Simulation of Breast Cancer

To the Editor.—  In their recent article, "Breast Carcinoma Simulation" (229: 682, 1974), Stolz et al discussed a patient whose congestive heart failure produced mammographic skin changes usually associated with malignancy.We also have observed these phenomena in a 66-year-old diabetic woman treated with dialysis because of dependent chronic renal failure and congestive heart failure. The patient was hospitalized for approximately three weeks when mastodynia developed with marked pitting edema of the areolae. Xeromammography was performed (Fig 1, top) and the patient was then instructed to wear a brassiere for continuous support 24 hours a day. Xeromammography was then repeated after four days (Fig 1, bottom), with marked resolution of the problem as shown by the decreased edema.While we are in complete agreement with Stolz et al that these phenomena are quite impressive when observed, we believe that xeromammography offers as good or better illustration of skin edema, thus