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Heterogenous, microcalcifications
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Heterogenous, microcalcifications

I had my annual mammo, and the a diagnostic mammo.
I have an appointment on Aug 11th with a surgeon for a follow-up.
The findings say the calcifications are persistent, they are somewhat heterogeneous, although not very tightly clustered. These do appear again to have either increased or developed since 2007 study.
I  am a little nervous about this report and what it means.
Any info or advice would be greatly appreciated.
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10 Comments
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Avatar_m_tn
Hi there.

Calcifications can have a variety of reasons in the breast, and the distinction of these calcifications being benign or something else will depend upon the amount, and the pattern of distribution along the breast tissues.  In your situation, I believe further work up is necessary, probably in the form of biopsy.

It is also worthwhile to ask your radiologist about the birads classification of your mammogram.  Birads is a unified or standardized reporting of mammogram that will give us the idea if the calcification pattern and amount is more likely benign or should warrant further work up (http://biradsclass.blogspot.com/).

Ask your doctor about a possible biopsy procedure and I'm wishing you all the best.

Regards.
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Avatar_f_tn
Thank you for the reply.
The  BI-RADS is category IV
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Avatar_m_tn
Ok. Then I believe that a biopsy is really recommended.

Regards.
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Avatar_f_tn
OK, Thanks.
I'm trying not get worked up and obsess as I have to wait until Aug 11th for the follow up with a surgeon.
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Avatar_m_tn
Hello,

     I had a diagnostic mammo on 7/14 after microcalcifications were found on my 7/8 mammogram.  The diagnostic showed a small cluster of microcalcs that were "indeterminate."  My birad was a category 4 indicating "suspicion of malignancy."  I had a biopsy on 7/23 and on 7/25 got the results.  It's DCIS (ductal carcinoma in situ), which is Stage 0 cancer--VERY early stage.  

     I met with the surgeon yesterday and they recommended an MRI since there's another area in the same breast with a few pinpoint calcs--mammogram resport did not consider them suspicious, but my surgeon wants to err on the side of caution and make sure there's nothing else to worry about.  As you may have heard, MRIs are very sensititve and can cause some chaos in that they may indicate things that really aren't a problem at all.  

     The most probable scenario will be a lumpectomy MAYBE followed by radiation.  Since I'm premenopausal (45) and the area is pretty small, he feels that he can get everything out that needs to come out with very clear margins.  I'm researching radiation to see if I want to do it--localized--or not.  They have already mentioned Tamoxifen since my cells are hormone receptive, but I am 99% sure that I don't want to take it given the litany of possible side effects.  

     Try not to stress out too much at this point.  I would have a biopsy done, but keep in mind that if it reveals anything, it's likely to be DCIS, which is non-invasive, Stage 0 cancer.  My surgeon and everyone I've talked too is very optimistic, so I'm keeping a positive attitude too!  :)
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Avatar_f_tn
Thank you for the reply.
Can I ask why you are hesitant on the radiation and Tamoxifen?
I haven't researched treatments etc yet as I don't want to jump the gun and convince myself it is cancer when I still have hope that it isn't.
I am 43 so also premenopausal , does that affect treamtment etc?
Good luck with whatever treatment path you choose!
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Avatar_m_tn
Hello,
     When I met with my surgeon he was the first to say that I might not even need radiation.  Honestly I was surprised to hear him say that.  Radiation is the standard, general recommendation following lumpectomy, but as with everything else there are pros and cons and each person's case is individual.  His view is that if the cells are fully removed with very clear margins, then essentially we'd be giving radiation to an area where abnormal cells no longer exist...the only cells that would likely be affected are normal cells.  I agree with him that it doesn't make much sense to radiate cells that aren't abnormal.  I have since read information that has questionned the blanket use of radiation for all cases of DCIS.

     Personally I am and always have been reluctant to take anything that I don't absolutely need.  I am sure that Tamoxifen has benefitted some women, but again each person's case is unique.  I have no family history risk factors, and I truly believe that my DCIS was influenced by what was probably a pretty long-term Vitamin D deificiency.  My levels were nearly fully depleted when it was diagnosed last month.  Severe Vit. D deficiency can increase a woman's vulnerability to breast abnormalities/cancer, as well as be linked to lots of other body system problems (I had multiple symptoms for months).  I am confident that if I get my levels up to an optimal level that I can reduce my risk of recurrence through nutrition, exercise and lifestyle without the side effects of a drug like Tamoxifen.

     I am not recommending these choices to anyone else, but they are ones that I am considering based on my circumstances.  My DCIS is grade 3 with necrosis, but again my surgeon is not terribly concerned about that.  His view is that regardless of the grade, it is still DCIS which means stage 0 (sometimes referred to as "pre-cancer") and that it's non-invasive.  As long as it's non-invasive that's a good thing!

    I hope your news is good, and even if you ultimately get a diagnosis of DCIS, keep in mind that it's the "best" of not-so-great-news!  The prognosis for successful treatment of DCIS is excellent.
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Avatar_f_tn
Thanks for the information.
You have a really good attitude.
Your positive post has put me at ease a little, although I wish I didn't have to wait so long
to see the surgeon.
Good Luck to you!
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Avatar_f_tn
Finally went to see the surgeon today.  
He was very thorough and took time to explain things.
he has advised a biopsy and me offered me two different types.
1 has a slight chance of a false negative so I opted for the other, slightly more invasive but sounds a little more accurate.
The problem now is that  he is going to be away for a couple of weeks, so I don't have the biopsy done until Sept 15th.
The stress of waiting and not knowing  is quite nerve wracking.
I was a very nervous when I  was at the office and now am trying to remember all that he told me.
I'll make sure I have someone with me on future visits :)

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Avatar_m_tn
You'll be fine, and it's good that you have a surgeon who talks to you and is patient.  That helps!  I had the MRI that my surgeon recommended and it showed an area of "delayed enhancment" in my right breast, and another area in my left breast (also just an "enhancement" that they want to biopsy.  So...I have an ultrasound on Thursday to look at my right breast and another biopsy (this one an MRI-guided biopsy) on Friday of the new area in my left breast.  They will biopsy the right breast also if the ultrasound is inconclusive.  When I got the MRI report results, I asked the nurse to please translate the medical jargon into something I could better understand.  I also asked, given their experience, how concerned I should be.  She told me that they expected that the MRI would show one or two things that would need to be explored more, mainly because MRIs are so senstive.  She said usually areas of "enhancement" turn out to be nothing, particularly in younger, premenopausal women who may be experiencing hormonal and/or fibrous changes in the breast.  She was not concerned,and that helped!

I agree that the tests and waiting are nerve-wracking, but keep in mind that if it's anything, its most likely at a VERY early stage and in that case the prognosis is excellent.  My husband and I attended a "breast cancer" information seminar at the hospital that was most helpful and reassuring.  We asked lots of questions!  I also ask my surgeon, the nurses, the MRI radiologists lots of quesitons too, and nobody seems to mind answering them.  If your hospital has any informal seminars like that, you might find it helpful.  Knowledge is power!

Be careful about getting too caught up in what you read in message boards and try to stick to researching information that is more scientifically objective when you need that kind of info.  This has been said before, but it's worth repeating...I think there tends to be more serious issues discussed in these message boards, and fear can be contagious!  Also keep in mind that everyone's personal and family history is unique.  What is applicable and appropriate for one person, may not be for someone else.  

I wish you all the best, and try not to worry--easy to say, I know!  
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