Calcifications of the breast
Calcifications of the breast refer to calcium deposits that form in breast tissue, which cannot be felt but can be seen on mammograms as white spots. They are classified into two types: macrocalcifications, which are larger and generally harmless, and microcalcifications, which are smaller and may require closer examination. While the majority of macrocalcifications and about 80% of microcalcifications are noncancerous, certain patterns of microcalcifications may indicate a potential for precancerous changes. Risk factors for microcalcifications are more prevalent among women in their childbearing years, while macrocalcifications are common in women over fifty.
Calcifications are typically asymptomatic and are detected primarily through mammographic imaging, as they do not show on ultrasounds or MRIs. If suspicious patterns are observed, doctors may recommend follow-up mammograms or, in some cases, a biopsy to rule out cancer. The prognosis for patients with identified precancerous microcalcifications is generally positive, with effective monitoring and removal options available. Additionally, recent studies have suggested a correlation between breast calcifications and cardiovascular health, pointing to the potential for mammography to serve as a tool for assessing heart disease risk in women.
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Calcifications of the breast
ALSO KNOWN AS: Microcalcifications, macrocalcifications, breast arterial calcifications
RELATED CONDITIONS: Hyperplasia, precancer of the duct, fibroadenoma
DEFINITION: Calcifications are calcium deposits in breast tissue, not detectable by touch but visible on mammograms as white spots. Macrocalcifications are large deposits, not indicative of cancer. Microcalcifications appear as tiny white specks on mammograms. Scattered throughout a mammogram, they are usually not cause for concern. They may indicate possible precancer when they appear in irregular patterns or are concentrated in one area of the breast.
Risk factors: Macrocalcifications and 80 percent of microcalcifications are harmless. Women in their childbearing years are prone to microcalcifications.
Etiology and the disease process: Macrocalcifications are related to changes in the breast due to inflammation, injury, or aging. Microcalcifications may appear in areas of rapidly dividing cells and therefore can indicate precancer.
Incidence: Macrocalcifications occur in about half of women over age fifty and in about 1 in 10 women under the age of fifty. Microcalcifications are usually evident in women only during their childbearing years. Studies have shown that calcifications may be linked to cardiovascular diseases (CVD) in women.
Symptoms: No symptoms are associated with calcifications of either kind.
Screening and diagnosis: Calcifications are visible only on radiologic images, like mammograms, meaning they do not show up on ultrasounds or magnetic resonance images (MRIs). Macrocalcifications are noncancerous. Doctors may order special magnified mammographic views of microcalcifications in clusters or in odd patterns. Generally, a biopsy is not needed at the first appearance of suspect patterns. Doctors typically have the patient repeat the mammogram three to six months later. If the repeat mammogram does not exhibit any obvious changes in the pattern or number of microcalcifications, a regular schedule of mammograms is adequate to monitor further changes. If microcalcifications appear particularly suspect on first appearance or if changes are noted in the repeat mammogram, a core needle biopsy or a surgical biopsy can be done to rule out precancer.
Treatment and therapy: If a patient has microcalcifications removed for biopsy that prove to be precancerous, she should be monitored closely with regular mammograms to identify any future occurrences.
Prognosis, prevention, and outcomes: Macrocalcifications and the majority of microcalcifications have no relation to cancer. If a precancerous area is identified in microcalcifications, it can be removed completely many years before it has a chance to develop into actual cancer, and the patient’s prognosis is excellent. Any other suspect microcalcifications should be removed fully and analyzed. Patients should be closely monitored for new microcalcifications. After menopause, microcalcifications generally no longer occur, though macrocalcifications become more prevalent.
A study published in 2023 demonstrated a connection between certain CVD characteristics and calcifications in women. Of the eighteen percent of the women in the study who had calficiations, their blood pressure, body-mass index (BMI), and diabetes rates were higher than those women who did not have calficifications. Researchers also found links between calcifications and coronary arterial calcifications (CACs). When both breast calcifications and CACs were present, a patient's 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was 13.3 percent, whereas a patient with no calcifications had an ASCVD risk of 4.4 percent. These findings demonstrate that mammogram technologies can go beyond detecting breast cancer as they can also help predict heart disease and stroke potential.
Bibliography
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