Bilateral Microcalcification clusters

[4hope]

I'm in my early 40's and have four children.  I breast feed all my children for total of over 8 years combined.  I thought these factors would offer me some reduced risk concerning breast cancer.  Yet, my annual Mammogram screening came back as a shock to me.  The information from the radiology report has me quite worried.
     My magnification radiology report stated there are two clusters of microcalcifications present bilaterally.  Left breast at 11:30 and Right breast at 1:00 (which is almost a mirror image).  The microcalcifications have a somewhat heterogenous appearance.  Biopsy is recommended.  However they state a biopsy will be technically challenging due to the faint appearance.  The final impression also states the clusters have an indeterminant appearance.  With a classification as Suspicious.  What are the chances that you get breast cancer in the same place on opposites breasts at the same time?  Do you think this is what is happening to me?  Also if it states it will be technically challenging to obtain the biopsy due to the faint nature of the calcilfications what would be the best method to try to obtain that biopsy?  Excisional biopsy or stereotactic biopsy?  Also, how can you be sure that the pathologists are experienced in reading slides?  There are scattered punctuate microcalcifications noted bilaterally which may represent sclerosing adenosis.  What does this mean?  I am grateful for all the insight you can give me into this situation.  Your forum is a blessing.

[leigh1971]

I had a mamogram and magnified mamogram yesterday they found several clusters of microcalcifications and also a lump next to my nipple that was only detected by mamo and ultrasound...do I need to be worried?

[CCF-RN,MSN-rf]

Dear 4hope:  Microcalcifications occur normally within breast tissue.  The concern is when they are clustered.  The calcifications themselves are not the concern but rather that they are growing around an abnormality.  In any case. based on this report, they need to be evaluated further.  Whether or not to do stereotactic biopsy or excisional biopsy would be best answered by a breast specialist (surgeon) who could evaluate the mammogram.  Most pathology departments have experienced people who read slides and others to confirm the conclusion.  If there is a question, they can be sent out to other pathology departments.  The following is a discussion about sclerosing adenosis.

A fibroadenoma is a smooth lump found in the breast. They are harmless in themselves and about 50% will disappear within 5 years. Another type of fibroademoa is a complex fibroadenoma. It is complex because not only were the glands and surrounding tissue in the lump (as usual) but the women also had microscopic entities such as sclerosing adenosis or apocrine metaplasia. These fibroadenomas serve as a marker for the possibility of developing cancer in the future - they are not cancer in themselves. It represents a 1-1.5 increase in relative risk.
Specifically,

Adenosis, an increase in the number of acini within lobules, occurs frequently as part of fibrocystic change.

Sclerosing adenosis includes an additional proliferation of myoepithelial cells associated with a very small increased risk for subsequent breast cancer development.

Finally, it is unlikely, but not impossible, that you have bilateral breast cancer.  In fact, it is quite possible that you have no cancer.  However, it is important to evaluate any abnormal finding.

[ritavv]

This summer I had bilateral microcalcifications of a suspicious nature.  They tried stereotactic biopsy on both.  They were only able to get a good sample in one breast.  The other calcifications were too close to the chest wall near the breast bone.  They tried for 45 minutes trying to squeeze and push me into position.  They finally had to give up.  Eventually, I had an excisional biopsy without problems.  Both biopsies were negative for cancer (and I've had breast cancer before!).  Good luck on whatever you decide.

[surgeon]

calcifications are very common: of the "indeterminate" category, 90% turn out ok. That they are bilateral makes cancer a bit less likely. If they are faint or not, the only way to biopsy begins with some form of xray localization, either by placing a wire to be followed by the surgeon, or by stereotactic biopsy; so either way the "challenge" is the same. Pathologists are trained to look at such slides; just as radiologists are trained to look at xrays, and surgeons to do biopsies: there's no more or less reason to worry about their competency than that of any of your other physicians. In most cases, malignant calcifications are not very faint. So overall, it sounds likely it'll turn out ok. And just for the record, having no family history, having nursed, etc, does not elimate risk: all women need to have regular screening, no matter what their profile is.

[river view]

I also had faint microcalcifications which were suspicious.  It took three biopsies over six months of time as they sampled the wrong area in the first two, one a stereotactic and one an excisional.  My third biopsy, an excisional at a teaching hospital, showed I did not have cancer.  The radiologist who placed the wire for the third biopsy suggested she do it without using the lidocaine as it would be easier for her to see them.  She said it would only hurt when the needle pierced the skin and she was right.  
There was little difference than when using the local anesthetic so I would suggest you consider this or at least ask a lot of questions about how they will get these "faint" calcifications.
Good luck to you and of course my experience was not typical so I didn't mean to scare you, just ask how faint and how hard it will be to sample them.