Q: I started having mammograms at 40 as a woman at average risk for breast cancer. This year, I received a notice from the radiologist that I have calcifications in my breast that need further imaging. Should I be worried?
A: While calcifications could be a cause for concern and need further investigation, they’re actually a common mammographic finding and are most often noncancerous (benign). However, additional imaging and testing is often necessary, as they could indicate cancer.
Professional organizations recommend a mammogram to screen for breast cancer starting at various ages — but most average-risk women will be encouraged to start breast cancer screening with imaging between the ages of 40 and 50.
A mammogram is an X-ray taken of the breast tissue after it’s compressed between two plates. A radiologist reviews the imaging to determine whether there’s cause for concern or suspicion of abnormal breast tissue. This may sometimes be cancer — but could also represent benign breast findings.
Calcifications, or small groupings of calcium found in breast X-rays, are one of the most common findings in breast imaging. Calcifications have different characteristics that indicate whether they are benign or need follow-up or further testing. Breast radiologists are specially trained to distinguish between those that can be effectively ignored and those that cannot. Calcium deposits in the breast have very little to do with calcium in your diet or your calcium balance in your body.
If the radiologist finds concerning calcifications, he or she will perform additional views (magnification views) to determine the characteristics of the calcifications.
When examining calcifications, a radiologist may find:
- Benign breast findings — This is the case 75% of the time.
- Noncancerous lesions — These suggest a woman is at higher risk of breast cancer, such as atypical ductal hyperplasia.
- Breast cancer — Common forms of breast cancer are either confined within the breast ducts (noninvasive) or break out into the normal breast tissue (invasive).
Calcifications from benign reasons have a certain appearance and can be related to benign cysts, blood vessels, prior surgery or trauma, or benign growths such as fibroadenomas. Benign calcifications in blood vessels can be seen more in those with diabetes, end-stage renal disease and in older adults.
At times, when radiologists think they are probably benign but are unsure, they will request short follow-up imaging after a few (three to six) months to determine whether the finding is stable or changing.
Q: The repeat imaging showed calcifications that they tell me are benign-appearing, but they want me to come back in six months to be sure. I’m anxious about waiting that long. What are my options?
A: Typically, a radiologist is going to recommend biopsy if there’s concern that the calcifications represent a cancer or high-risk finding.
When short-term interval imaging (such as six months) is recommended, the radiologist generally believes the calcifications are benign — but wants to be reassured in this opinion by observing the calcifications over time to make sure they are not changing.
If waiting six months does not seem like something you can do — maybe because of other health issues or social concerns such as an upcoming move — you can ask your doctor or the radiologist whether a biopsy could be considered right away. They may be able to accommodate this — though typically fewer procedures on the breast is better if repeat imaging is a viable option.
Denise Millstine, M.D
Dr. Millstine is a Women’s Health internist and Integrative Medicine specialist at Mayo Clinic in Scottsdale, Arizona, where she lives with her husband and twin sons. She serves on the Editorial Board for the Mayo Clinic Health Letter and is the Medical Director for Women’s Healthsource. Find her on Twitter @drdmaz.