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Wednesday, April 23, 2014
I am a 49 year old white female. My mother lost both breasts to cancer 40 years apart. I have had 3 surgeries on my right breast for what turned out to be benign cysts which never showed up on mammography. They were found during manual breast exams. Now I have had a mammogram (with magnification) which shows a cluster of microcalcifications in my left breast. (This is my first ever abnormal mammogram.) The radiologist has told me I have the choice of either going ahead and doing a biopsy or taking the "wait and see" approach. Although, rather than the normal 6 month wait he has recommended a follow up in 4 months. Between his not wanting to wait the full 6 months and my mother having had breast cancer twice, I am leaning toward going ahead with the biopsy. But,then again, I have been through 3 surgeries that were not malignant so I`m wondering if I`m jumping the gun. I am also wondering if, should this be a malignancy, waiting 4 months would alter the prognosis and/or treatment. I would appreciate anything you can share with me. Thank you.
Microcalcifications within the breast can reflect the presence of a number of conditions, most of which are types of fibrocystic changes. However, clustered or linear microcalcifications can indicate an early form of cancer, ductal carcinoma in situ (DCIS), if it is not associated with a distinct mass. Most biopsies today should be approached by stereotactic core needle to sample the area, not a full surgical approach, as the standard of care. In rare occasions, if the breast is small, or if the calcifications are close to the skin or chest wall, the stereotactic approach cannot be performed.
If only DCIS is present, you do have some time where follow-up will have no impact on survival. The problem is, you and your doctors do not know specifically what the microcalcifications reflect in terms of tissue changes. In the rare possibility of this being associated with an invasive malignancy, a wait could have possible survival implications. The needle type of biopsy makes for a very accurate sampling, though. In light of your family history, I think simply getting a sample by stereotactic core needle biopsy is the safer, quicker way to go.
Elizabeth Shaughnessy, MD, PhD
Associate Professor of Surgery
College of Medicine
University of Cincinnati