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Wednesday, May 21, 2008

Breast calcifications

This information is about breast calcifications. It explains what breast calcifications are, and how they are diagnosed.

What are breast calcifications?

Breast calcifications are small areas of calcium in the breast. They cannot be felt and can only be detected on a breast x-ray (mammogram). Calcifications are very common, and in most cases are harmless. There are two types:

Macro-calcifications are coarse calcium deposits in the breast. They look like large white dots or dashes on a mammogram. They are a natural result of breast ageing, and are found in about half of women over the age of 50, and in about 1 in 10 younger women. They may be caused by calcium deposits in a cyst, or in milk ducts, as women get older. They may also be the result of previous injuries or inflammation. Calcium in the diet does not cause calcifications.

Macro-calcifications are harmless. They are not linked with cancer and do not need any treatment or monitoring.

Micro-calcifications are tiny calcium deposits that show up as fine white specks on a mammogram. They are usually found in an area of the breast where cells are being replaced more quickly than normal. Usually, micro-calcifications are not due to cancer. However, in a small number of cases, a group of micro-calcifications seen in one area (a cluster), may be a sign of pre-cancerous changes in the breast, or of an early breast cancer.

If calcifications are seen on a mammogram

If your mammogram shows that there are calcifications, a person who specialises in reading x-rays and scans (such as a radiologist) will look at the size, shape and pattern of calcifications to decide if any further tests or investigations are needed.

If macro-calcifications are found, no further treatment is needed.

If micro-calcifications are found, you will usually be asked to have a close-up mammogram (magnification views) of the affected area. Depending on the results of this, your doctor may recommend:

  • no further action, as the changes are clearly not cancer
  • a biopsy – taking a small sample of tissue from the area so that it can be looked at under a microscope.

Breast biopsy

When calcifications are detected, there is usually no lump in the breast to show exactly where the calcification is, so a biopsy is taken using one of the following techniques:

Needle (core) biopsy using image guidance An ultrasound or a mammogram linked to a computer is used to produce detailed pictures (images) of the breast tissue. These images help the doctor to guide a needle to the area of the calcifications, so that samples of the tissue can be taken. The needle biopsy is done under a local anaesthetic, which numbs the area. The tissue that has been removed is then x-rayed to confirm that the area of calcification has been biopsied successfully.

Needle or wire-localisation with surgical excision This is usually only done when a core needle biopsy has been unsuccessful at removing enough of the calcification, or when the result is not clear. It is a two-stage procedure. Both stages usually take place on the same day, but occasionally localisation may be carried out on the day before the operation.

  • Localisation: You will have a mammogram to show the positions of the micro-calcifications within the breast. Local anaesthetic is injected into that area of the breast to make it numb. A thin wire is then usually inserted into the area of micro-calcifications and kept in place with a dressing. Alternatively, a small amount of radioactive drug (or tracer) is injected into the area of micro-calcification.
  • Excision: Using the wire or the radioactive tracer as a guide, the surgeon removes the area of tissue to be biopsied. This may be done under a local or general anaesthetic.

What the biopsy might show

Most micro-calcifications are shown by a biopsy to be non-cancerous (benign).

When breast cancer cells are detected, they tend to be either non-invasive ductal carcinoma in situ (DCIS) – cancerous changes in the milk ducts of the breast – or small early breast cancers that have not spread.

Your feelings

When a woman is told she has breast calcifications, her first reaction is often one of anxiety. Some women immediately think that they have cancer, but it is important to remember that most breast calcifications are benign and are not caused by cancer. If you have worries or concerns, you may it find it helpful to discuss these with your doctor or specialist breast nurse at the clinic, or to contact one of our specialist cancer nurses.

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