Understanding the Meaning of Breast Calcifications on Your Mammogram

Types and Patterns of Breast Calcifications and Their Causes

Breast Calcifications on a Mammogram
What is the meaning of breast calcifications on a mammogram?. National Cancer Institute

Breast calcifications on a mammogram can be either microcalcifications or macrocalcifications, and the significance of each of these can vary considerably. While many people associate calcifications with breast cancer, there are a number of other potential causes, ranging from benign breast conditions such as fibroadenomas, to conditions unrelated to the breast, such as calcifications in the arteries that travel through the breast. What should you know about the type, pattern, and arrangements of calcifications and how this may determine the meaning of any changes on your mammogram? While historically, the primary role of detecting breast calcifications has been the early diagnosis of breast cancer, recent research also suggests that calcifications may be a marker for underlying heart disease.

Overview

Breast calcifications are one of the findings that may be seen on your mammogram, and are very common. In fact half of women over the age of 50 will have some type of calcifications on their mammograms. Calcifications appear as white dots on a mammogram and may or may not be worrisome for breast cancer, depending on the type, pattern, and arrangement of the calcifications. Let's take a look at the characteristics of breast calcifications, and how this helps doctors either determine the cause or recommend further evaluation.

Types

There are two types of breast calcifications, which often mean very different things. Instead of "macro" or "micro" your doctor may use to describe these different types such as small or large. There are also many ways in which these are described.

Macrocalcifications

Macrocalcifications are large bits of calcium deposits found on a mammogram. They may be due to natural changes in a woman's breast, like hardening of her breast arteries. Macrocalcifications may also represent areas of inflammation from an old injury or breast trauma.

Macrocalcifications are not usually linked to breast cancer. According to the American Cancer Society, macrocalcifications occur in about 50 percent of women over the age of 50 and about 10 percent of women under the age of 50. 

Microcalcifications

Microcalcifications are tiny bits of calcium deposits that may be an early sign of breast cancer, although not always. The pattern of microcalcifications in a woman's breast tissue helps a radiologist decide whether breast cancer could be present. 

Pattern and Shape 

The pattern and shape of microcalcifications is often different depending on whether the finding is benign or malignant. For example, eggshell calcifications or rim-like calcifications on a mammogram are usually benign, as are popcorn-like calcifications. Benign means that the calcifications are not due to cancer. Calcifications arranged in a loose cluster are also more likely to be benign.

Suspicious findings may be described as calcifications that are irregular in size or shape, such as spiculated. Changes such as linear rod-like calcifications are commonly seen in breast cancer, as are calcifications that vary in shape and size. Calcifications arranged in a tight cluster are also concerning for cancer. 

Benign (Non-Cancerous) Causes 

There are many different possible causes of breast calcifications, both those that are benign and those that suggest a malignancy. Some of the causes of breast calcifications unrelated to breast cancer include:

  • Scar tissue related to old breast injuries (dystrophic changes), leftover from prior breast cancer surgery (fat necrosis), injuries or trauma to the breast, or simply due to the natural wear and tear of the breasts
  • Mastitis or inflammation caused by a breast infection
  • Calcium collected inside a dilated milk duct
  • Calcium mixed with fluid in a benign breast cyst
  • Powders, ointments or deodorants deposit calcium on the skin (this is the reason that women are advised not to wear deodorant before their mammograms)
  • Radiation treatment for breast cancer
  • Calcification in the arteries within your breast
  • Calcifications in a fibroadenoma (benign growth)

Diagnosis

If your mammogram shows microcalcifications that are worrisome for breast cancer, a biopsy is recommended. A biopsy means that a small area of the suspicious breast tissue is removed and examined under a microscope for cancer cells. The most commonly performed procedure when calcifications are found is a stereotactic breast core biopsy. In this procedure, imaging is used to guide the biopsy to make sure that the area seen on mammogramis sampled.

A biopsy is not always needed if there are microcalcifications — sometimes just close follow-up. It’s very important to do follow-up exams and tests to make sure that you get the best information on your health.

Being Your Own Advocate With Your Mammogram

Doctors do not always mention the word "calcifications" when talking to women about their mammograms. They may instead mention a "small abnormality." It's important to ask specifically what was found if you have an abnormal result. You should also ask for clarification if you are simply told that you have calcifications.

Don't be afraid to call your doctor or her nurse and ask for more information about the size or pattern of the calcifications. If you want to advocate for yourself it's important to have all of the pieces of the puzzle if you will. After learning about the descriptions of calcifications, also ask what the pattern is. Ideally, ask your doctor to send you your report so that you can review it and ask any further questions you may have.

Significance of Breast Calcifications With Breast Cancer

The presence of calcifications on mammogram can sometimes alert physicians to breast cancers that would otherwise go undetected. Yet we are learning that breast calcifications may provide information about prognosis if breast cancer is found as well.

According to a 2018 study breast cancers that have microcalcifications are more likely to have HER2 positive breast cancer, tend to have a higher tumor grade, are more likely to have spread to lymph nodes, and have a greater risk of recurrence. This information may be helpful for women with early-stage breast cancers who are weighing the benefits of treatments such as chemotherapy after surgery.

Breast Arterial Calcifications

While calcifications that are felt to be in the arteries of the breast have traditionally been thought of only as an incidental findings that isn't associated with breast cancer risk, recent research suggests that this finding should not be ignored. It's now been found that the presence of breast arterial calcifications is associated with underlying coronary artery disease in women who are over the age of 40, but do not have any symptoms of heart disease. This was significant enough that the presence of these calcifications was more likely to predict the presence of arteriosclerosis than the presence of risk factors such as high blood pressure, a family history of heart disease, and more.

Unfortunately, symptoms of coronary artery disease or a heart attack in women are often different from what is considered "typical," and symptoms such as profound fatigue, nausea, or even jaw pain may be the only symptom heralding a heart attack. Mammograms may, by finding arterial calcifications, help in detecting coronary artery disease before problems occur.

Since much of the research looking at the meaning of breast arterial calcifications is relatively new, it's important to be your own advocate and ask questions if you should see or hear of these on your report.

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