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Against Breast Cancer

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Posted by Betsy Mullen on 4/1/2000 from 205.188.192.27:

In reply to: breast calcifications posted by Mary on 3/17/2000 from 205.188.199.145:

Dear Mary:

I would like to first provide you with some good information about breast calcifications. I am using a pamphlet produced by the U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health as the source of this information (NIH Publication No. 91-3198).

Breast calcifications are small calcium deposits in the breast that can be detected by mammography. They are divided into 2 categories: 1. Macrocalcifications and 2. Microcalcifications.

1. Macrocalcifications are coarse calcium deposits that most likely represent degenerative changes in the breasts, such as aging of the breast arteries, old injuries, or inflammations. These deposits are associated with benign (noncancerous) conditions and do not require a biopsy (a procedure that removes the tissue for examination under a microscope). Macrocalcifications are found in about 50% of women over the age of 50, and in about 10% of women under the age of 50.

2. Microcalcifications are tiny specks of calcium in the breast. These tiny calcifications are usually in an area of rapidly dividing cells. When many microcalcifications are seen in one area, they are referred to as a cluster they may indicate a small cancer. A large percentage of the cancers detected by mammography appear as a cluster of microcalcifications.

Question and Answer: What if microcalcifications are found on a mammogram?

An area of microcalcification that is seen on a mammogram does not always mean that a cancer is present. In some cases, the microcalcifications do not even indicate a need for a biopsy. Instead, a doctor may recommend a follow-up mammogram within 3 to 6 months. In other cases, the microcalcifications are more suspicious and a biopsy is recommended.

Question and Answer: How can a breast biopsy be done if there is no lump?

A mammogram and ultrasound may show an area of abnormal tissue that is too small to be felt. Here is some information straight from our web site (winabc.org):

When Your "Lump" Can Be Seen But Not Felt

Sometimes you can have an area of concern that cannot be felt in the breast but shows up on pictures of the inside of the breast. These pictures are taken by either mammography (a type of x-ray) or ultrasound, a process that shows harmless soundwaves as they travel through a breast. In these cases you may have one of two biopsy procedures:

1. Needle Localization Biopsy

Using a mammogram or an ultrasound as a guide, a doctor places a needle or fine wire into the suspicious area. The area is then removed with a surgical biopsy. A second picture of the biopsy area may be taken later to make sure that the area of concern was entirely removed.

2. Stereotactic Needle Biopsy

This procedure pinpoints the area of concern with a double-view mammogram. A computer plots the exact area and guides a fine needle or a large-core needle so that a doctor can remove a sample of tissue for the pathologist.

If your biopsy result is negative, your treatment is over. It still will be important to have your breasts checked regularly for any future signs of change. If the result is positive, the cells did contain cancer and you will need to make decisions about your treatment options. Remember, "early detection is a key to protection"; and there are people who can help you through this process.
(Adapted from "A Woman's Guide to Breast Cancer Diagnosis and Treatment", published by the California Department of Health Services, and "The Breast Buddy Volunteer Training Curriculum", © WIN ABC 1994.)

Question and Answer (same source from the US HHS/NIH): Why is a biopsy done if there is no lump?

Breast cancer can be present in the absence of a lump. A biopsy is done to find breast cancer in its earliest stage, before it has spread and when it is most curable. As a rule, breast cancers discovered as a result of mammography tend to be small, and they are ideal for treatment with lumpectomy and radiation, treatment that preserves the breast.

The 3:00, 5:00 and 6:00 comment that you heard the radiologist say to your ultrasound technician refers to the areas of your breast that I am assuming, needed to be concentrated on. I know first-hand how scary this all is, but always try to keep in mind that you are the boss – health care providers work for you and with you – it needs to be a team effort and you should always feel free to ask questions and ask for, and receive full explanations of what is taking place before, during and after any medical examination and/or procedure.

Now, let’s get to some specific information/questions you should discuss with your doctors:

1. Do you have a family of breast cancer?

2. Do you have any known risk factors?; Do you know what some of the breast cancer risk factors are?

3. Do you know how to do a proper breast exam? You can receive this information and register for monthly breast self-exam reminders right on our web site (www.winabc.org)

4. How old are you?

5. Was your current mammogram compared with previous mammograms?

6. Did you receive a copy of the radiologist’s report/findings from this last mammogram?

7. Did your physician(s) mention whether or not the calcifications were a cluster of microcalcifications, and if so, where the affected areas are in your breast (e.g., 3:00, 5:00 and 6:00)?

8. Did you physician(s) discuss the possibility of a breast ultrasound for your left breast?

8. Have you ever had a breast biopsy prior to these findings?

These are all things to think about and discuss with your health care team. We would be happy to send you educational materials, free of charge regarding breast self-exam, breast health, understanding breast changes, questions to ask your health plan about exemplary care (found on our web site under help yourself – 10 key questions for women to ask their health plans), breast cancer myths and much, much more depending upon your needs.

AN IMPORTANT REMINDER: It is very difficult to render an opinion without knowing all the facts of any one particular case. But one strong recommendation we would like to make is that you pursue your question(s) with your own physicians. You should feel fully empowered to obtain a satisfactory answer and feel free to seek a second or third opinion. We have some great tips on partnering with your health care team and key questions to ask your doctors, communication tips and informed decision-making tips to help you get the information you need. There is a special form on our web site that you can fill out and e-mail to us to help us best meet your needs and you are also welcome to call us at (626) 332-2255. Your information will be kept confidential.

I will close with this thought and a saying of mine: "When in doubt, check it out." You know your body well and are your own best advocate. Pursue any concerns with your health care team. I am a strong advocate of second opinions.

I completely agree with Melissa when she replied to your message saying: "If you’re concerned, which I can see you are, set up an appointment to talk with your doctor(s), that's part of their job. Don't walk around feeling unsure and uneasy! It's your life, no one else’s."

I hope that his information is helpful to you and answers many of your questions. Please let us know how you are doing.

Betsy Mullen
President/CEO
WIN Against Breast Cancer

Follow Ups:

• Re: breast calcifications - Linda Roberts   5/21/2000 (1)
  • Breast Calcifications - Betsy Mullen   5/26/2000 (0)

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