Microcalc cluster BIRAD4 - second opinion on having biopsy?

[Cinc]

I'm 44 & just had first mammo. They took many pictures and found suspicious microcalcifications. At first the radiologist talked in very simple terms, said I'm on borderline of "don't worry" but should make sure with surgical biopsy. I went home in shock, then called him the next day for more info. He reluctantly showed me xrays and report which said "moderately prominent fibroglandular elements identified. Suspicious calcium deposition in posterior third of left upper outer quadrant.Deep location precludes stereotactic procedure. Preoperative mammographic localization would be required. BIRAD4."  He showed me a 1.2cm line of maybe 10 dots with a dash or two located near chest wall. I felt uncomfortable with him saying things like he was "leary of giving me my report because I'll just show it to 100 doctors".  Now I'm wondering how borderline my mammo sounds. I've read that cancerous shapes often include radiating spokes which I didn't see. Is the linear shape of my cluster or the combo of dots & dashes what makes it suspicious? Is the size of cluster a concern? I know a biopsy is the only way to make sure, but I don't want invasive surgery when 85% of biopsies prove unnecessary, and I have no family cancer history and few risk factors.  Should I get second opinion reading of the mammos or just go to surgeon next? Does it sound like a definite 4 or could I consider waiting for another mammo? I'd be less hesitant if I had the needle option but I guess the chest wall location is a real problem?  Thanks for any help!

[Christie2004]

I was 35 when I had my first mammo (12+ years ago).  They weren't really using the BIRAD system back then.  I had microcalcifications, but was told due to my lack of any family history of breast cancer, and no risk factors, a biopsy wasn't necessary.
However, for my own peace of mind I went ahead and had one.  I had invasive ductal carcinoma.  It was found very, very early and I had no positive nodes.

I don't want to scare you, but do realize that 75% of women with breast cancer have NO family history and NO risk factors.

  Get this checked out.  If you don't have cancer, the worst result will be a small scar.  If you do have early cancer, you will have just saved your own life.

[ritavv]

Sheila,
I had linear calcifications in both breasts almost two years ago.  This was 2.5 years after I had been diagnosed with breast cancer so I was really worried.  Both biopsies turned out negative.

I would never call these 'unnecessary' biopsies.  They were necessary to determine if the calcifications were cancer.  Yes, it would be great if one didn't have to undergo surgery.  That is why it was such a break through when they developed the mammatone biopsy.  Doctors are always trying to find less invasive ways of making a diagnosis  Like you my calcifications were too close to the chest wall.  I was just thankful to have the option of the excisional biopsy.

Good luck on your biopsy.

[Cinc]

Sheila - Congratulations on the good biopsy. I hope the pain goes away quickly.  I did more online research last night and found references to linear patterns being malignant, so I will probably go ahead with the biopsy. I still have real concerns about how common it is for mammograms to lead to unnecessary biopsies.  I don't think I have much of a choice though, which honestly, stinks.

I appreciate your support. Good luck to you too.

[SheilaSee]

I had Microcalcifications too. I had the biopsy, turned out to be non-malignant. What a relief!! The procedure was a bit more intense than I expected, but the not knowing would have been too hard to handle. I am still a little sore, and feel wierd things in my breasts that make me worried, yet I'm hoping just resulting from the biopsy. I am nearly 43, and have a history of fibroid cysts. I didn't feel I had an option, as my surgeon who I've seen before for the cysts advised that I get it done. I had the procedure done a week ago, so I imagine I'll feel sore for a little bit longer. To think that 85% are OK, and wondering why must we go through that is still mind bogeling to me, but better safe than sorry, I guess. Perhaps a surgeon from this site can comment on why it is so important for us to go through that, and to answer when the pain fully goes away. I don't know all the exact results, pertaining to size and all, but I do have to go back in 6 months for a follow up mammogram, hopefully no more biopsies, yet time will tell. I hope this helps, I was so scared a week ago, thought my Mother's Day was ruined, as it turned out it was great, so there is hope for you! This will be an ongoing worry that we just have to deal with. It's so hard, but we must be strong!!

[CCF-RN,MSN-rf]

Dear Cinc:  It is normal for calcifications to develop in the breast tissue.  The pattern of their growth will increase or decrease the level of concern.  The concern comes when calcifications are clustered.  Clusters often form around areas of abnormal tissue growth.  This could be many things but generally requires further investigation.  A BIRAD category 4 on mammogram is defined as: Suspicious abnormality. Most category 4 abnormalities are benign but a biopsy may be the only way to identify the 25-50% of these cases that may turn out to be malignant.  The BIRAD reading is determined by the radiologist's level of suspicion.  If you have an appointment with a surgeon, he/she will take a look at the mammogram and make recommendations accordingly (and this is the person who can make the best decision regarding the type of biopsy that will be necessary).  If you remain concerned, you certainly have the option of seeking a second opinion.