Breast Calcifications: What You Need to Know and Do

Q: Breast Calcifications: What You Need to Know and Do

Dear Annie： <br>1. <br>The assessment of calcifications depends on their distribution, density, and whether they are unilateral or bilateral. <br>If they are bilateral, scattered, and without localized clustering, they are mostly benign changes and can be monitored. <br>It is rec

Breast calcifications issue?

(1) I am 47 years old and regularly undergo mammography and ultrasound follow-ups at a teaching hospital.
About a year ago, calcifications were found in both breasts, and two doctors I consulted said that monitoring was sufficient (the calcifications are scattered and not clustered).
However, a friend of mine mentioned that she also had calcifications (which her doctor deemed benign and recommended monitoring), but when she returned for follow-up a year later, it was directly diagnosed as stage 2 breast cancer.
She firmly advised that if calcifications are present, they must be addressed, or they will inevitably turn into cancer (she insists that calcifications are precursors to cancer).
Both hospitals I consulted (which are reputable) recommended monitoring.
If treatment is necessary, wouldn't that leave the breast with numerous holes? How should I proceed? I read online that calcifications are quite common, isn't that true?
(2) Additionally, I underwent minimally invasive surgery (vacuum-assisted biopsy) in January to remove an entire breast fibroadenoma (the report indicated it was benign).
I read online that doctors typically place a metal wire or some marker in the breast before performing minimally invasive procedures to facilitate the identification of the area for subsequent tissue removal if the biopsy results are malignant.
However, my doctor did not inform me of this.
Is it possible for such a situation to occur? If there was indeed a metal wire placed and it was not removed, could that pose any issues? Thank you, Dr.
Zhou! I appreciate your help!

Ani, 40~49 year old female. Ask Date: 2016/01/26

Dr. Zhou Jiazhen reply Breast and Thyroid

Dear Annie:
1.
The assessment of calcifications depends on their distribution, density, and whether they are unilateral or bilateral.
If they are bilateral, scattered, and without localized clustering, they are mostly benign changes and can be monitored.
It is recommended to have a mammogram at least once a year to evaluate any changes in the calcifications (if they are scattered and surgery is necessary, a total excision or targeted excision of the suspicious calcification points can be performed).
2.
Generally, the placement of markers in breast tumors is intended for malignant cases where chemotherapy is administered first, as there is a concern that the tumor may disappear.
The marker is then implanted during a core needle biopsy to facilitate surgical marking after chemotherapy.
However, if the tumor is already planned for excision, this step is unnecessary (especially since vacuum-assisted excision is not used for malignant tumor removal due to concerns about contamination and spread).

Reply Date: 2016/01/26

More Info

Understanding breast calcifications and their implications can be quite complex, especially when navigating the nuances of medical advice and personal health concerns. Let's break down your questions and provide a comprehensive overview.

1. Understanding Breast Calcifications
Breast calcifications are small deposits of calcium that can form in the breast tissue. They are often detected during mammograms and can appear in two main forms: macrocalcifications and microcalcifications. Macrocalcifications are usually benign and often associated with aging, while microcalcifications can sometimes indicate the presence of breast cancer, particularly if they are clustered or have irregular shapes.

In your case, you mentioned that both breasts have scattered calcifications, which is generally considered a benign finding. The fact that two different doctors have recommended monitoring rather than immediate intervention suggests that they do not see any concerning features in the calcifications that would warrant further action at this time. It is important to remember that not all calcifications lead to cancer, and many women have benign calcifications that do not progress to malignancy.

Your friend's experience, while alarming, is not the norm for all cases of calcifications. It is crucial to understand that while some calcifications can be associated with cancer, the majority are benign. Regular follow-ups, as recommended by your doctors, are a standard approach to ensure that any changes in the breast tissue are monitored over time.

2. The Importance of Follow-Up
The recommendation for follow-up is based on the principle of vigilant observation. If calcifications remain stable over time and do not change in appearance, the likelihood of them being associated with cancer is significantly reduced. However, if there are changes in the calcifications during follow-up mammograms, further evaluation, such as a biopsy, may be warranted.

It is understandable to be concerned about the potential for breast cancer, especially when hearing anecdotal stories from friends. However, it is essential to rely on the expertise of your healthcare providers, who can assess your individual risk factors and the characteristics of your calcifications.

3. The Role of Minimally Invasive Procedures
Regarding your question about the minimally invasive procedure you underwent in January, it is common practice for doctors to use localization techniques, such as placing a metal wire or clip, to mark the area of concern before performing a biopsy. This helps ensure that the correct tissue is removed and allows for accurate follow-up if further treatment is necessary.

If a clip or wire was placed during your procedure, it is typically left in place unless there is a specific reason to remove it. These markers are designed to be safe and are often made of materials that do not cause harm or interfere with future imaging. If you have concerns about whether a marker was placed or if it was removed, it is best to discuss this directly with your healthcare provider. They can provide clarity on the procedure and any follow-up care you may need.

Conclusion
In summary, while breast calcifications can be concerning, the majority are benign, especially when they are scattered and stable over time. Regular follow-up with your healthcare providers is crucial to monitor any changes. Additionally, if you have undergone a procedure that involved localization, it is standard practice, and these markers are generally safe. Always feel empowered to ask your healthcare team any questions you may have about your health and treatment options. They are there to support you and provide the best care possible.

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