Breast Calcifications: Everything You Need to Know

Breast calcifications are small deposits of calcium that appear as bright white spots on mammograms. They are extremely common, especially in women after menopause. While most breast calcifications are harmless, some types may indicate an increased breast cancer risk.

Here is a detailed overview of breast calcifications – what they are, why they form, how they are evaluated, and when they may signal an underlying problem.

What are Breast Calcifications?

Breast calcifications, also called microcalcifications, are tiny specks of calcium that develop in breast tissue. On a mammogram, they appear as bright white dots against the soft tissue background. Breast calcifications can range in size from 0.1 mm to 2 mm.

Calcifications form when calcium builds up in the breast ducts, lobules, blood vessels, or connective tissue. The calcium is not related to calcium in the diet. Rather, it accumulates due to cellular processes in the breast. For example, when cells in a milk duct die, they may deposit calcium as they degrade. Benign breast conditions like cysts, tumors, and infections can also trigger calcifications.

Can Breast Calcifications Be Removed?

Benign breast calcifications do not need to be removed. In fact, attempting to remove them could cause unnecessary complications. For confirmed breast cancer, treatment focuses on eliminating the cancer cells, not the calcifications themselves. After successful treatment, remaining calcifications generally pose no further threat.

If calcifications are causing significant anxiety, discuss your options with your care team. In select cases, benign calcifications may be surgically excised to provide peace of mind.

Additionally, there are some holistic approaches that claim to eliminate breast calcifications naturally. If you’re considering any natural methods, ensure you consult with a medical professional to understand their efficacy and appropriateness for your condition.

Common Types of Breast Calcifications

There are two main categories of breast calcifications:

Macrocalcifications – These are larger deposits over 0.5 mm. They have clear edges and are oval, round, or curvilinear in shape. Macrocalcifications are almost always benign.
Microcalcifications – These are tiny specks under 0.5 mm. They vary in size and have irregular, indistinct edges. Certain patterns of microcalcifications may require further testing.

Are Breast Calcifications Dangerous?

The vast majority of breast calcifications are harmless. They simply indicate some past injury, infection, or benign change in the breast tissue. However, certain microcalcification patterns may prompt additional testing:

Tiny size (under 0.1 mm)
Irregular shape
Clustered distribution
New appearance or change since prior mammograms

These suspicious microcalcifications are more likely to be related to ductal carcinoma in situ (DCIS). DCIS is a non-invasive breast cancer confined to the milk ducts. If abnormal cells are blocking a duct, they may calcify as they break down.

How are Breast Calcifications Evaluated?

If suspicious microcalcifications are seen on a screening mammogram, additional imaging will be recommended. This may include:

Magnification mammography

Magnification mammography involves taking focused images of the specific region containing the calcifications. This specialized technique uses higher resolution to better characterize the shape, size, and distribution of individual calcifications and clusters. The radiologist can zoom in up to 3 times closer than a standard mammogram. Detailed magnification views allow the radiologist to clearly see the morphology of the calcifications and ensure none have features that require biopsy.

Spot compression

During magnification mammography, the radiologist may also perform spot compression. This uses a smaller paddle to apply targeted pressure directly over the area of interest. By flattening the breast tissue in this region, spot compression improves the visibility of the calcifications. It ensures the calcium deposits are as close to the detector as possible, maximizing their appearance on the images.

Diagnostic mammography

After initial screening mammograms are complete, some women are called back for additional diagnostic mammography. This allows for more detailed imaging of any findings requiring further investigation, such as suspicious calcifications. Diagnostic mammography may include extra views focused specifically on the region of concern. The images can then be compared side-by-side with the original screening mammograms to check for any changes in the calcifications.

Ultrasound

Although calcifications do not show up on ultrasound, this modality is sometimes used to look for associated findings. Ultrasound uses sound waves to create images of the breast tissue. If a cancer is present, it may produce a visible mass even if the calcifications themselves cannot be seen. The radiologist can target the ultrasound to the segment of the breast containing the calcifications.

MRI

Like ultrasound, breast MRI can detect structural changes in breast tissue near suspicious calcifications. MRI does not visualize the calcifications themselves. However, it provides a very detailed view of the breast that may reveal other causes for concern, such as distorted architecture or a suspicious enhancement pattern. The location correlates with the area of calcifications seen on the mammogram. If additional lesions are present, this information helps guide proper biopsy placement.

Biopsy

If imaging results remain uncertain or highly suspicious, a biopsy is typically the next step. This removes samples of breast tissue from the region containing the calcifications. A pathologist examines the biopsy specimens under a microscope to make a definitive diagnosis.

What Do Biopsy Results Mean?

After biopsy, breast calcifications are classified as benign, likely benign, or malignant:

Benign – No cancer cells are present. No further testing is needed.
Likely benign – Atypical but non-cancerous cells are seen. Follow-up mammograms may be recommended.
Malignant – Cancerous cells are found. Treatment planning for breast cancer begins.

Around 80% of biopsies for suspicious calcifications turn out to be benign. Of the remaining 20%, about half show DCIS, and half show invasive cancer.

Conclusion

Breast calcifications are extremely common mammogram findings, especially as women age. While most are harmless, certain patterns require additional testing to check for underlying breast cancer. If you are called back for more images or a biopsy after a screening mammogram, try not to panic – there is a good chance calcifications are benign. Stay in close contact with your medical team and follow their recommended next steps. Catching concerning changes early leads to the best outcomes.