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What the heck ARE they?


What are calcifications?

Calcifications are calcium deposits found within the breast tissue. These deposits can be identified by mammography. They are extremely common and are frequently due to non-cancerous causes. They can, however, be an early sign of breast cancer. They should be analyzed carefully by your radiologist.


There are two main types of calcifications:

Macrocalcifications. These calcifications are usually large and round. They are ordinarily recognized as benign (non-cancerous) and need no additional testing.


Microcalcifications. These calcifications are smaller and may be numerous. They can be random or clustered and may vary in size and shape. The radiologist may request additional mammography views for further evaluation. For example, magnification views (enlargements) may provide more detailed information.


Microcalcifications are very small, salt-like crystals that can be seen on mammography. When 5 or more of them are huddled together, there is a 20% chance of having a cancer in the area of the calcifications. And often the cancer that is discovered is very early, without signs of invasion. Calcifications seen along with a lump or mass have a higher chance of being cancer. 


Where do these calcifications come from? All of your body's cells grow and rest; new ones form each week and the old ones are thrown away – into the center of the milk pipes of the breast, aka the ducts. If the breast cells are growing faster than normal, the old cells are thrown away faster than the body can remove them. The old cells pile up in the ducts, disintegrate, and form calcifications. 80% of the time clustered microcalcifications are seen, there is just hyperactive growth of relatively normal breast cells. Cancer cells are found in 20%. (But the crystals themselves are not cancer.)


Microcalcifications are one of the earliest signs of cancer seen on mammography, but are NOT seen on other imaging studies such as MRI, PET scans, Miraluma, and many ultrasound tests.


There are several kinds of microcalcifications. Three frequently noted types are as follows:


Benign. These microcalcifications can be identified clearly as benign (non-cancerous) by an experienced radiologist and need no further work-up.

Indeterminate. Such calcifications are not clearly benign or malignant and need additional work-up. (See evaluation below).

Malignant. These microcalcifications are almost always related to malignancy and a biopsy should be performed.

How are indeterminate microcalcifications evaluated?
Calcifications classified on a routine mammogram as indeterminate may be evaluated with magnification views (enlargements). This assists the radiologist in determining the cause of the microcalcifications and whether it is benign, probably benign, suspicious, or malignant. (Benign and malignant calcifications are discussed above).


"Probably benign" means that the calcifications have a 98% chance of being caused by a non-cancerous process.


"Suspicious" microcalcifications, however, may be seen with either benign or malignant processes, but most commonly these are benign, as with fibrocystic change. Biopsy is the best method to determine the cause of calcifications classified as "suspicious," since the chance of malignancy is 20-25%.


If you have any questions about microcalcifications, or if your results of your mammogram are unclear to you, discuss this with the radiologist. If you still have questions, you may want to seek a second opinion from a radiologist who is independent of the first. Furnish the original set of mammograms when seeking a second opinion. Be prepared to deal with conflicting opinions. You may want to seek a third opinion, possibly from a surgeon.


To find a reputable surgeon, ask your primary care physician for a referral or contact your local medical society or a local breast cancer organization. Choose a surgeon who has a special expertise in breast surgery.


Questions to ask your radiologist:


Has my mammogram changed since the previous one?


What changes do you notice? What do these changes mean?


If you suggest I come back for a follow-up mammogram, what are the benefits and risks of waiting? What are the benefits and risks of having a biopsy now?


Questions to ask your surgeon:


What kind of biopsy will I have?

Where will the procedure be performed? What type of anesthesia will be used?

How should I expect to feel after the biopsy? When will I be able to return to my normal activities?

After the biopsy, how soon will I know the results?

If cancer is found, who will tell me the results and discuss treatment options?


How soon do I need to make a decision on treatment choice?


Where can I get more information?