Breast Calcifications

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Q: My doctor recently told me I have breast calcifications. Will these lead to breast cancer?

A: Calcifications are deposits of calcium salts that can occur anywhere in your breasts. They are one of the more common findings on mammograms and may be caused by a variety of factors including older age, prior radiation to the chest, breast implants, or secretions from cells within the breast. While calcifications are most often benign (not cancerous), they do have the potential to indicate a precancerous or malignant condition.

Types of calcifications

There are two main types of deposits that can can occur in breast tissue:

Macrocalcifications are most often benign and appear as large white areas on a mammogram. They usually do not trigger further testing other than routine clinical breast exams and annual mammograms beginning at age 40 (or as scheduled by your physician).
Microcalcifications appear as small white specks on the mammogram and may appear in various patterns. Usually benign, this type of calcification does have the potential to be more concerning, including its association with ductal carcinoma in situ, or DCIS. This early form of breast cancer is located within a milk duct of the breast. It is considered noninvasive (meaning it has not spread), but does have the potential to spread to other parts of the breast if not treated. (Usual treatments include lumpectomy with or without radiation, use of tamoxifen after lumpectomy, or mastectomy.)

Fortunately, most types of calcifications are benign. Common reasons leading to their appearance in breast tissue and on mammograms include the following:

Previous injury to the breast tissue
Previous surgery involving the breast tissue (silicone implants, removal of tissue, etc.)
Residue on the skin from the use of deodorants, lotions, perfumes, ointments or powders (especially if used on the day of the mammogram)
Prior radiation treatment to the breast or chest region
Age, especially being 50 or older (calcifications are more common as the breast tissue ages during the middle and senior years)
Calcifications within the arteries of the breast (may also be an early clue to cardiovascular disease—please speak with your physician)
Calcifications within a noncancerous fibroadenoma (more common in women younger than age 35) or noncancerous cyst
Remnants from previous infection or inflammation of the breast (mastitis)
Calcium deposits within the milk ducts

Understanding your mammogram

Breast calcifications are very small and most commonly diagnosed during a mammogram. Once seen, the radiologist will examine their size, shape and geographic distribution (whether they're in tight clusters in a small area, or found throughout the breast). The radiologist will report a finding of one of the following: "benign," "probably benign" (risk of malignancy is less than 2 percent with a recommendation for a follow-up mammogram in three to six months), "indeterminate," or "suspicious." The last two often require a more detailed mammogram and biopsy.

However, the radiologist may instead list results consistent with the categories of the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology. The advantage of this system is a clear guideline to any needed follow-up testing and includes these categories:

Category 0—Additional imaging studies are needed to help the radiologist make a recommendation. This may include a diagnostic mammogram with additional views (including magnified imaging) of the breast, ultrasound and/or magnetic resonance imaging (MRI).
Category 1—Negative, no abnormalities (breasts are symmetrical, no skin changes or masses noted). Routine follow-up as recommended by your physician.
Category 2—Benign result, as no abnormalities of concern were noted. Routine follow-up as per regular screening recommendations.
Category 3—Probably benign (greater than 98 percent chance), meaning something was found that needs to be followed to watch for any changes. A repeat mammogram may be suggested in three to six months. Please note that some specialists may prefer additional testing (breast MRI, biopsy, etc.) while others may be more conservative. A lot has to do with your personal or family breast health history.
Category 4—Suspicious abnormality that has the potential to be malignant (3–94 percent) and further testing, including a biopsy (needle biopsy, excisional biopsy), is recommended.
Category 5—High probability of malignancy (greater than 95 percent) requiring biopsy (needle or excisional) and follow-up with a breast health specialist (surgeon with fellowship or extra training in diseases of the breast, oncologist, etc.)

Reviewing your test results

Lastly, getting a mammogram result that's totally normal is great, not to mention a big relief. However, when words such as calcifications, findings (probably benign, suspicious, etc.), BI-RAD classification and follow-up recommendations are mentioned, they can be pretty scary-sounding and confusing. That's why it's important to have a physician or nurse knowledgeable in breast health explain the test results in person (preferably) or over the phone. After all, a result is just a starting point. You need to fully understand your diagnosis and treatment options to take charge of your health while actively participating in the decision process with your medical team.

For further information, please speak with your physician. Also, visit Susan G. Komen for the Cure, Network of Strength, and Cancerbackup.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)