Segmental Calcifications (BI-RADS 4) & Biopsy Questions
Hello! I (40F, no family history, no children, no symptoms) got my first mammogram in December and was called back to do another one two weeks ago. I was recommended a stereotactic biopsy because they found calcifications in my left breast. Like a lot of people, I googled my findings and started to have a lot of worries and questions.
I am very glad to have come across this insanely supportive community. So far I have found a lot of great info here, but I haven’t seen anything similar to my scan, so I thought I should ask to see if anyone had findings that are similar to mine or if anyone knows anything about this type of calcifications.
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My report:
“The breasts are heterogeneously dense, which may obscure small masses. There are no suspicious masses or areas of architectural distortion. Segmental coarse calcifications are seen within the 12 o'clock position of the anterior left breast spanning 7 x 25 x 11 mm.
IMPRESSION:
Segmental coarse calcifications in the 12 o'clock position of the anterior left breast are suspicious.
BI-RADS 4: SUSPICIOUS”
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My own description of the scan:
Side view: There are 9 specks (1-2 irregular shapes, the rest are smaller and rounder) starting from the top part of the areola spanning across the upper part of the breast. They just are spread across that area. And there is a bigger one by itself near the bottom of the areola. I’m not sure why this one isn’t included in the report. (I tried to measure the distance according to the scale between the farthest speck in the top segment and the standalone speck at the bottom and they measure about 5 cm, which is not what they say the longest dimension of “the area” is.
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My questions:
- Is it normal to go straight to biopsy without any ultrasound/MRI done? (I assume that’s because no masses were seen on my scan?)
- Is it possible that my type of calcifications is benign? I read that it can be hard to distinguish between regional and segmental distributions.
- How do benign calcifications form in the beginning? For example, older women tend to have benign calcifications spread across the whole breast. When they first appear, are they already on the bigger end? And they just appear suddenly all across the breast? I read somewhere (forgot where) that it could be benign calcifications starting to form. But I’m not seeing this info anywhere else.
- If mine turns out to be benign, is it likely that I’ll need biopsies from time to time if they keep popping up?
- If the specks are across such a big area, do they take samples from this whole area? How do they determine the locations?
- I got the mammogram through a breast center and received a follow-up call asking if I wanted to schedule a biopsy (and I immediately did). But now I’m thinking if I should talk to the radiologist who reviewed my scan first. Is it standard procedure that patients just show up to the biopsy appointment without having anything explained to them? My obgyn called me and asked how I was doing. For some strange reason I answered “I am good.” I think I was still in a bit of a shock. I recall her mention it could be benign and if not, stage 0.
- Is it better to do the biopsy with a breast surgeon? I saw conflicting info regarding needle biopsies. If there are abnormal cells, does this type of biopsy aggravate them? (I apologize if this sounds ignorant. I’m trying to learn more.)
- Do most people get surgery and treatment for DCIS? I saw it being discussed as “controversial”. I would think the smart thing is to get rid of any cancerous cells asap. But I also want to know my options and others’ experiences.
Sorry, that was a lot. I hope to get some answers to my questions. I’m not expecting anyone to answer all of my questions, but any advice/info is welcomed and appreciated!
Thank you so much for your time!
Comments
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Welcome Gh0st although sorry it is for this reason.- Yes, it is common to go from Mammogram to biopsy, that is the only way to know for sure if the calcifications are from cancer.
- Yes, you can have calcifications without it being cancer.
You will find answers to most of your other questions on the Learn topics on BCO.
You definitely should get the biopsy done. You don't need to talk with the radiologist before hand, normally it is the radiologist who does the biopsy and he/she will answer any questions you might have.
DCIS, ductal carcinoma insitu and IDC, invasive ductal carcinoma often present with calcifications.
I had breast cancer three times, each new, not recurrence, in a 20 year span. I also have a strong family history of breast cancer.
All I can say is mammograms save lives! Take it one step, one day, at a time, but if you are diagnosed, I can assure you there are so many treatments available today that were unavailable when I had my first breast cancer in 2003. Breast Cancer is NOT a death sentence! My last diagnosis was in Aug of 2022 and I am perfectly fine today!
Hang in there and please keep posting here as I do want to know how things go for you. I am also sure more people will add comments here and they will want to know how you are doing too. This is a great community with a wealth of information!
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Thank you @mavericksmom for this insightful response! And kudos to you for kicking cancers three times and am very glad to hear you are doing fine today!
Was there a particular reason as to why the surgeon denied your bilateral mastectomy request?
I guess I am just a little concerned about the distribution of my calcifications being more likely for it to be malignant. But I know there is basically nothing I can do now until I get my results. It's just extremely hard to not look for answers at this point. I'll definitely keep you posted!
Best wishes!
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Hello @gh0st._ I just want to say, I love how your brain works and how organized you are!! I have a feeling you’ll be in very good hands at the breast center where you are going. They expect us to be in a state of shock and they are super kind when you get your biopsy (or they should be anyway!!) and they will arrange for everything you need.
I know I desperately tried to search for answers in the words of my radiology report, answers that no one can give except by doing the biopsy. I’m sorry you are in this surreal place of waiting.
Here’s a link you might find helpful … and to partially answer one of your questions (#1), quoting from this same link, “Calcifications typically don't show up on ultrasounds, and they never show up on breast MRIs.” Ok, that really didn’t answer your question. An ultrasound may not give any more information about the calcifications but it might help you feel peace of mind that they are being thorough. I’m not sure why they aren’t doing an ultrasound first to be sure nothing else is there that wasn’t seen on mammogram due to your dense tissue. That’s a good question, definitely one to ask. I hope all goes well for you and we are here for you!
https://www.breastcancer.org/screening-testing/mammograms/calcifications#
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I will join the chorus and hope to reassure but I have a caveat… anything that anyone here has experienced, even if it seems similar to your situation, can turn out to be quite different. Also, we are not doctors and , most importantly, we are not your doctor.*
Yes, mammo to biopsy is usually how it goes as they need the biopsy to determine if something is cancer or not. Sometimes other imaging may be used on the breasts but that is why I mentioned that we are all different.
Calcifications are not cancer! They are simply calcifications. Your doctor may keep a close eye on them as there is potential for cancer development but in and of themselves they are benign. This is not false assurance as my own dd has calcifications that are being monitored and I am not worried.
No idea how/why calcifications form but anything that grows in the breasts, cancer, cysts, etc. has to reach a certain size before imaging can detect it. Again, calcifications are by definition benign. If it’s malignant it isn’t/wasn’t simply calcification.
How likely you are to need biopsies in the future is anyone’s guess. If something crops up on future imaging that necessitates a biopsy, your doctor will order one, if not , no biopsy.
Sampling a wide area of calcification? This would be an excellent question to ask your doctor.
After my suspicious mammo, a biopsy was scheduled (actually two). Other than explaining how they would conduct the biopsies, there was nothing else to explain since I had already had the reason for the biopsies explained to me. The radiologist has no further info than was noted in report after the mammo. What questions might you have for him/her?
I am not sure about needing a breast surgeon for a biopsy as the vast majority of us don’t, unless your personal circumstances merit it. A biopsy is very standard and generally does not require the skill of a highly specialized surgeon. Additionally, surgeons generally have a packed schedule and you may have to wait longer for something which could be handled in a faster, routine way. When you mention “aggravating “ cells you are referring to seeding. In theory, it could happen but in reality that doesn’t appear to be something that actually happens. Has it ever happened? Maybe but not really a concern when you need to see if something is malignant or not. Seriously, after 12+ years on bco I have never seen this be an identifiable issue.
DCIS is non-invasive and that is why some believe that it is not really cancer and that it is over treated. However since DCIS can evolve and undergo changes that turn into IDC, the vast majority of doctors will urge patients to treat it. Why? Because there isn’t a way to predict if or when it will become invasive. Depending, again, on the individual some choose to closely monitor DCIS, known as watch and wait. This is where individual feelings and choices come in and that approach is best discussed with your doctor. Remember, if your biopsy is negative (fingers crossed!) you will still be monitored more closely due to the calcifications. My dd, mentioned earlier, alternates mammos and MRIs every six months. I would not be comfortable with watch and wait for DCIS but it works for some and oncologists do support it if the patient’s situation merits.One bit of advice is to try to stick with what you know for certain right now and not spend lots of time focusing on things that might never happen. This is not easy but worth practicing. Take care
* I have strong feelings about saying anything that even sounds like I’m interpreting tests/reports or giving medical advice. I simply don’t do it as I have no medical training and I’m not your doctor. Like anything you discover online, be critical about what you read, even here.2 -
Wow, I could have written this post! This was me 3 years ago, though my initial report noted "grouped microcalcifications."
You wouldn't get an MRI at this point, though if they find some troubling things after the biopsy, you should definitely push for one.
As mentioned, every situation is different, even if they seem very similar. At my mammogram appointment, I was told by a technician looking at my imaging that "90% of the time calcifications aren't anything to worry about!" and then I Googled it and Google made it sound like 80% of the time calcifications are no big deal. I have fibrocystic breasts, which are common and normal, and ruptured cysts can leave calcifications on mammograms. So, I just went into a stereotactic biopsy with the mentality of "of course it's nothing, but I just have to check anyway!" It did turn out to be DCIS, but after the initial shock, everything was OK (well, that's another story for a different reason). It was very treatable.
DCIS treatment does seems to be evolving, but if you get it at a young age, I feel very strongly that you should have surgery at minimum. It may be very slow growing, but I don't want this potentially cancerous thing just hanging out spreading in my breasts over the next 40 years (plus, the sooner you do it, the less tissue they have to remove to get it out). I wanted a lumpectomy only - no radiation, but my team was very patient with me and thoroughly addressed my concerns. I also extensively researched everything, and even though I didn't want it, the research overwhelmingly supported rads (basically, it's the age) and tamoxifen (I opted for low dose).
Anyway, it's hard not to, but don't stress! Just take everything as it comes. At least you have it on your radar and are starting to plan for things now, even though you don't have all the information. But truly, no need to deep dive into something that may not even happen. Really hoping the best for you!
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Welcome, @gh0st._! We're so sorry you find yourself here, but we're glad you've found our community and hope you can lean on us for support during this time. We know it's overwhelming, but as you can already see from the responses you've gotten, you are not alone!
The Mods
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I will also chime in to say - push for the biopsy (praying all is benign for you) - my calcifications were not benign, but DCIS - stage 0, but this was a second time for me. I opted for a second lumpectomy and start a second course of radiation in April. I feel grateful and blessed that my radiologist suggested biopsy as my DCIS was negative for hormones and had it been left in there to grow, it could have possibly become invasive and triple negative. I was more than happy to get it out of there! Best wishes to you and this site has been the most wonderful wealth of information and support for both of my bouts with this bitch of a disease!
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