One of the main questions that women ask when breast calcifications show up on their mammograms is whether there is a cause to worry or not. The answer depends on the type of breast calcifications you have, your age, and whether you have a history of breast cancer or not.
What are Breast Calcifications?
Breast calcifications are tiny white spots that appear on the mammogram. You cannot feel them physically like you can feel a lump in the breast, because they are very, very small and show no symptoms. They are discovered by radiologists during mammograms and ultrasound scans. In vast majority of the cases, they turn out to be non-malignant; however, certain types of breast calcifications can be sign of precancerous stage of breast cancer or early stage of breast cancer.
Causes of Breast Calcifications
One of the first points to understand is that breast calcifications are in no way related to intake of calcium in your diet. Breast calcifications are often caused due to the natural aging process. As one gets old, the body goes through various changes and deterioration. The natural changes in the breast show up as breast calcifications.
Over a period of time, blunt injury to the breast can lead to formation of calcifications in the breast. Similarly, chronic infection of sebaceous glands and mastitis can also cause breast calcifications. Fibrocystic breast condition is also associated with breast calcifications. If you had radiation therapy in the past, it can lead to the formation of breast calcifications.
Sometimes calcium gets deposited in the milk ducts and this can cause breast calcifications. If the breast arteries show deposits of calcium, then it can lead to formation of breast calcifications.
Types of Breast Calcifications
Breast calcifications are of two types- macro-calcifications and micro-calcifications. Macrocalcifications appear as large white round shaped deposits of calcium on mammograms. They are very common in women above 50 years of age. They are usually benign, thus they do not require further probing.
Microcalcifications, on the other hand, can be a cause for concern. Micro-calcifications appear as tiny white specks on mammograms. In 80% of the cases, they turn out to be benign. However, if they are of certain shape and size, and appear in particular patterns, they need to be probed further.
Microcalcifications and Breast Cancer
Most of the breast cancers start out as micro-calcifications. Out of all the breast cancers, majority of the ductal carcinoma in situ cases start out as micro-calcifications. However, some cases of breast cancers are also related to macro-calcifications. The question that arises is how are radiologists able to distinguish between calcifications that are benign from the ones that are malignant or has the potential to turn malignant in the future.
Upon examination of mammograms, radiologists classify calcifications as benign, indeterminate, and malignant. In order to classify calcifications as benign, indeterminate, and malignant, the radiologist will first carefully look at the morphology, size, distribution, variability, number, and stability of the calcifications. They will also look at previous years mammograms to reach a final verdict.
Morphology and Cancer Risk
Morphology refers to the form and structure of the calcifications. The morphology of micro-calcifications also indicates where they originate from. For example, if the microcalcifications change their structure and form as they develop, have irregular structure and form, are branching out in fine lines, or have no form or structure, they are most likely to originate in the breast ducts. Such microcalcifications are considered suspicious.
On the other hand, if the form and structure of the micro-calcifications is smooth, oval, and have tiny depression points on them, they are most likely to be found in the breast lobules. Such micro-calcifications are considered benign.
Distribution and Cancer Risk
When looking at microcalcifications on mammograms, the radiologist is going to pay close attention to how they are distributed, because that gives a clear indication of whether they are malignant or non-malignant. Microcalcifications that appear very closely clustered or are located segmentally are likely to be cancerous.
Stability and Cancer Risk
If the doctors or radiologists notice that the microcalcifications have not changed in two or more years, these microcalcifications are more likely to be non-cancerous. However, this is not a definite rule. Basically any calcifications with a suspicious form and structure demand further probe, even if they have been stable for two or more years.
Lucent-centered calcifications, skin calcifications, rim or eggshell calcifications, milk of calcium calcifications, and arterial calcifications are some of the breast calcifications that are benign. Calcifications in the breast skin are often small, have clear centers, and are clearly defined. They appear in groups in the sebaceous glands. They develop due to chronic inflammation of the hair follicles. Milk of calcium breast calcifications is also benign in nature. These microcalcifications are usually round in shape and are caused due to fibrocystic breast condition.
Eggshell calcifications, rim calcifications, and lucent centered calcifications are also classified as benign breast calcifications. They often develop due to a condition called fat necrosis. Blunt injury to the breast or breast surgery can also cause eggshell calcifications and lucent centered calcifications.
Indeterminate or suspicious calcifications are always probed further. Microcalcifications that appear very unclear or are granular looking are termed as suspicious calcifications. Upon magnification mammography of these microcalcifications, more such calcifications are revealed in many cases. If these microcalcifications appear in clusters or are distributed segmentally, they carry a high risk for breast cancer.
90% of the ductal carcinoma in situ cases start of as microcalcifications. Cancerous calcifications vary in shape, form, and size. Cancerous microcalcifications usually appear in tight clusters. However, they can also be distributed linearly or segmentally.
Linear distribution means that the microcalcifications organized in a straight line. Sometimes the linearly distributed microcalcifications also have branches, like in microcalcifications related to ductal carcinoma in situ. Microcalcifications with linear distribution and branching are always considered high risk for breast cancer. Segmental distribution means that the microcalcifications are located in a particular segment of the breast, such as the ducts or ducts’ branches.
Further Tests on Suspicious and Cancerous Microcalcifications
If the radiologist notices microcalcifications in the mammogram, the first thing he/she would do is go for magnified view of the particular area. If the microcalcifications are of suspicious or cancerous nature, biopsy would be recommended. Doctors either go for needle biopsy, or surgical biopsy to determine whether the microcalcifications are cancerous or benign.
Need For Annual Mammogram
In majority of the cases, breast calcifications are benign. Even if microcalcification has been found to contain cancer cells, you should not worry too much. This is, because your breast cancer has been detected in the very early stage and is totally curable.
One message that we get out of breast calcifications study is that it is very important to go for annual mammogram. This is especially important for women who are forty and above.