Calcifications & Surgical Biopsy

[Soldier37]

I am 37yo.  I had my 1st mamo. at 35.  Calcifications were found on left breast, 2" up and left of my nipple.  Repeated mamo. every 6 mos.  This time they found growth on original calcifications and new microcalcifications.  Did magnified mamo. at hospital.  New clusters run from larger calcifications down to behind my nipple.  Radiologist said I can't have a needle biopsy because of position so I have an appointment for surgical consultation.  The only thing I know from last mamo. is BIRAD 4.  Should I be concerned this is cancer?  Everything I read says only about 1 in 4-5 is malignant.  I have history of other cancers in family but not breast (that I know of).  I used to smoke heavily but not for about a year.  I know you can't diagnose.  I just want to be prepared if cancer is more than a slim chance.

[Cleveland Clinic]

Dear Soldier37, A BIRADS rating of a mammogram helps to categorize a finding in terms of how suspicious an abnormality looks, and whether further evaluation of an area is recommended. A BIRADS rating of 4 would be described as a suspicious looking abnormality, not characteristic but has a reasonable probability of malignancy and a biopsy should be considered.  To know for sure what this area of concern is, a biopsy would need to be done.

[lizziecee]

Hi soldier - as far as I am aware, a BIRAD score of 4 means highly suspicious of malignancy. You might try googling "BIRAD scores" for further information.
I would guess you need to see a breast cancer surgeon for further testing.
Good luck
Liz

[japdip]

I disagree with the above post in that a BIRAD 5 is highly suggestive of malignancy but a score of 4 is 25 - 50% might be due to something OTHER than cancer. The surgical biopsy is not such a big deal .... a very small incision (1-2 in.) Evreything will be explained by your surgeon and don't forget to ASK, ASK, ASK until you are satisfied. Let NO question go unanswered. Best of Luck to you, stay cool and take it one step at a time.

[Montana girl 06]

Yes, Birad 4 is suspicious, but with calcifications around 80% of biopsies tend to be benign. I've had 2 benign biopsies for calcifications myself and now they just follow mine with a mammo every 6 months. Mine also increase over the years until they get to the point the radiologist recommends a biopsy. I know how upsetting it is to get this news, but there is a great chance they will be benign. It's still best to get the biopsy to set your mind at rest.

[Soldier37]

Thanks for the input!  My niece (by marriage) is in the middle of chemo.  I guess I'm just nervous because someone close to me has been recently diagnosed.  I wish I had the radiology report.  I'm going to call on Monday to see if I can get a copy before I meet with the surgeon on Tuesday.  I want to be able to ask as many questions as possible.  The nurse was very vague when she told me I needed to follow-up with biopsy.  The only information I came away with was just what I wrote in my first post.  I'm glad that things seem to be moving along though.  I've read so many posts about having to wait up to weeks between appointments before you get any answers.  My mammogram was Thursday and I get to see the surgeon on Tuesday.  I'll let you know how things turn out.

[lizziecee]

I  do unfortunately take exception to your last post. A BIRAD score of 4 is possibly malignant - criteria is 3 or 4 malignant findings. Why don't you research it, as I have done? We as breast cancer survivors, owe it to the newly diagnosed, to post here with the very best information we have.
I am very disappointed with your post - I do the best research I can, having breast cancer, and I do not like people like you coming on here with inaccurate information when people newly diagnosed are floundering for information.

[japdip]

PLEASE READ ...... this is one of the many replies by the Professional who routinely answers questions on this board. My reply was a professional one but in no way to be thought of as that. This was copied from a previous post.

A BIRAD Category 4 means that there is a suspicious abnormality. Most category 4 abnormalities are benign but may require biopsy since this category can be malignant in 25-50% of cases. You should discuss with your radiologist or surgeon when it is safe to breast feed from that breast again.

I am sorry you objected to my previous post but please try not to advise patients if your information isn't correct. What you read was that 3 or 4 out of a certain number of cases were found to be malignant with a score of 4 ..... NOT 3 or 4 indicates malignancy.

To the original poster .. the Professional from the Cleveland Clinic will answer your questions on Monday. Hang in there and take everything with a grain of salt .....

[Montana girl 06]

You have been helpful to many at this site but according to my research I have to agree with Japdip that your first post in this thread was incorrect. You stated BIRAD 4 is highly suspicious of malignancy. BIRAD 4 is "suspicious" and using the word "highly" belongs to BIRAD 5 - "Highly suggestive of malignancy" as I quote directly from my radiology report. To me the words "highly suspicious" are very alarming and that's why they are used for BIRAD 5.

This is supposed to be a support forum and when one person attacks another it destroys the comradery at this site. It seems we should be able to express differences and corrections without attacking.

[Avidhiker]

I am a breast cancer survivor.  In April of 2006, my mammo was given a BIRAD of 4 which I know for a fact means "suspicious abnormality".  A biopsy was recommended.  I had microcalcifications spread out over too large an area for any needle biopsy.  I had an excisional biopsy and unfortunately mine turned out to be malignant.  At the time, I asked my surgeon the chances of this happening and he advised that 15% turn out to be malignant.  This, of course, means that 85% of the time it is not.  Since April of 2006, perhaps these percentages have fallen or risen.  My surgeon has 33+ years of breast surgery and diagnosing and treating breast diseases.  I believe what he tells me.  

By the way, I also know for a fact that a BIRAD 5 rating is "highly suggestive of malignancy".  A BIRAD 6 is after the biopsy and means "known biopsy-proven malignant".

To soldier37:  GO ASAP FOR YOUR BIOPSY!  If it is cancer, it will be EARLY and that is the most important issue.  Good luck.

[blkw]

You mention the percentage of biopsy of calificatioin clusters that are cancer vs. benign. Does this percentage vary by age? I'm 37 and having a calification cluster biop this Thursday (my mother also had breast cancer), I'm wondering if the percentage of non-cancer findings is higher over 50/under 50 or over 40/under 40. Thanks,

[lizziecee]

I truly apologise if I said anything incorrect.... I would not purposely mislead anyone with this awful disease.  When I had my 3rd mammo at 58 yrs, at a travelling van in the isolated place I live, I had a BIRADS 4 - then I was recalled to a breast care centre where my surgeon said that a BIRAD 4 was highly suspicious of malignancy - perhaps by the mammo which I eventually saw, that showed a black mass, which was spiculated. I may be in a minority of BIRADS stage 4. that was dx with breast cancer,  but at least it was picked up. I just wanted to detail my own experience and let Soldier realise how important the score is/was.

I eventually was dx with a 2 cm invasive tumour and spread to the lymph nodes
I apologise to anyone I upset by my post.
Liz.

[japdip]

Hi .... I believe there isn't a difference due to the age of the patient. If you would like an answer from the Cleveland Clinic Professional you should ask your question as a post rather than just a comment. They never read the comments; just the original post. I know it's difficult to get on the forum but if you try at different times of the day (and even late at night) you will eventually be able to post. They reset at different times each day to give those in different time zones an opportunity to post.

[boninclyde]

Well I guess I'll butt in. I have been scolded and I have scolded some on this site. I had to learn patience. It is most of the time a mis-interpretation and we don't mean to harm anyone. We only try to help. We appreciate being corrected. We are all here to learn. Lizzie has been a great help on here and has helped alot of people. Thank you all who post so much for taking your time to help.

[Soldier37]

Thanks to everyone for all the info.  I got my report today but it was only one page and not very descriptive.  Most of the information I got from the nurse after my appointment wasn't even on it.  Do they do a summary report or something?  I wanted to see it so I could ask questions tomorrow.  My BIRAD rating wasn't even on it nor were any of the measurements of the clusters.  One thing I did see is that if I have a family history, the radiologist thinks this could be more of an indication of malignancy.  The only problem is that my mom died at 52 with colon cancer.  She had something in her breast but since she refused further treatment for the colon cancer, she never did anything about the spot on her breast.  I have no idea whether it could have been something or not.  I guess I'll see tomorrow what the surgeon thinks.

[Montana girl 06]

I hope all goes well. Keep us posted.

[blkw]

Thanks for the advice and reply. I'm new here. I've been trying to do some of my own research (which is probably making me more nervous instead of helping) but can't find the answer to this question.  I got it posted this morning.
Thanks again and best regards to you,
-blk

[Soldier37]

Hi everyone!  I had my consultation with the surgeon today.  I feel so much better!  I'm having a stereotactic biopsy next Tuesday.  He gave me the same percentages as most of you - "...85% of cases similar to your circumstances are benign".  I am also glad I don't have to have an open biopsy.  Hopefully, I'll know for sure by the end of next week.  I really think everything is going to be alright.  I'll pass on the good news to you when I get it.  Hope you all are doing well. Thanks for all the support.

-Soldier

[Montana girl 06]

Thanks for keeping us posted. I'm glad your biopsy is scheduled soon so you can get some answers. I hope you join the benign group.

[lasimon]

I went for my mammogram a few weeks ago and I was asked to come back for some additional pictures for my right breast- ( I have family history of breast cancer also- Mother at 37 and an aunt also ) When I had the additional pictures done the radiologist said that everything is fine but they want to have me come back in 6 months for another mammogram.  After this I received a letter in the mail from the place where my Mammogram was done and they used the term you "PROBABLY" dont have cancer but you need to come back in 6 months for a recheck- I called my Dr who was to get the information and wanted to understand what the word"probably" meant???  I could have cancer or I don't?? really felt uneasy about the letter just leaving it as is.  My Dr. Then called back and sent a referral for and MRI to be done.  Is this letter common for woman to get with high risk of cancer history in family?  Just curious if I am overreacting.....

Thanks in advance for any advice!!!

[Montana girl 06]

I recommend you get an actual copy of the radiology report so you have as much info as possible. It would be a good idea to ask for a copy after every mammogram so YOU can follow your reports and not just leave it in the doctor's hands. It is fairly common for women (whether they have family history or not) to get a notice that they should come back in 6 months to check an area that is probably benign, but since they're not certain they want to keep an eye on it. It's also fairly common for radiologists to follow somewhat suspicious findings in the breast and not even let the patient know! Since they said come back in 6 months I'm guessing the radiologist gave it a BIRADS 3 rating on a scale of 1-5. That means it's highly unlikely it will be cancer. But, with your family history it's great that your doctor is moving forward with an MRI. I just want you to know that MRI's have a fair number of FALSE positives. I really hope you get some answers, because I know how scary it is to just wait and wonder if you have cancer. I hope all goes well with your MRI.

[lasimon]

Thanks Montana girl.  I'm praying that everything goes good also- my test is on Friday the 13th-:(  but hey- never had anything bad happen before on this date so I hope that the trend continues!

Have a great 4th of July!!!

[stresscase123]

Get it checked out for peace of mind, if there is *any* question, IMO.

For the record, I had my baseline mammo and was given a BiRADS score of 3 for calcifications.  The radioloigst suggested I have a biopsy, since we had no history on the calcs, but also told me waiting 6 months was an option, since it was highly likely to be benign.  I went ahead with the biopsy, and lo and behold was diagnosed w/DCIS!

Regardless of BiRADS, if the techology exists to rule something in or out, we should take advantage of it.  The benefits of early diagnosis far outweigh the inconvenience/risks of an unnecessary biopsy, IMO!

[Montana girl 06]

How are you doing? Did you need more treatment after your surgery, or did they feel they removed everything? Haven't heard from you in awhile and just wonder how you're doing.

[Bay area girl]

I would like some comments about this. I am 53 with this being my first call back on a mamogram.   I have a core biopsy scheduled 2 days from now on one of 2 similar cluster amorphic microcalcifications on the right breast.  I got a birad 4 classifications but the dictor said in the report that they were faint and hard to see and that is why the biopsy.  I insisted that both clusters be biopsied and removed but the doctor said emphatically that that would be removing too much tissue and if I wanted both removed I should go to a breast surgeon.  I read every forum comment on core biopsies and I noticed that many had more than one cluster biopsied.  I am going ahead with the initial biopsy but I am of couse concerned and frightened.  Any  comments?