QUESTION: My 53-year-old sister's latest mammogram shows new calcifications. Since I am a breast cancer survivor (five years now!), she is especially concerned. Her gynecologist has told her not to worry. What do you think? Should she seek a second opinion? And if so, should she consult her primary care physician, a surgeon, or a radiologist?
ANSWER: First of all, there are all kinds of calcifications that can be seen on mammography. When they are small, they look like grains of salt and are called "microcalcifications" (micro means small). Larger calcifications look like big grains of coarse kosher salt (like on pretzels) and are called "macrocalcifications" (macro means big).
New small calcifications that are clustered together in groups of five or more may be associated with hyperactive breast cell growth-and sometimes cancerous cell growth. The calcifications themselves are not cancer. They occur in disintegrated old cancer cells that were "thrown out in the garbage" but haven't yet been disposed of by the body. While they are waiting to be carted away, the old cells disintegrate and calcify.
What does this mean in relation to concerns about cancer? Roughly 80% of biopsies of clustered microcalcifications turn out to be normal or "benign." Twenty percent of these biopsies are cancerous, and of that 20%, many show no signs of tissue invasion. In the case of microcalcifications that are scattered (appearing singly) rather than clustered, or that are "macro," there is even less of an association with breast cancer.
A biopsy is appropriate when a mammogram identifies a new cluster of microcalcifications that look "of concern" or "suspicious." If a woman has any question about the accuracy of her mammogram report or the radiologist's recommendation for what to do with the results, she should certainly get a second opinion from another radiologist who has expertise in reading mammograms.
—Marisa Weiss, M.D.