Many women, once they reach a certain age, begin having mammograms on a regular schedule — usually either annually or biannually starting at age 40, 45 or 50 — to look for signs of breast cancer. This routine screening is something of a rite of passage for many women: The National Cancer Institute reports that “mammography is the most widely used screening modality for the detection of breast cancer.”
Although it’s widely used, mammography isn’t perfect — it misses some cancers and picks up on some masses that aren’t actually a problem, resulting in false positives and potentially unnecessary procedures. Still, it’s currently the most widely available means of detecting breast cancer in the earliest stages.
And cancer caught in earlier stages tends to be more responsive to treatment and more curable than later-stage cancers. The American Cancer Society reports that five-year relative survival rates: stand close to 100 percent for women with stage 0 or stage 1 breast cancer; drop to about 93 percent for women with stage 2 breast cancer; fall to 72 percent for those with stage 3 breast cancers; and drop further to 22 percent for metastatic or stage 4 breast cancers. Therefore, many doctors recommend that women have mammograms on a regular schedule to catch breast cancer earlier.
[See: A Tour of Mammographic Screenings During Your Life.]
Mammograms show your doctor a number of things about your breasts, including how dense (or fatty) they are and any lumps or cysts that may be present. Many mammograms also show small white flecks — some no bigger than a grain of sand — called calcifications or microcalcifications.
“Calcifications are a sign of cellular turnover or activity in the breast,” says Dr. Tari A. King, chief of breast surgery at Dana-Farber/Brigham and Women’s Cancer Center in Boston. “Calcifications can be normal, because normal cells only live so long and when the cells die, they [may] show up as calcifications on the mammogram.”
Calcium deposits can turn up in almost any body part, but they are common in breast tissue, especially as you age.
Dr. Nikita Shah, section leader, breast medical oncology at Orlando Health — UF Health Cancer Center in Florida, describes calcifications as “basically calcium deposits that are opaque, so they will they will be seen on a mammogram.”
You can’t feel breast calcifications with your hand — the only way to learn they are there is with imaging tools such as a mammogram or MRI. The Susan G. Komen Foundation reports that calcifications are very common and “are found on about half of all mammograms in women ages 50 and older (and on about 1 in 10 mammograms of women under 50). Calcifications may be due to older age, past injury or an infection in the breast tissue. They are not due to the amount of calcium in a woman’s diet.”
“Normal breast tissue has calcifications,” Shah says. And most of the time, they’re nothing to be concerned about. If your doctor determines your calcifications are benign, there’s little reason to worry about them becoming a problem in the future. Stable calcifications do not elevate your risk of developing breast cancer.
[See: 12 Things to Know Before Your First Mammogram.]
Although they usually are not a problem, King notes that “some calcifications may be concerning for an early sign of malignancy,” meaning that they can be one of the first signs of breast cancer. Therefore, your doctor may recommend a biopsy of certain calcifications to have a closer look at what’s going on. “Other calcifications may not be concerning and the radiologist reading the mammogram may simply comment that they see calcifications but there may not be any follow-up necessary.”
Although having calcifications does not increase your risk of developing cancer, and most are benign, some may be flagged by your radiologist as warranting further investigation. “If they look abnormal, the next step would be to have an ultrasound to see if there is a correlating abnormality, maybe even an MRI and then potentially a biopsy,” Shah says. “Calcifications are often associated with ductal carcinoma in situ, or stage 0 breast cancer,” she adds. DCIS or stage 0 breast cancer refers to abnormal cells in the milk duct that are precancerous and could break out beyond the confines of the duct, but have not spread yet.
Doctors still can’t predict which cases of DCIS are likely to become invasive breast cancers and which will remain in the duct and not cause further problems, so DCIS is typically treated with surgery and possibly hormone treatments. There’s some controversy over whether DCIS should be classified as “cancer,” because it has not yet spread beyond the milk duct, but the ACS notes it’s “considered non-invasive or pre-invasive breast cancer.” The good news is, DCIS has a very high survival rate. The National Breast Cancer Foundation reports that the five-year relative survival rate for DCIS is 100 percent. “With invasive cancer, you tend to have a mass or a lump,” Shah says, because the cancer has grown more and moved beyond the walls of the milk duct. “DCIS is more associated with calcifications,” so if there’s a concern about a calcification, chances are good it’s being caught very early.
When your radiologist reviews your mammogram images, he or she is looking for certain characteristics that could signal a problem. “Calcifications that are brand new, increasing in number or size, tightly clustered together or are different sizes or shapes or appear to be in a linear pattern, those could be concerning for the first sign of an early breast cancer,” King says. “There’s a threshold that breast imagers have for when they will recommend a biopsy for new or increasing calcifications.”
Just because you are advised to have additional testing to get a closer look at a calcification does not mean you have breast cancer. “Most of the time, biopsies that are recommended for calcifications will not show cancers. Most of the time calcifications are associated with benign changes in the breast tissue,” King says. She stresses that “having calcifications on a mammogram does not increase your risk of future breast cancer. The key is if you have new calcifications or increasing calcifications and there’s a recommendation for a biopsy, you should follow through with the biopsy to make sure there’s nothing going on right now.”
[See: 10 Innovations in Cancer Therapy.]
Looking for new masses, cysts, calcifications and any other changes that occur in your breast tissue over time is a critical piece of how mammographic screening works. Shah says that for best results, it’s important to visit the same screening facility every time you have a mammogram. If you do need to change screening facilities, she says it’s important to make sure your images and records from your previous screening center are forwarded in advance of your mammogram. The new radiologist needs to have those previous images to compare to the current one in order to properly track any changes that could signal a problem. “That comparison will give you a better idea of whether anything is changing and help you avoid unnecessary testing and procedures,” Shah says. “If you can look at the last five years and it looks the same, you don’t need to put a patient through a biopsy or an MRI.”
She also notes that 3D mammography, also called tomosynthesis, is a better option than conventional 2D imaging because it provides a more detailed view. Tomosynthesis may not be covered by all health insurance policies, so check with your plan and ask your health care provider what your options are.
More from U.S. News
10 Innovations in Cancer Therapy
Breast Pain? Stop Worrying About Cancer
A Tour of Mammographic Screenings During Your Life
What Are Breast Calcifications? originally appeared on usnews.com
