Group of amorphous microcalcs found on my 1st mammo

Mila82 · September 2014

Hello folks,

I'm 32 years old and was recently sent for a mammogram and breast ultrasound after a doctor felt that I had very dense and lumpy breast when he examined me, and in light of a family history of breast cancer (both my maternal great aunts died in their early 50's from it, and cancer generally is strong in my family).

To my shock the mammogram came back abnormal (followed by an ultrasound which was put at BI-RADS 3) - the finding was extremely dense breasts and in my left breast a single group of amorphous microcalcifications was seen (see below for details).

Subsequently, two doctors on a health forum have said it would be more appropriate at BI-RADS 4 and would strongy recommend biopsy, so I have spoken to my referring doctor. He agreed that he didn't want me to wait 6 months for repeat imaging as written on the mammo/US reports, because it is my first baseline mammogram, because of my age, and because of family history, so he wanted to send me for an MRI. I asked about biopsy, and he has now referred me to a surgeon at a breast clinic to discuss in full.

Below are the results and reports from the mammo and US. It's a small comfort to know that my Mom was found to have the same thing - a group of amorphous microcalcs in her left breast - but it has been stable for over a year now, so I'm wondering if I could in fact, just have something similar, and fall into the 80% group that turn out to be benign.

If anyone can advise me on how best to proceed and if there are any specific questions I should be asking, or things I should be looking out for, I'd be very grateful.

Examination Name: MAMMOGRAM SCREENING BILAT

Examination Date: 08/09/14

Bilateral mammogram

Clinical indication: Family history of breast cancer, lumpy breasts. 32-year-old female.

Technique: Full field digital CC and MLO views of both breasts were
obtained. Evaluation was aided by use of CAD and tomosynthesis.

Comparison: None.

Findings:

Breast density: Extremely dense fibroglandular pattern is identified
bilaterally, which may lower mammographic sensitivity for detecting
small lesions.

Calcifications: A group of tiny amorphous calcifications are
identified at about 2:00 position in the posterior third left breast.

Masses: No overtly suspicious mass lesion is identified.

Impression: Incomplete assessment, BI-RADS Category 0. Sonographic
evaluation of both breasts with particular attention given to the left
upper outer quadrant is recommended.

___________________________________________________________________

Examination Name: US BREAST BILAT

Examination Date: 08/09/14

Ultrasound bilateral breast

Clinical indication: Abnormal mammogram in a 32-year-old female with family history of breast cancer.

Technique: Greyscale and colour Doppler evaluation of both breasts
was performed. Particular attention was given to the left breast
upper-outer quadrant.

Findings: No suspicious soft tissue mass is identified within the breast by ultrasound.

Impression: Probably benign findings, BI-RADS Category 3. Repeat
unilateral left breast mammogram in six-month (with magnification views)
is recommended.

Mila82 · September 2014

Just a quick update: I saw the breast surgeon that my doctor referred me to in order to discuss whether or not to simply have an MRI or proceed to stereotactic biopsy. The surgeon reviewed the mammo and ultrasound with 2 radiologists and came back and said that because it is a loose group of microcalcs, they are not too worried and suggest MRI. If it is normal, review in 6 months.

I'm of course relieved to not have to go through with a biopsy right now if it's not highly necessary.

I just wanted to ask how many of you here had a loose cluster, as opposed to a tight cluster, and it still turned out to be DCIS or malignant? I'm quite relieved after my appointment, but do want to be prepared for both outcomes, even though I know that 80% of the time, it's benign.

I'd really like to hear about your experiences with this. Many thanks.

Best,

Mila

Mila82 · September 2014

Anybody?

Anyone have a "loose" cluster of (amorphous) microcalcifications (as opposed to tight) that still turned out to be malignant?

Moderators · September 2014

Dear Mila, sorry you didn't get any real answers yet. If it helps, here is a topic posted by member Idontlikethis3 back in Aug 3, 2013 that offers a good description and some statistics about amorphous and other types of calcifications.

Here is the thread, just click on the link: Topic: Article about Calcifications

Hope this helps!

The Mods

Ariom · September 2014

Hi Mila, sorry you haven't had any responses. I'm sorry I can't help, I personally haven't had any experience with that Dx mine was a tight linear presentation that looked like a Nike tick.

It does sound like you have had some good opinions though, from several professionals and you're right when you say 80% of these breast issues turn out to be benign.

I wish you all the very best and hope that someone will answer you, who has experience with that Dx.

PoppyK · September 2014

Hi Mila,

I don't know how my calcifications were clustered, so what I am sharing may not apply to your situation.

My mammogram was BI-RAD 3a. It was only a 3-4% chance for a malignant result. No history of breast cancer in my family. I was given the option of biopsy or waiting 6 months. I wanted the biopsy. The doctor had difficulty isolating the area for the biopsy, and again asked me if I wanted to wait 6 months. I told her I wanted to find out what was going on and for her to continue. I'm glad I did because I was diagnosed. I have more treatment options available to me.

I also did the genetic testing. My results are negative.

Let us know what you learn from your MRI. More information should help you make your decision.

Mila82 · September 2014

Thank you all for replying. I'm going to wait to see what the MRI throws up and hope to get a definitive diagnosis, one way or another. It's awful waiting and not knowing what you're dealing with, but I'm trying to put the worry aside.

I'm scheduled for the MRI with contrast on Monday morning and hope I'll get the results by the end of the week. I'll post back either way. If it's benign, which I hope it is, maybe it will help ease other peoples worries! I was told that because the cluster was loose, they felt more confident that it was probably benign. Breast cancer is in my family though, but I won't get gene tested, because I don't know that I could face making a decision to remove my breasts if it was positive!

Best wishes to all of you here,

Mila

Sassa · September 2014

My left breast had a BIRADS 5 classification due to a large area of micro calcifications. I had a simple mastectomy done because of a uncomfortable body asymmetry problem due to the removal of the huge right breast (IDC).

Pathology found only benign conditions in the left breast.

PoppyK · September 2014

Mila,

I just wanted to mention that mastectomy is not the only option if someone has the BRCA1 or 2 genes. Increased monitoring is a very good option. It is your choice, of course. I simply wanted to make sure you know surgery is not the only option.

Wishing you the best.

Mila82 · September 2014

I got my MRI result - or at least I heard from the doctor that it is fine - there were no suspicious findings in the MRI, so he's happy to see me in 6 months (just to make sure that there's been no change). I am very relieved. I do hope MRI with contrast is enough to accurately diagnose microcalcs without biopsy, but at any rate, I just wanted to report back that the MRI is normal. Thanks for all of your replies here. I wish all of you here the very best.

PoppyK · September 2014

This is wonderful news! Thank you for the update.

Mila82 · September 2014

Thank you! It's a big relief for now. I've been asked to go back in 6 months to make sure there is no change with the loose group of microcalcifications. I half expected the MRI report to say something about them, or the nature of my breasts, but all it said was "no suspicious findings or mass seen", which of course I'm very happy about.

I do just have a couple of questions that would help me know how to follow up properly in the future, and I wonder if I can ask you guys:

1) Can initially benign amorphous microcalcifications ever turn into cancer later on, over time?

2) I know that biopsy is the only way to completely rule out a malignancy.
Can an MRI with contrast ever miss certain types of non-mass forming cancer? Pardon my ignorance, I don't know if that makes sense. But I've read it can miss early low grade DCIS for instance. I'm not going to worry now, though I had really wanted the biopsy, but I am due for follow up in 6 months, so would like to know what future options are.

Thanks again and all the best

Mila82 · December 2014

I have a few more months until my 6 month follow up, but just wanted to ask if breast pain is something I should alert my doctor to if it persists?

I've been having on/off pain in my left breast where these microcalcifications were found 3 months back - though my MRI came back clear.

I've also noticed that for a couple of weeks now, I have a visible vein running down my left breast (not in my right), and have read this can be a warning sign of BC?

If the breast pain persists (outside of menses) and the vein remains, is it worth going back to my doctor about this? Thanks in advance.

Mila82 · December 2014

Sorry for the deleted posts - hope this works:

I have a few more months until my 6 month follow up, but just wanted to ask if breast pain is something I should alert my doctor to if it persists?

I've been having on/off pain in my left breast where these microcalcifications were found 3 months back - though my MRI came back clear.

I've also noticed that for a couple of weeks now, I have a visible vein running down my left breast (not in my right), and have read this can be a warning sign of BC?

If the breast pain persists (outside of menses) and the vein remains, is it worth going back to my doctor about this? Thanks in advance.

Moderators · December 2014

Dear Mila82

We advise that ANY changes to your breasts should be discussed with your doctor. It may be just scar tissue from your prior biopsy site and the vein could be numerous things. In the new year have a check-up for your own piece of mind.

(Also, instead of deleting posts and starting again, try editing your original post - you can totally edit contents)

We wish you the best

The Mods

Mila82 · December 2014

Thanks for the reply - I never had a biopsy, only an MRI which was thankfully normal. I showed my Mom and she also thinks I should email the breast surgeon, because my left breast's areola definitely looks different to normal. There is also the vein running down that breast, but that could just be hormones. I do have PCOS.

Thanks for the advice though, I think I will raise it just to be safe. My follow up is now in 3 months...

(And thanks, I will make sure to edit future posts!)

Lolis197138 · December 2014

Hi Mila,

I had persistent pain on my left breast and my left areola was smaller than the left. I would go see the doctor as soon as you can.

I had a big palpable lump which along with the change in the areola which made me realize I had BC before I went for u/s, biopsy and mammogram. My BC also had clustered microcalcification.

Good luck and hopefully you get to see your doctor and receive some good news

Mila82 · December 2014

Thanks Lois, the breast pain is intermittent, but this change in my areola is strange and has me concerned again - its the one on my microcalc breast - the areola looks poorly defined even though my right areola is clearly defined, and my left one always used to be. The bottom part of it also looks missing, so instead of a full circle, it looks like someone has taken an eraser to it.

When I went to see the breast surgeon after my abnormal mammo, he felt my breasts and couldn't feel any lump, which I took as a good sign, and then my MRI was clear. My worry is I read DCIS can be missed by MRI, more than other breast cancers.. I have written to him and will check it out in the New Year as soon as I'm back home. Thanks for the input here.

Mila82 · March 2015

I was due to have my 6 month follow up this week but I suddenly lost my medical insurance! Long story, but I'm looking into getting covered so I can go for my follow up.

Six months ago on my first mammogram, a cluster of amorphous microcalcifications were found in my left breast. The BS shared the scan with 3 radiologists, all of whom agreed that because it was a "loose" cluster, it was less of a worry and I could wait 6 months rather than having an invasive biopsy. They did send me for an MRI with contrast, however, as there is family history of BC, and the MRI reassuringly didn't show anything suspicious.

I posted a couple of months ago about how my left areola seems to have changed, and looks different to my right one - though maybe I'm just more breast aware since my abnormal mammogram. My right areola is a well defined circle all the way round, and the left areola is not well defined at the bottom - it looks as though someone has erased it. It's odd.

What has me more worried, is that this week I noticed that my left breast is actually larger than my right - it is wider and fuller than usual - though again I begin to doubt my eyes. My mom agreed that it looks larger. This has never happened with my period, and actually my period has just ended. Also the visible veins I asked about back in December, are still there with no change - if anything there seem to be more veins, so they don't seem to wax and wane with my cycle.

Is this all something I should be concerned about? Can an MRI with contrast miss cancers related to microcalcifications? If getting new medical insurance looks like it will take a while, I may have to decide whether to pay for a follow up myself. So this is why I'm asking. I know many benign conditions can cause breast enlargement too, but all of these things I've noticed are in my left breast, where the microcalcs are..

Mila82 · March 2015

Sorry if my post above was overly long. Anyone?

Mila82 · March 2015

I've now found a very tiny lump inside my left breast which feels like a tiny hard piece of grain (or less than half a grain of rice). You can really feel it when I'm lying down, right at the back of the breast inside. My Mom felt it too and there's nothing similar in my right breast. I'm still waiting on my medical insurance before i can return for follow up!

What benign conditions could this be? My mammogram over 6 months ago found a cluster of amorphous microcalcifications in that same left breast, US didn't show anything and nor did MRI.

Ariom · March 2015

Hello Mila, I am terribly sorry you are going through this. I don't have any definitive answers for you, only a Doctor can order the tests required to give you those answers.

I can say that breast cancer is the least likely outcome, because there are so many other benign conditions that this could be. I do know how difficult the waiting is. I had made myself black and blue, trying to find a lump, before I went back for my callback. I also found a hard small lump, 18 months after my Mx surgery and I was convinced it would be something sinister, but it turned out to be a cyst, when it was biopsied.

I don't want to minimize your fears, or your symptoms, but the one thing I learned in all this, was the fear and stress don't change the outcome. I understand, it must awful for you, being held up waiting for the insurance to come through.

I wish you all the very best and hope you get some resolution soon. Let us know how you get on.

Mila82 · March 2015

Thanks a lot Ariom for your encouraging words - you're right, stressing doesn't change anything or the outcome. I will of course raise it with the breast surgeon and have him feel it when I do (eventually) get to my follow up when my insurance is settled. There have been so many small changes n that left breast which is why I've worried, but it's futile, because I won't know until a doctor examines me and tests are done. Thanks for putting that in perspective.

Ariom · March 2015

You're very welcome Mila! All the best with it and please let us know how you are doing!

Mila82 · March 2015

Went for my follow up today and my microcalcs in my left breast are stable But I'm still BIRADS 3 and given family history, I still need follow up every 6 months to monitor.

I asked the breast surgeon about the small nodule in my left breast and he felt it and said he thought it was fibrocystic changes, which the mammogram did show (the changes were seen, but not the small nodule which is only a couple millimeters in size, but then I have extremely dense breasts).

Is it safe to sit back and wait 6 months, even with this palpable nodule, or should I get a second opinion? I thought fibrocystic changes felt like larger, bulkier lumps, not small grain-like nodules?

I'd be grateful for any feedback. Thank you

Mila82 · March 2015

I received the latest mammogram report by email today and it says that scattered and occasionally grouped amorphous micro calcifications are found in *both* breasts. My doctor didn't mention this change to me, as the previous (and first) mammogram only commented on the presence of a tiny group of microcalcs in my left breast, and now it says both breasts, but with no essential change to the original group they wanted to monitor.

Here's the report below. Somehow I'm not feeling settled about this, should I be getting a second opinion, or asking about the new bilateral finding? He didn't send me for an ultrasound this time either, so it's only this mammogram. And I still feel this small nodule.

Any advice/support would be much appreciated!

Clinical Information/Reason for Request/Comments

6 month f/u

left breast microcalcifications

___________________________________________________________________

Examination Date: 24/03/15

Examination Name:MAMMOGRAM DIAGNOSTIC BILAT

EXAMINATION: BILATERAL DIGITAL MAMMOGRAM WITH COMPUTER-AIDED DETECTION

CLINICAL INFORMATION: Six-month follow-up for report of amorphous calcifications in upper outer

quadrant left breast on recent mammogram without sonographic or MRI correlate.

Comparison study date(s): Mammogram and breast ultrasound dated 9/8/2014 and breast MRI 9/22/

2014.

DESCRIPTION: Routine CC and MLO views and spot compression magnification views and true 90° lateral

projection of each breast were also performed using full field digital technique. Mole marker were placed in

each breast. This examination was evaluated with computer-aided detection following primary review.

The breasts are extremely dense, which lowers the sensitivity of mammography. There are scattered, and

occasionally grouped, amorphous appearing calcification in the upper quadrant of each breast. These

appear essentially unchanged in the upper-outer aspect of the left breast since prior study. No evidence of

architectural distortion is noted.

IMPRESSION:

Scattered and occasionally grouped amorphous calcification in the upper outer quadrant of each breast.

The calcifications in the upper outer aspect of the left breast essentially appear unchanged since prior

study. Extremely dense breast parenchyma which lowers sensitivity of mammography. Continued six-

month follow-up bilateral breast mammogram with magnification and true 90° lateral views is

recommended.

Mila82 · March 2015

I just came across this online - the breast surgeon said he's fine to see me in a year but commented that the radiologist has her own opinion, and advises 6 month follow up again:

"Scattered bilateral microcalcifications are usually present in benign breast diseases, but in this study, two patients with breast cancer had profuse bilateral scattered microcalcifications.

Conclusion: This study shows that specific and statistically significant criteria for malignant microcalcifications, are irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. Scattered bilateral microcalcifications are usually present in benign breast diseases, but irregular shape and development of new calcifications among diffusely scattered bilateral calcifications, on follow up study, should also raise suspicion for being malignant. (JPMA 54:24;2004)."

http://www.jpma.org.pk/full_article_text.php?artic...

Group of amorphous microcalcs found on my 1st mammo

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