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If women are having their annual mammogram, chances are that sooner or later they will be told that calcifications have formed in breast tissue.
Dr. Jason Allen, a radiologist and Medical Director for Breast Imaging for UCHealth in Colorado Springs says, “Calcifications occur in the breast quite a bit, especially in women who are over the age of 50. Most commonly they are benign and are associated with cystic changes within the breast.”
When calcifications first form, they are usually so small they can't be felt. However, they can be seen on a mammogram, which can prompt additional evaluation depending on their appearance, usually with a follow-up mammogram.
“We want to magnify those (calcifications) to try to get a good look at them and compare with other prior examinations to see if there's been any change. There are a few other bits of information we can gather from previous mammograms if they're available. We can determine if those calcifications are something that is just benign - or if we are not sure, we can go onto a biopsy to find out specifically what's causing those calcifications.”
Dr. Allen says while the majority of calcifications that appear on a mammogram are benign, some do need to be biopsied to rule out a specific type of cancer. “The thing we are concerned about with calcifications that we can't definitively characterize as benign on a mammogram is what is called DCIS, or ductal carcinoma in situ.”
With DCIS, the cells that line the milk ducts of the breast have become cancerous, but they have not spread into surrounding breast tissue, which Dr. Allen says is the reason it’s so important these calcifications are investigated. “It’s basically the earliest form of breast cancer that we can detect. It's a non-invasive form of breast cancer that we refer to as “stage zero breast cancer,” and that's the stage of cancer we want to catch,”
A study from The National Cancer Institute in 2015 suggests that women who are diagnosed with abnormal cells in the lining of a breast duct generally have a low risk of dying from breast cancer.
The American Cancer Society says that in most cases, a woman with DCIS can choose between breast-conserving surgery (BCS) and simple mastectomy. But sometimes a mastectomy might be a better option.
Dr. Allen says It’s another reminder of why yearly mammograms are so important. “A mammogram is really the only way to see calcified DCIS.”
UCHealth recommends patients adhere to NCCN (National Comprehensive Cancer Network) screening guidelines which mirror ACR (American College of Radiology), SBI (Society of Breast Imaging), and ASBS (American Society of Breast Surgeons) breast cancer screening guidelines. These guidelines recommend that ALL women at average risk of developing breast cancer begin ANNUAL screening at age 40."
Women that are at higher risk of developing breast cancer due to significant family history, genetic predisposition (BRCA1/2 gene or other genetic mutation) or other risk factors such as dense breast tissue on mammography, should speak with their doctor to determine if beginning screening earlier or having additional supplemental screening (usually with MRI) in addition to annual mammography may be of benefit to them.
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