These are common questions about breast abnormalities. Have a question of your own? Contact us.
What are Breast Calcifications?
Breast calcifications are calcium deposits within the breast. Extremely common in women of all ages, calcifications are typically found during a screening mammogram, appearing as white spots similar to grains of salt. They usually cannot be felt.
Calcifications are very common on mammograms and increase with age. Some type of calcification is seen on about 25% of all mammograms by age 40, and on about 2/3 of all mammograms by age 65.
The vast majority of calcifications are benign. However, the earliest type of non-invasive breast cancer shows up as calcifications on mammograms. Calcifications associated with early cancer often have an abnormal appearance on mammograms.
Certain patterns of calcifications—such as tight clusters with irregular shapes—can indicate a problem, and when they are seen on a screening mammogram, they may need to be analyzed more closely. Your radiologist may suggest a diagnostic mammogram with magnification views. Magnification views allow the radiologist to analyze the shape and distribution of the calcifications within the breast more clearly and often determine whether calcifications appear benign or suspicious.
If the calcifications have benign-appearing features, then routine follow-up mammograms are important to allow continued monitoring of the calcifications over time. Sometimes calcifications appear benign but represent a change from prior mammograms. In that case, short-term follow-up, such as a mammogram in 6 months may be recommended. If the radiologist is concerned that the calcifications may be associated with cancer, a biopsy is necessary to analyze the significance of the calcifications.
Because benign calcifications are so common, they can sometimes mimic the appearance of suspicious calcifications. Of all biopsies done for calcifications, about 3/4 turn out to be benign. However, once calcifications have a suspicious appearance on the mammogram, a biopsy is necessary to determine the cause of the calcifications.
Biopsies can be done as needle biopsies or surgical biopsies. You can talk with our radiologist or your physician about the different types of biopsy.
What is a Breast Lump?
Finding a breast lump can be alarming, but it does not necessarily mean you have breast cancer. A breast lump can result from many benign conditions including fibrocystic changes, a cyst or a benign (non-cancerous) tumor called a fibroadenoma. If you feel a breast lump, you should contact your physician promptly for an evaluation. Your physician may do a clinical breast exam, and refer you for a diagnostic mammogram and ultrasound. They may do a follow-up breast exam one month to see if the lump changes with your menstrual cycle.
Normal breast tissue can sometimes feel lumpy. This usually feels smooth, mobile and soft or slightly firm. Normal lumpiness is common and is one reason why women should examine themselves monthly. However, if you notice a new lump, you should contact your physician.
Cysts are fluid-filled masses in the breast. Cysts are very common and are rarely associated with cancer. Ultrasound is the best way to tell a cyst from a solid mass because sound waves pass right through a liquid-filled cyst. Solid masses, on the other hand, produce echoes that are detected by the ultrasound equipment.
Cysts can make it hard to examine yourself since it’s hard to feel around and behind them. For women with multiple cysts, if a new lump is found, you should contact your physician promptly. Although a new lump may be a new cyst, you cannot assume that. Cysts look like masses on mammograms, and ultrasound is usually needed to determine whether any changes correspond to new cysts.
Sometimes cysts are simple, and clearly represent fluid-filled cysts on ultrasound. Sometimes they are not simple (called complex or complicated cysts) and have echoes within them on ultrasound. This can mimic the appearance of a solid mass. Either cyst aspiration using ultrasound guidance or short term follow up ultrasound (for example, in 6 months) may be recommended if there is a possible complex cyst.
Cyst aspirations are sometimes performed under ultrasound guidance, by removing fluid from a lump with a needle and a syringe. This may be done if there is uncertainty as to whether the lesion is cystic or solid. It can also be done to relieve discomfort from a painful cyst. When cysts are drained, the fluid is usually discarded unless it is bloody or looks suspicious. In these cases, it is sent to the lab for analysis.
Fibroadenomas are mobile, solid, rounded lumps made up of normal breast cells. They are the most common kind of benign (non-cancerous) solid breast mass, especially in young women. Depending on the appearance, a solid mass with benign appearing features may be followed with mammogram and/or ultrasound imaging. This is usually done for at least two years, initially in 6 months. If the mass has any suspicious features such an irregularity or lobulation of the wall, a biopsy can be done. A biopsy, if needed, can be done as a needle biopsy or surgical biopsy.
Sometimes a biopsy may be needed to determine whether a breast lump is benign or cancerous. This is often done as a needle biopsy under imaging guidance as an alternative to a surgical biopsy. If a clearly benign result is obtained (which is the case in about 3/4 of cases), the mass does not need to be removed and can be followed with mammograms and/or ultrasound. If cancer is diagnosed on a needle biopsy, the patient is referred to a surgeon for definitive management.
Needle biopsies give definitive results (benign or malignant) about 95% of the time. About 5% of needle biopsies require follow-up surgical biopsies to obtain more tissue for more accurate diagnosis. The most common example of this is when a needle biopsy shows atypical cells. Although they are benign, they can indicate a pre-cancerous condition. It has been found that about 10-15% of patients with atypical cells may have cancer cells in the vicinity that were not included in the tissue samples obtained with the needle biopsy. Surgery is recommended in those cases to sample the surrounding tissue more thoroughly.
What is Breast Pain?
Breast pain is the most common breast-related complaint among women. Nearly 70% of women experience it at some point in their lives and approximately 15% of women require treatment. Breast pain may occur in one or both breasts or in the underarm region. Usually, breast pain does not indicate breast cancer, though women should discuss the condition with their physician.
Focal breast pain (which you can point to with one finger) is often evaluated with a diagnostic mammogram in a manner similar to a new breast lump.
Regional or diffuse breast pain is rarely associated with cancer.