The need for storage, transmission, and archiving of medical images has led researchers to develop adaptive and efficient data compression techniques. Among medical images, x-ray radiographs of the breast are especially difficult to process because of their particularly low contrast and very fine structures. A block adaptive coding algorithm based on the discrete cosine transform to compress digitized mammograms is described. A homogeneous repartition of the degradation in the decoded images is obtained using a spatially adaptive threshold. This threshold depends on the coding error associated with each block of the image. The proposed method is tested on a limited number of pathological mammograms including opacities and microcalcifications. A comparative visual analysis is performed between the original and the decoded images. Finally, it is shown that data compression with rather high compression rates (11 to 26) is possible in the mammography field.