Breast Calcifications: When to Consider Biopsy and Follow-Up

Breast calcification

Hello, in July 2022, a mammogram revealed calcifications in my left breast.
I underwent a breast magnification mammogram, and the report indicated a BI-RADS category 3, recommending follow-up every six months.
However, the doctor mentioned that the magnified images were still unclear, making it difficult to discern the shape of the calcifications.
Although the calcifications are small, there is a cluster of about five grouped together.
Compared to the mammogram from 2018, the number of calcifications has slightly increased.
The doctor suggested that it would be best to arrange for X-ray localization for a biopsy, but this would be out-of-pocket.
I would like to know if it is indeed necessary to proceed with this.
Will there be pain from the internal deep wound after such a localized biopsy? Can the calcifications be completely removed? The doctor also mentioned that if I choose not to have the localization, I could follow the report's recommendation for a follow-up in six months.
However, I am concerned that if it turns malignant by then, it could become complicated.
I find it difficult to decide and would appreciate your opinion.
Thank you.

tina, 50~59 year old female. Ask Date: 2022/08/25

Dr. Yuan Tianmin reply Breast and Thyroid

I believe that if there are no other concerns, it is best to follow the physician's recommendation for a targeted excision.
I have also had a diagnosis from a radiologist indicating a grade three, but ultimately there was still the presence of carcinoma in situ.

Reply Date: 2022/08/25

More Info

Understanding breast calcifications and the decision-making process regarding biopsy and follow-up can be quite complex, especially when faced with the uncertainty of potential malignancy.
Breast calcifications are small deposits of calcium that can appear in breast tissue and are often detected through mammography. They can be categorized into two main types: macrocalcifications and microcalcifications. Macrocalcifications are usually benign and often associated with aging, while microcalcifications can sometimes indicate the presence of breast cancer, particularly when they appear in a clustered pattern or have irregular shapes.

In your case, the report indicates that the calcifications in your left breast have been classified as BI-RADS category 3. This category suggests that the findings are probably benign, but there is a recommendation for follow-up imaging within six months to monitor any changes. The fact that the calcifications have increased in number since your last mammogram in 2018 is a point of concern that warrants further investigation.

Your doctor’s recommendation for a stereotactic biopsy (a type of biopsy that uses imaging guidance to locate the area of concern) is based on the need to obtain a definitive diagnosis. While it is understandable that you may be hesitant to undergo a procedure that requires out-of-pocket expenses, it is important to weigh the risks and benefits. A biopsy can provide clarity on whether the calcifications are benign or malignant, which can significantly influence your treatment options and peace of mind.

Regarding your concerns about pain and the ability to "clean out" the calcifications, it is important to note that a stereotactic biopsy is generally well-tolerated. Local anesthesia is used to minimize discomfort during the procedure, and while some patients may experience mild pain or tenderness afterward, it is usually manageable with over-the-counter pain relief. The biopsy itself does not remove the calcifications; rather, it allows for the examination of the tissue to determine the nature of the calcifications.

If you choose not to proceed with the biopsy and instead follow the doctor's advice for monitoring, it is crucial to maintain regular follow-up appointments. This approach can be appropriate for many patients, especially if the calcifications remain stable and there are no other concerning symptoms. However, if there are any changes in the characteristics of the calcifications or if new symptoms arise, further evaluation would be necessary.

Ultimately, the decision to undergo a biopsy should be made in consultation with your healthcare provider, taking into account your personal health history, the characteristics of the calcifications, and your level of anxiety regarding the situation. It is essential to communicate openly with your doctor about your concerns and preferences, as they can help guide you through this decision-making process.

In summary, while the recommendation for a biopsy may seem daunting, it is a proactive step towards ensuring your breast health. Early detection and diagnosis are key factors in successfully managing any potential breast issues, including cancer. If you have further questions or need more information, do not hesitate to reach out to your healthcare provider for clarification and support.

Similar Q&A

Understanding Breast Calcifications: Should You Consider a Biopsy?

Hello Doctor: My mammogram report has come back, and the doctor mentioned that there are calcifications, with one area appearing clustered and irregular. He recommended a needle biopsy to further determine whether it is benign or cancerous. I am very scared and unsure if I should...

Dr. Wu Jingtang reply Breast and Thyroid
Dear Miss May, The presence of clustered microcalcifications on your mammogram, especially when irregular, indeed requires further diagnosis. While it could potentially indicate a malignant tumor, the likelihood is not very high. Whether to perform a core needle biopsy (which ca...

Understanding Breast Calcification: Biopsy and Local Excision Options

Hello, I have undergone a mammogram at the hospital, and the doctor informed me that the calcification is classified as 4B. They suggested scheduling a biopsy and a partial mastectomy on the same day. Can I inform the doctor to perform the biopsy first to determine if it is malig...

Dr. Yuan Tianmin reply Breast and Thyroid
According to our hospital's practice, we remove it all at once since the results are likely benign. I have already cleared it completely, and if it were malignant, I have also removed it. This approach is better as it resolves everything in one go.

Understanding Follow-Up Procedures After a Mammogram: What to Expect

My mother had a mammogram in July this year and was advised to return to the hospital for further examination and treatment, which has made me very anxious. What situations would lead to the need for additional testing? Could it be that my mother has calcifications in her breast?...

Dr. Lin Zhemin reply Surgery
Hello: It is quite common to be asked to return for a follow-up appointment if abnormalities are found in a mammogram. The original physician is the most familiar with your case. Further examinations may include ultrasound, fine needle aspiration, or biopsy, all of which require ...

Understanding Breast Calcifications: Risks and Next Steps for Your Health

Hello Doctor, I am 53 years old. About 20 years ago, I discovered a lump in my breast, and after a biopsy, the report indicated it was benign. A few years ago, I noticed some signs of progression, and upon further examination, it was said to be a calcification phenomenon. At that...

Dr. Lin Kecheng reply Surgery
Hello Ms. Lin: Your follow-up examination shows calcifications. Could you clarify whether this was determined through breast ultrasound, mammography, or a physical examination by the physician? In women aged 53 and postmenopausal, statistically, small calcifications do have a pot...