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Breast Cancer

Breast microcalcifications

12/21/2006

Question:

I am a 40 yr. old woman that has recently had a second mammo due to lumps in my underarm and what my dr. and I thought was a breast mass. Although the tests (ultrasound and diagnostic mammo) showed these areas to be fine, the mammo showed something else.... breast calcifications. I have many "specks" through out my breasts, but one cluster. My mammo results were a Bi-Rad rating of 3 on a scale of 0 to 6. The rating of three is noted as .....probably benign, on a microcalcification they saw in the upper outer left breast. Although they say there is a 98% chance that this `fairly tightly cluster" is benign, I don`t like having ANY chance of cancer (even if it is only 2%). PLUS, they noted in my results that "The very dense nature of the patient`s breast parenchyma can obscure abnormalities". This also isn`t very positive. So I went for a biopsy on Friday to finally ease my mind and find out for sure whether or not the spot is benign, but they were unable to do it based on it`s location and the trouble they had getting all the correct views to locate it and biopsy it. It is apparently in a very thin area above my breast, close to the skin surface AND the chest wall. There were muscle and other tissues obstructing the views. I am now being told that it is completely up to me to either wait 6 months to get a new mammo, to show if the stability of the area is ok or if it changes, or have a breast surgeon remove the area in question. My concern is that no matter if it changes or not, it was there 3 yrs. ago but they didn`t know that then, only know it now since they had a new mammo to compare it to. It is more prominant now than it was 3 yrs. ago, which is another reason why I am concerned. I am also concerned because if I wait for another mammo, I am just going to go through the same "not knowing" again in six months based on the location and the inability of the radiology staff to biopsy it.

So, to reiterate..... I am being told my only options are to wait (again, I would just go through the same predicaments again of not being able to get a biopsy and the ongoing worry til March `07), or have a breast surgeon remove the area. And since my mom did have some type of cancer in her uterous years ago, everyone I talk to is suggesting I go through with the surgery. I am just very concerned, even more now than I was before the biopsy attempt, since I have no way of knowing if it is benign or not.

Can you let me know what YOU would do? I am being told by some people to go to an actual breast surgeon and have them give me a second opinion. A friend of the family has recommended a woman breast surgeon to contact. Please let me know your thoughts. Thanks

Answer:

Breast calcifications are actually very common, and, as you stated, when classified as BI-RADS 3, there is a very low likelihood (2% or less) that they are in fact malignant. Unfortunately, there is not always one right answer when faced with the problem that you described. I am a breast surgeon, and so I think it is ALWAYS reasonable to get an expert opinion about these calcifications. I think that a breast surgeon could review the films with you and provide you with another opinion regarding the options.

Based on what you describe (and of course, not seeing the films myself does limit my ability to judge), it sounds like repeating the films in 6 months to assure stability is a very reasonable approach. I think that is what I would do. Of course, you have to be comfortable with waiting, since without removing these calcifications, there is no way to know for sure that this area does not represent a small cancer. If you feel that not having a biopsy will cause too much anxiety, then I think that having the biopsy is the way to go. I don’t think that your mother’s uterine cancer should influence your decision, because I don’t think that it would increase your risk for developing a breast cancer.

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Response by:

Doreen M Agnese, MD Doreen M Agnese, MD
Clinical Associate Professor of Surgery and Internal Medicine
College of Medicine
The Ohio State University