Breast calcifications

This information is about breast calcifications. It explains what breast calcifications are, and how they are diagnosed.

• What are breast calcifications?
• If calcifications are seen on a mammogram
• Breast biopsy
• What the biopsy might show
• Your feelings
• References

What are breast calcifications?

Breast calcifications are small areas of calcium in the breast. They cannot be felt and can only be detected on a breast x-ray (mammogram). Calcifications are very common, and in most cases are harmless. There are two types:

Macro-calcifications are coarse calcium deposits in the breast. They look like large white dots or dashes on a mammogram. They are a natural result of breast ageing, and are found in about half of women over the age of 50, and in about 1 in 10 younger women. They may be caused by calcium deposits in a cyst, or in milk ducts, as women get older. They may also be the result of previous injuries or inflammation. Calcium in the diet does not cause calcifications.

Macro-calcifications are harmless. They are not linked with cancer and do not need any treatment or monitoring.

Micro-calcifications are tiny calcium deposits that show up as fine white specks on a mammogram. They are usually found in an area of the breast where cells are being replaced more quickly than normal. Usually, micro-calcifications are not due to cancer. However, in a small number of cases, a group of micro-calcifications seen in one area (a cluster), may be a sign of pre-cancerous changes in the breast, or of an early breast cancer.

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If calcifications are seen on a mammogram

If your mammogram shows that there are calcifications, a person who specialises in reading x-rays and scans (such as a radiologist) will look at the size, shape and pattern of calcifications. They will then decide if any further tests or investigations are needed.

If macro-calcifications are found, no further treatment is needed.

If micro-calcifications are found, you will usually be asked to have a close-up mammogram (magnification views) of the affected area. Depending on the results of this, your doctor may recommend:

• no further action, as the changes are clearly not cancer

• a biopsy – taking a small sample of tissue from the area so that it can be looked at under a microscope.

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Breast biopsy

When calcifications are detected, there is usually no lump in the breast to show exactly where the calcification is, so a biopsy is taken using one of the following techniques:

Needle (core) biopsy using image guidance An ultrasound or a mammogram linked to a computer is used to produce detailed pictures (images) of the breast tissue. These images help the doctor to guide a needle to the area of the calcifications, so that samples of the tissue can be taken. The needle biopsy is done under a local anaesthetic, which numbs the area. The tissue that has been removed is then x-rayed to confirm that the area of calcification has been biopsied successfully.

Needle or wire-localisation with surgical excision This is usually only done when a core needle biopsy has been unsuccessful at removing enough of the calcification, or when the result is not clear. It is a two-stage procedure. Both stages usually take place on the same day, but occasionally localisation may be carried out on the day before the operation.

• Localisation: You will have a mammogram to show the positions of the micro-calcifications within the breast. Local anaesthetic is injected into that area of the breast to make it numb. A thin wire is then usually inserted into the area of micro-calcifications and kept in place with a dressing. Alternatively, a small amount of radioactive drug (or tracer) is injected into the area of micro-calcification.

• Excision: Using the wire or the radioactive tracer as a guide, the surgeon removes the area of tissue to be biopsied. This may be done under a local or general anaesthetic.

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What the biopsy might show

Most micro-calcifications are shown by a biopsy to be non-cancerous (benign).

When breast cancer cells are detected, they are usually either non-invasive ductal carcinoma in situ (DCIS) – early cancerous changes contained within the milk ducts – or small, early breast cancers that have not spread.

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Your feelings

When a woman is told she has breast calcifications, her first reaction is often one of anxiety. Some women immediately think that they have cancer, but it is important to remember that most breast calcifications are benign and are not caused by cancer. If you have worries or concerns, you may it find it helpful to discuss these with your doctor or specialist breast nurse at the clinic, or to contact one of our specialist cancer nurses.

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References

This section has been compiled using information from a number of reliable sources, including:

• Diseases of the Breast (4th edition). Eds Harris et al. Lippincott-Raven, 2004.
• ABC of Breast Diseases (3rd edition). Ed Dixon. BMJ, 2006.

For further references, please see the general bibliography.

Prevention of cancer

Although we don't know how to prevent someone developing cancer, we do know that you can reduce your risk by making lifestyle choices. For example, not smoking, avoiding sun damage to your skin and not drinking heavily can all reduce the risk of developing some cancers. Also, eating a well balanced diet, that includes five portions of fruit and vegetables, and taking regular exercise may reduce your risk.

There are a number of questions and answers about how to reduce your risk of developing cancer that you may find helpful to read.

Viruses

It is important to remember cancers are not infectious and cannot be caught from someone. However, there are a number of different viruses that are thought to be contributing factors in the development of cancer.

For example, exposure to HPV (human papilloma virus) is known to increase the risk of developing some types of cancer. For further information about this, see the section about HPV.

Other viruses include the Epstein-Barr virus, which is linked to some types of lymphoma.

There is also a bacterial infection known as H-pylori which is linked to a rare type of stomach cancer.

Cause : Environmental and occupational causes

Environmental and occupational causes

Contact with certain harmful substances in the environment or workplace can cause cancer. Substances that are known to cause cancer are called carcinogens.

We know, for example, that 9 out of 10 people who develop mesothelioma (a rare type of cancer affecting the linings of the lung and abdomen) have had contact with asbestos. People who have worked in industries such as ship-building and construction may have come into contact with asbestos. Its use is now banned in the UK.

Certain chemicals used in dye factories, rubber production, gas works and other chemical industries have all been linked to bladder cancer. Fortunately these chemicals have now been banned.

Environmental causes include natural radiation, for example, from the sun. We know that most skin cancers, including melanoma, are caused because of prolonged exposure to the sun. Naturally occurring radon gas has also been linked to some types of cancer, namely lung cancer.

It is important to remember that we don't know the cause of many cancers and that there is often more than one cause. Also, although cancer can occur at any age, one of the biggest risks of it developing is increasing age.

There are a number of questions and answers about the causes of cancer that you may find helpful to read.

Cause : Diet and lifestyle

Diet and lifestyle

There are over 200 different types of cancer. We don't know the causes for each one of these cancers, but we do know about some. It is important to note that for many cancers, there may be more than one cause.

One of the biggest risks is increasing age. Cancer can occur at any age but the risk of developing it increases with age. Nearly two thirds (64%) of people who get cancer are over the age of 65, and more than a third are over 75.

We make lifestyle choices everyday - some we know increase our risk of developing cancer, others may have an influence on our risk. For example, smoking is a major cause of lung cancer and is a factor in other cancers, such as bladder cancer and cancers of the head and neck. Other factors that can influence our risk of developing cancer include heavy alcohol consumption and exposure to sunlight.

It is also thought that diet can influence the development of some cancers, although the evidence is less clear. Diets high in animal fats have been linked with breast cancer, bowel cancer and prostate cancer. A diet that is low in fresh fruit and vegetables may also increase your risk of developing some types of cancer. Obesity has been linked to some cancers, such as cancer of the breast or kidney.

There are a number of questions and answers about the causes of cancer that you may find helpful to read. You can also look in our section about eating well for further information on healthy diets.

How is cancer diagnosed?

Most people experience symptoms and begin by seeing their GP. If your GP thinks that you have symptoms that may be caused by cancer, they will examine you and refer you on to a specialist at the hospital for tests and treatment, if necessary.

At the hospital, the doctor will take your medical history and do a physical examination. You may have x-rays and blood tests taken and possibly scans. You may need to have a sample taken of the lump or abnormal area – this is known as a biopsy. The biopsy sample is then analysed in a laboratory and the cells examined so that the doctors can see exactly what type of cancer it is and whether it is likely to grow slowly or more quickly.

Scans can measure the size of the cancer and whether it has spread to other tissues or nearby lymph glands (nodes). This process is called "staging" the cancer. Once the type and stage of the cancer is known, the doctors can decide how best to treat it.

There are questions and answers about the different tests and investigations, that you might find helpful to read.