Micro calcifications on Mammo -

[Kimberlie]

I have read many of the postings about micro calcifications and still have a question.  I had a baseline mammo when I was 42.  Due to family stuff haven't taken time to get next mammo until 8/31/06 at age 48.  Went for routine mammo; they found small cluster on R. bst.; immediately did diagnostic mammo; and Dr. came in to explain findings.  Immediatley sent me next door to my gyn to get info on surgeon to do sterotatic biop.
I know calcifications are normal; but what is the specific pattern/in clusters/ or number in cluster; size etc. that cause concern and rating of Birads 4?  If clusters can indicate tumor
why doesnt that show up on mammo?  No one has felt breast for lump/ should that have been done that first before suggesting bioposy?  Just seems like a whirlwind of activity for micro calc.
Are they over reacting?

[CCF-RN,MSN-JS]

Dear Kimberlie, Microcalcifications are actually very fine specks of calcium that light up on a mammogram.  Sometimes they can be an indication of cancer or precancer.   Based on their pattern on the mammogram it gives the radiologist clues as to their cause.  For instance microcalcifications that are more scattered are probably due to a benign (non-cancerous) cause, a “cluster” of microcalcifications may increase concern that there may be an underlying tumor.  If the microcalcification pattern is indeterminate the radiologist usually recommends a more focused mammogram (diagnostic) which would include magnified views to the area.   These magnified views will help to clarify what is being seen on the mammogram.  

BIRADS scale is a rating system used by radiologists to categorize findings on a mammogram. The scale runs from 1 to 5. 1 being nothing to comment on. Routine screening. to 5 being highly suggestive of malignancy.  A BIRADS rating of 4 indicates that there is a suspicious looking abnormality that is not characteristic but has a reasonable probability of malignancy.  Biopsy should be considered.  On physical examination a lump may not always be felt in the area of where the microcalcifications are seen on a mammogram.  One of the reasons for having a screening mammogram done is to locate a possible early cancer or precancer before it can be felt on physical examination.

[DonnaRee]

Hi Kimberlie, my advice would be to see a breast specialist, preferably a breast cancer/surgical oncologist and get a second opinion. I was/am in the same situation as you are and did go for a stereotactic biopsy, which unfortunately didn't work. My only option was to then have a wire localization biopsy, but I wasn't comfortable with that, so I went to a breast cancer center for a second opinion where I was told I could wait 4-6 months, then back to see if there's been any changes. I am comfortable with the surgeon's opinion and credentials, but most importantly with my decision to wait. I do recommend having a stereotactic biopsy, as the less invasive route, just make sure the radiologist really numbs you up well. Also, not to contradict the RN who answered you here, but my understanding is that BIRAD 4 is suspicious and abnormal, needing further testing, hence a biopsy, but it's not necessarily cancer. There are many conditions which mimic cancer, sclerosing adenosis is an example of one. BIRAD 5 is highly supicious of malignancy. And please remember, 80 - 85% of BIRAD 4 biopsies are benign.

[Kimberlie]

I still don't understand what they are looking for in a particular cluster that warrants concern?  Is it the number of very fine microcalcifications?  A certain pattern?  If so what sort of pattern?  My calcification is very tiny specks grouped close together; making up a very small space on the radiograph;  I would guess there were about 20.  Does that in itself warrant a biop.?  Since the site is so small, should I have a mammotone instead?

I called the nearest Breast Center in Annapolis and they want me to just drop off all my films for them to review before I think about which way to go.  

Another concern has been how many women on this forum and several others I have been reading that end up with a hemotoma after the stereotactic biop!
    

Thank you Nurse JS and Donnaree for the reply.
Donnaree - Did they rate you as BIRADS 4, as well?  

[cyn17]

A cluster of micro calcs has a higher incident of being cancer (why, I don't know). If your calcs were spread out they probably would not biopsy them.

As for the hematoma...I think I'm the only one that has written about that. I had a large fluid filled cyst that was aspirated and then a nodule right next to it biopsied. When they biopsied the nodule, the tissue bled into the cavity that was just drained, creating a hematoma (blood clot). I have had biopsies before and didn't have any trouble or pain. This time was unique because there was a cyst and nodule right next to each other.

[Montana girl 06]

I've had 3 biopsies (only 1 stereotactic) and have had no complications and only minor discomfort (and all were benign.) Mine were Birad 4 also.I believe a mammotome and stereotactic biopsy are the same.  Mammotome is a brand name of a machine some places use to do a stereotactic biopsy. I hope you get the answers you're looking for.

[DonnaRee]

Mine were classified as a Birad 4. There were 6-8 in a cluster in my left breast. When I took my films (which included the magnified films) to a university breast cancer center, the surgical oncologist (who had previously worked at a national cancer center in Philly) sat and explained all about calcs and that in itself made me very comfortable with waiting. I think the number, shape and pattern matter with calcs, so again if you have the ability to take your films to a breast cancer center, have them reviewed and then have them explain the whole biopsy process etc., it will help you understand it better and also help you feel more control in a scarey situation. Believe me, I spent many a sleepless night worrying, but after I did this, it made all the difference for me. What also helped was that he asked me what I was more comfortable doing. He also said that many radologists who perhaps aren't as experienced in reading mammos sometimes classify calcs as a BIRAD 4 just because they aren't sure of what they're seeing, or the calcs may be too small to really be sure. Hope this helps and I wish you good luck with everything. Let me know if you have any more questions, I'm happy to help.

[DonnaRee]

I meant to also suggest the Johns Hopkins Breast Center Ask the Expert website. It has also helped me tremendously. Here's their link: http://www.hopkinsbreastcenter.org/services/ask_expert/index.asp

[Kimberlie]

I finally got the radiographs and the written report.  Yes, sleepless nights.  I have read so much that now I am more worried about what the report does say.
RB - 10 oclock; cluster of microcalcifications.  There is some pleomorphism and architectural distortion.  Magnification views demonstrated this on CC projection. The extent of these microcals is 5mm.
The best news If I understand this would be the size. Very small area involved.
Thank you each for encouraging me.

[Montana girl 06]

Did they recommend a biopsy? Remember, around 85% of calcifications are benign. Will keep you in my prayers because I know how hard it is not to worry.

[Kimberlie]

Hi, yes there was recommendation by radiologist for biopsy.  He also mentioned DCIS at time of magnification.  I'll see what the Breast Center recommends.
Thanks for keeping me in your prayers.

[MaryO]

I will tell you my story about microcalifications I'm a 45 year old R.N. who works in L&D - no family history of breast cancer.  Scheduled my routine mammogram, my appointment had been scheduled for 6 months, 3 weeks prior to my mammogram my 48 y.o. non-sister was in for her "routine" mammogram and they had found califications on her mamm.  On the day of my mammogram she was finding out the results of her "biopsy" which revealed malignancy.  To her story short, she has since had a lumpectomy and then her margins weren't clean and she has had a mastectomy and needs further follow-up because from this she ended up with a small invasive area.   To explain my story further, my microcalcifactions that really appeared to be nothing on my x-ray and further magnified xrays were excisionally biopsied under local anesthesia and on the day my sister was having her mastectomy I found out my pathology report - MALIGNANT Ductal Carcinoma In Situ (DCIS), the best kind to have but still malignant cancer.  I had a lumpectomy on 8-29-06 and received good news that my margins were clear, my next steps are to meet with medical oncologist and radiology oncologist to set up Anti-hormone therapy and radiation to put me at the lowest reoccurrence percentage.   With this said you can tell that when I read "microcalcifications are nothing" I ache in my heart because they can be something although the percentage is low - you don't know until you investigate!  As an optimist with a positive outlook on everything it was quite a blow to think that these "little, itty bitty things in my boob could be anything - especially that darn would cancer.  Hope this helps and "breast wishes" - Mary

[MaryO]

Typed faster than I could read - My previous comment should have read "non-nurse" sister - I love my sister and would never call her a "non-sister".

[MaryO]

By the way Kimberlie - as far as pain and discomfort I will let you know that my surgery was 8/29 and today I played for both church services.  I never needed to take the prescription pain reliever offered - I slept in my Lazyboy recliner, used Ice on and off every 20 minutes the 1st 24-48 hours and took prescription strength Ibuprofen did the trick. I still take Ibuprofen and occ. use and ice pack for comfort. I think the most uncomfortable part of everything is exposing your breast to everyone.  Imagine me who has worked at the hospital for 29 years and exposing to all my friends/coworkers - what fun!  Let the support of your friends, family, coworkers, and if you have church family and now let us people who don't even know you help carry you through this bump in the road.  I'm sending positive thoughts and prayers your way!   Mary

[Montana girl 06]

Thanks for sharing your story but sorry yours turned out to be cancer. May I ask who said your microcalcifications looked like nothing? Doctor, surgeon, radiologist, breast specialist? I'm on the other end of the rope where they keep sending me for biopsies that are suspicious and they turn out benign. I keep wondering if a breast specialist could be more specific/accurate to allow me to avoid more biopsies. Did they decide to do a biopsy because your sister had bc or because someone felt your calcifications were suspicious? Also, did they give you a birad rating? I'm still collecting info to help me be informed when I go for my 3 month followup mammo in October since I opted not to have a 4th biopsy in July.

[Kimberlie]

Mary,I am sorry that yours and your sister's turned out to be cancer:(  I believe in the Lord and believe He will see me through whatever storms life brings.  I am sadly in the middle of a separation from my husband after 29 yrs.; father died of cancer less than year ago; mother severly depressed and tried to commit suicide in May.  Storms- yes- many.
I will keep you both in my prayers for wisdom and healing.

Montana Girl, My radiologist immediately mentioned DCIS.  I will take the films and report to a BREAST Center for review before I do anything.  One of my biggest fears is someday looking back and saying "what if I had done.....instead of this?"  That's where I need peace and wisdom to get quiet in my soul to hear what I need to do.  I hope you hear good news in October.  Please let us know.  I'll keep you in prayers.  This forum has been a God-send to me now.  My children are grown and I have a beautiful 1 1/2 year old grandson (Elijah) to help me keep focused!  
Bless you ladies!

[MaryO]

The radiologist is the one who on the "magnified mammogram" said "I think you need this biopsied".  Of course being a nurse, I knew when the radiology tech. said "you need to talk to the radiologist" I knew something was up! Who would think something so small could create such a large problem!!  It was even more fun when I saw who the radiologist was and he is a friend of the family-how coincidental was that - oh boy, another person getting a look at this ever popular breast!  Need to head off to my 1st meeting with the medical oncologist-decisions, decisions, never a dull moment!

[Vetiver]

I have a hemotoma after my stereo biopsy. It was huge and now its about half the size. It still hurts and it was about 6 weeks ago. I still don;t really get why I have to do surgery now. I hope they find NOTHING in my pathology

[cyn17]

I'm sorry to hear you got a hematoma. It's been 4 weeks for me. The bruising has just gone away and the size of it is about 1/2 what it was. I'm looking forward to it being healed.

What surgery are you having?

[cyn17]

Just saw your post to the nurse. Good luck with your follow up surgery!

[jc76001]

had my first mamogram (mammogram) yesterday, a diagnostic one, lots of pictures and a sonogram... radiologsits told me a "cluster of microcalcifications" but i also had a fibro...something tumor, but she was less concerned about that and a probable papaloma cyst, which she said i will probably need to see a surgeon for. she said that we were going to handle this one at a time and do a biopsy, stereotatic (sp??) a week from monday....
should i be concerned that ALL 3 of these things are going on in ONE breast?
35 yrs old, mom of 11 yr old special needs child and a 9 yr old. very scared.

[cyn17]

Of the things going on, the most concerning is the cluster of micro calcs. They have a 25-50% chance of being cancer and need to be biopsied. The other things...cyst and fribroadenoma are generally benign. Usually doctors will watch those over time to see if any changes occur. If changes do occur, they will biopsy them. It's not unusual to have all these in the breast at one time, but you do need to stay on top of your exams, as you have been.

Good luck with your follow up and keep us posted!

[Kimberlie]

I took my films to the Breast Center and they immediately scheduled me for the stereotactic biopsy.  It was yesterday.
I am very happy with my decision to go the B.C.   They were wonderful!  It was just a bit uncomfortable, but nothing like I was anticipating.  With ice and tylenol I have been experiencing only minor pain.
I will get my results on Monday or Tuesday.
One thing that got my attention and wanted to know if anyone elses' dr. did this.
After all the samples and mammograms to be certain they had gotten enough sampling of calcifications, the dr. then wanted to check the lymph nodes under my arm.  It was virtually the last thing she did and then told me she would be calling me with the results.
Has anyone else experience this?
Feel just a bit alarmed about that....

[jc76001]

thank you cyn17...
kimberlie...i just want to make sure i understand.. after they do the biopsy then they do more mamo's??? and that is when the radiologist said they wanted to check your lymph nodes... how did they check them.?

[Kimberlie]

JC,  The surgeon took the samples of microcals and mammos to be sure they were in the right place.  They put the little strips and bandage on my breast and told me I could now sit up.  That is when the surgeon said she wanted to examine (feel with her fingers) my lymph nodes under my arm. Just wondered if she was expecting to find something??  Was that a normal part of the procedure?
I see you are having your biposy soon.  I hope it goes well.  The anticipation was much worse than the procedure for me.  Please keep us posted as to how you make out.  

[Montana girl 06]

So sorry to hear about your difficult year. Glad to hear your stereotactic is done and that you had a Breast Center nearby where you could go. It's procedure to follow the stereotactic with a mammogram, but I haven't heard about checking the lymph nodes before. Keep us posted on the results.

[Montana girl 06]

I also have multiple cysts, fibroadenomas and other things in my breast besides the microcalcs. But, it's always the microcalcs they are concerned with. I have questions to ask at my next appointment about that. I do know that they worry more about lumps that do not have well-defined margins. I understand the part about being scared, as do most of the people posting here. Keep us posted. I'll keep you in my prayers.

[boninclyde]

Hello Ladies,
I am back from a much needed break. And some of you will probaly wish I stayed gone. Just kidding. Look guys I don't want to offend anyone or **** anyone off cause you all have helped me so much and if I am wrong please let me know but...
OK here goes (please don't take offense)

cyn17 says the chance that microcalcifications are a 25% - 50% chance of being cancer.

Montana girl 06 says that there is a chance that 85% of calcifications are benign.

Donnaree say that there is a 80-85% chance of Birad 4 being benign.

This is all so confusing to me and to newcomers. Those percentages just don't mean anything. Like I have said before is that 25%, 50%, 80-85% out of 100, 1000, 10000. Sorry but it just seems misleading.

Again I am not writing this to offend anyone because without you guys (not these percentages) (ha) I probablay would not have made it to my surgery.

Yes, let me know what you think.

Kimberlie please let us know as soon as you get your results.

[jc76001]

NEW HAPPENINGS TODAY!
I called friday to see if they could move the biopsy up b/c i was going crazy....today they (the breast center) called and said yes they could and they moved it to wednesday,.. the day after tomorrow.
i then got a call from my gyno's nurse saying that they got the results..(which she, the same nurse that called, and i discussed on thursday and friday) she then tells me that the dr says i have 2 options:
  1) to go ahead with the scheduled biopsy from the radiologist
  2) or go see a breast surgeon..."we strongly reccommend that you see dr. ___________" when i asked why her response was "we know her work and we strongly recommend you see her"

ok, i am TOTALLY FREAKED OUT!!!!!!!

PLEASE LET ME KNOW IF ANYONE ELSE HAS HAD THIS EXPERIENCE!

[cyn17]

JC - My doctor did the same and I went to the radiologist they recommended for the biopsy instead of waiting and watching. This turned out to be the best for me...the doctor was great and by having the biopsy and finding out it was benign, I was able to get some relief. In a way I wanted my doctor to make the ultimate decision for me, but sometimes our situations aren't cut and dry.

boninclyde - I agree the percentages get confusing and no offense whatsoever is taken.
Here is my understanding:
Clustered micro calcs have a 25-50% chance out of 100% of being cancer, or 50-75% chance of being benign.
Fibroadenomas have a 15% chance out of 100% of being cancer, or in other words an 85% chance of being benign.

At the end of the day, these are just numbers. As we know, any one of us can fall on the wrong side of the statistic.

I'm glad you're back and hope your recovery is going well!

[jc76001]

I WASN'T GETTING THE IMPRESSION THAT THEY WANTED TO WATCH AND SEE I GOT THE IMPRESSION THAT THEY WERE DEFENITELY ALARMED AND WANTED ME TO GO STRAIGHT TO THE SURGEON AND HAVE THEM BIOPSY SO THEY COULD TAKE ADDITIONAL STEPS IF NEEDED.....
I DON'T THINK I GOT IT WRONG, .... IF I DID WHY WERE THEY RECOMMENDING A BREAST SURGEON???
I AM SOOOOOO CONFUSED.!!!!!

[cyn17]

Hi JC - Sorry, I responded inaccurately to your concern. Oops! I believe your doctor is strongly suggesting you see a breast surgeon as that is their specialty. A radiologist probably has plenty of breast experience, but isn't THE specialist. I wouldn't be worried that doctor's are suggesting something bad, they just want you to see the best doctor.

[Montana girl 06]

It's hard to say why the nurse called back with 2 options this time. It makes me think the doctor looked at your test more thoroughly and decided maybe a stereotactic is not the best option. For example, if the microcalcs are too close to the chest wall, stereotactics don't always work. Maybe the doctor feels a breast surgeon could better determine whether your lump(s) need to be biopsied. Or, it could be something totally different. It's reassuring to know that they highly recommend this surgeon. Did you decide which option you'll take?

[Montana girl 06]

It is good to have you back boninclyde and I think you bring up a very good point. This is the way I understand it but I have no medical background to back it up.

My surgeon told me around 85% of microcalcifications are benign. From what I understand, this includes all of them, scattered or clustered. If people don't realize it includes all microcalcs I can see why it could be confusing. (Someone at this site posted that 85% of "clustered" microcalcs are benign but I have never seen that statistic officially so I tend to doubt it.)

The medical practitioner giving advice at this site says around 25-50% of all BIRAD 4 biopsies are cancerous. But, this includes all types of breast biopsies - microcalcs and masses. I haven't heard an official % on just microcalc biopsies, but maybe someone else has.

Maybe the others can let us know where their statistics came from so we can figure out if we have conflicting info or if we're misinterpreting the figures.

One thing I've noticed is that from time to time new people to this site respond to the "posters" (that's us) as if we are medical professionals. I think we need to make it clear that we are offering advice only from personal experience. (Altho I know a couple of "posters" have had medical experience with breasts and that's a different story.)

[Montana girl 06]

Clarification - 25-50% of Birad 4 ABNORMALITIES (not biopsies) are benign.

[jc76001]

THANK YOU ALL FOR THE ADVICE..... I THINK THAT IF THE SURGEON CAN GET ME IN THIS WEEK THEN I WILL SEE HER; I THINK THE NURSE SAID SOMETHING ABOUT THE SURGEON DOING A BIOPSY....MAYBE A DIFFERENT KIND... AND ONE OF YOU SAID SOMETHING ABOUT THE DR CHANGING HIS MIND BUT I THINK HE TRULY JUST GOT THE RESULTS TODAY AND WANTED TO LET ME KNOW WHAT HIS THOUGHTS ARE.
APPRECIATE AND RESPECT ALL OF YOU MORE THAN YOU KNOW... EVEN THOUGH IT HASN'T EVEN BEEN A WEEK SINCE THIS ORDEAL STARTED, THIS SITE HAS BEEN AN ENORMOUS AMOUNT OF SUPPORT.  THANK YOU AND ALL OF YOU ARE IN MY PRAYERS.  WILL KEEP YOU GUYS POSTED, SUPPOSE TO GET A CALL FROM THE NURSE TOMORROW LETTING ME KNOW WHEN THE SURGEON CAN GET ME IN.

[boninclyde]

breastcancer.org is a wonderful site.
Maybe you could find out what type of biopsy you are having and let us know. It could be your doctor trust this other doctor so much to just look at your films without a biopsy. Like someone else said it is good they have so much confidence in this dr. I would then let this dr. suggest a biopsy.

[boninclyde]

Thanks guys for not jumping down my throat. It is just confusing. The %'s.
They are sending my breast (I would say biopsy but it is much to personal to call a biopsy LOL) off for the oncotype test to see how many cancer cells and how strong the cancer is. That should tell us the chance for re-occurance. They said Tamoxifen probaly but they way my situation has been since the begining I am planning on chemo. But not shaving my head just yet. (LOL) Those who have watched me post for awhile now what I am talking about. Keep you posted.

[Kimberlie]

Well the results are in and it is fibrocystic in nature.  Recommended following area every six months instead of yearly for a while, but what a weight off my mind!  When everything suggested differently, it is not the feared 'C' word.  

JC- I do hope you get good news when you have your biopsy!    

Montana Girl- Thank you for you kind thoughts and prayers.  I am so grateful for them and each of the beautiful women on this forum who are just a click away.

boninclyde-   It sounds like you have some dear friends (on here)who know what you have been going through.  I pray you stay well in the mist of this storm and come out the otherside showing other woman the way.

[Montana girl 06]

Kimberlee, So glad to hear it's benign. I hope this is the end of your breast problems.

boninclyde, It's interesting following your progress. Why are they just now sending your breast for the onconotype? Interesting how everything takes so much tiiiiiime. I guess if you think about chemo now it can be a pleasant surprise when you find you don't need it.

[jc76001]

KIMBERLEE......GREAT NEWS!! GOOD LUCK TO YOU

WELL, TODAY I TALKED TO THE SURGEONS OFFICE AND SHE SAID THAT THEY COULD NOT GET ME IN UNTIL 10/4/06, NEXT WEDNESDAY AND THAT THEY WOULD LIKE FOR ME TO DO THE BIOPSY, STEREOTECTIC (SP??) TOMORROW...... THEY THEN SCHEDULED ME AN APPOINTMENT WITH THE SURGEON FOR WEDNESDAY THE FOURTH...(I AM GUESSING THEY DID THIS BECUASE OF THE CLEAR DISCHARGE I HAD HAD; THE RADIOLOGIST HAD TOLD ME THAT IF IT LEAKED AGAIN TO SEE A SURGEON....THIS IS ALL SO CONFUSING...
I DID FIND OUT THAT MY BIRAD SCORE WAS A 4.3
OH AND GET THIS...
THE SURGEONS OFFICE TOLD ME THAT THE BREAST CENTER WILL CALL ME AND TELL ME MY RESULTS OVER THE PHONE!!!! IN A DAY OR TWO....
MAYBE I AM JUST NEW TO ALL OF THIS, BUT I AM STUNNED THAT I WILL BE WAITING ON A CALL TO SAY YES YOU HAVE CANCER OR NO YOU DON'T...
STILL TRYING TO DECIDE IF I WANT TO BE AT WORK WHEN THAT CALL COMES OR STAY HOME TILL I GET IT.

I WILL SAY THIS I HAVE A NEW APPRECIATION FOR THE PATIENCE THAT ALL OF YOU HERE HAVE ENDURED.... I AM SAD THAT WE ARE ALL HERE FOR THIS REASON, BUT I AM GRATEFUL THAT YOU ALL ARE SO KIND, CARING AND HELPFUL.  I HOPE I CAN RETURN THE FAVOR, IRREGARDLESS OF THE OUTCOME.

[Montana girl 06]

Yes, they do often just call and let you know the results. I'm just glad to get them quickly. (The first two times I had a biopsies I did have to go to the surgeon's office, but most offices just call you.) Every time I go through this my heart races and I get very anxious when I know it's them calling and I feel I can barely breathe. Then it's a hugh sigh of relief when I find out it's benign. Just one suggestion, have your questions ready to ask right away on the phone regardless of whether it is benign or cancererous, so you don't have to wait for the answers later on.

[mickib33]

A related discussion, DonnaRee are you aware?... was started.