparous, age at menarche 11+5
Narrative

Maya's lifetime breast cancer risk is in the high-tier band (>40%) driven primarily by her BRCA1 variant. Annual mammography + breast MRI alternating every 6 months is recommended (NCCN Breast 2024, Category 1).

02

Scan + AI report

What MMG found · Right MLO + CC views, full-field digital mammography
MMG · DEMO
BI-RADS 4B
OCTON · scanning · live
conf 0.84
OCTON Impression · 84% confidence

Cluster of pleomorphic microcalcifications with linear-branching distribution in the upper-outer quadrant of the right breast (10 o'clock, ~6 cm from nipple). Morphology and distribution are highly suspicious for high-grade ductal carcinoma in situ (DCIS).

Findings
  • Pleomorphic microcalcifications in linear-branching distribution, ~12 mm cluster · Right breast, upper-outer quadrant, 10 o'clock12 mm
  • No associated mass or architectural distortion identified · Right breast
  • Left breast unremarkable; benign scattered calcifications only · Left breast
Differential diagnosis
  • High-grade ductal carcinoma in situ (DCIS)65%
  • Atypical ductal hyperplasia (ADH)18%
  • Invasive ductal carcinoma (small focus)12%
  • Benign secretory calcifications5%
Recommended actions
  • ▸Stereotactic vacuum-assisted core biopsy of the calcifications within 7 days
  • ▸Breast MRI to assess extent of disease (DCIS often more extensive than mammographic finding)
  • ▸Genetic counseling already documented; surgical consult for risk-reducing mastectomy discussion
Caveats
  • Final diagnosis requires histopathology; AI category is a screening signal not a diagnosis.
  • BRCA1+ patients have higher rate of contralateral disease — bilateral evaluation indicated.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Genetic counselling + risk-reducing surgery discussion
FrequencyAlready established · annual review
Startsage 25
NCCN Genetic/Familial High-Risk v1.2024
Monitoring
Diagnostic mammography + breast MRI
FrequencyAlternating every 6 months
Startsage 30
NCCN Breast Screening v1.2024 · BRCA carriers Category 1
Monitoring
Stereotactic core biopsy of right-breast calcifications
FrequencyWithin 7 days (urgent — current finding)
Startsage 47
ACR BI-RADS 4B management guideline
04

What changed

The early-detection win

On a routine annual screen, OCTON's clinical AI flagged a 12 mm cluster of pleomorphic microcalcifications that the prior-year baseline did not contain. The BI-RADS 4B classification triggered a same-week biopsy referral; histopathology returned high-grade DCIS confined to the duct — Stage 0. Maya was treated with breast-conserving surgery and adjuvant radiation; 5-year survival for DCIS is >98%.

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