Breast Calcifications on Your Mammogram

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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.

Historically, the primary role of detecting breast calcifications has been the early diagnosis of breast cancer, but recent research also suggests that calcifications may be a marker for underlying heart disease.

A lot of other things besides can lead to breast calcifications, too. It helps to know the type, pattern, and arrangements of calcifications and how this may determine the meaning of any changes on your mammogram.

Non-Cancerous Causes for Breast Calcifications
Verywell / Cindy Chung

Overview

Breast calcifications are a very common finding on your mammograms. In fact, half of all women over the age of 50 will have some type of calcifications show up.

On a mammogram, calcifications appear as white dots and may or may not be worrisome for breast cancer, depending on their type, pattern, and arrangement.

Types

Two types of breast calcifications exist, and they often mean very different things. Instead of using the terms "macro" or "micro," your doctor may call them large or small.

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 younger women.

Microcalcifications

Microcalcifications are tiny bits of calcium deposits that may be an early sign of breast cancer, although they aren't 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 are often different depending on whether the finding is benign (non-cancerous) or malignant (cancerous). For example, calcifications described as eggshell, rim-like, popcorn-like, railroad tracks, coarse, or arranged in a loose cluster typically are benign. A high volume of calcifications that don't follow ducts is also a sign that they're not cancerous.

Calcifications that are irregular in size or shape, such as spiculated (spiky) calcifications, may be suspicious. Changes such as linear rod-like or branching calcifications are commonly seen in breast cancer, as are those that vary in shape and size. Calcifications arranged in a tight cluster also raise concerns about cancer. 

Benign (Non-Cancerous) Causes 

Many different things can cause breast calcifications, both those that are benign and those that suggest malignancy. Some of the benign causes 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
  • Radiation treatment for breast cancer
  • Calcification in the arteries within your breast
  • Calcifications in a fibroadenoma (benign growth)

Powders, ointments, or deodorants deposit calcium on the skin that may be mistaken for breast calcifications, which can cause concern about abnormal breast changes. That's why you're advised not to put on deodorant before a mammogram.

Diagnosis

If your mammogram shows microcalcifications that may suggest 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 common procedure after calcifications are found is a stereotactic breast core biopsy. In this procedure, the doctor uses imaging to guide the process and make sure tissue from the suspicious area is sampled.

A biopsy is not always needed if there are microcalcifications—sometimes just close follow-up is all that's warranted. No matter the course you and your doctor decide to take, it’s extremely important to get the recommended follow-up exams and tests for safeguarding your health.

Calcifications and Breast Cancer

While the presence of calcifications on a mammogram can sometimes alert doctors to breast cancers that would otherwise go undetected, we're learning that breast calcifications also may provide information about the prognosis of breast cancer.

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.

Arterial Calcifications and Heart Disease

Calcifications believed to be in the arteries of the breast have traditionally been thought of as incidental findings not associated with breast cancer risk, so they didn't get much attention. However, that's changing.

Recent research suggests that the presence of breast arterial calcifications is associated with underlying coronary artery disease in women over 40 who don't have any symptoms of heart disease. Their presence was even more likely to predict the presence of arteriosclerosis than 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.

A Word From Verywell

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. That's an important part of advocating for yourself. Be sure to ask about the description and the pattern. Ideally, you should ask for your report so that you can review it and ask any further questions you may have.

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