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Against Breast Cancer

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Posted by Betsy Mullen on 4/20/2001 from 205.188.200.192:

In reply to: Breast Califications posted by Diane on 4/19/2001 from 216.25.205.165:

Dear Diane:

I know first-hand how scary this all is, and I have a favorite quote by Ralph Waldo Emerson:

"Knowledge is the antidote to fear."

Please try to keep in mind that health care professionals work for you and with you; it is a partnership in which you are the boss 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. I am glad that you have been your own patient advocate Diane, and are up-to-date with your follow-up care.

We have trained information specialists in our offices that can speak with you one on one to determine the best materials to send you (all free of charge). You are more than welcome to call us at (626) 332-2255. If it is a long distance call for you, just ask us to call you right back so that the call is "on our dime."

If you have not done so already, you are also welcome to fill out the special form (blue link at the top of this page) with your specific information and with requests for some of the information and resources I have outlined here. Your e-mailed form will remain confidential.


Here is some information about breast calcifications that I hope you find useful:

Microcalcifications are tiny deposits of calcium that occur normally in breasts. They are indicative of changes taking place. In certain patterns they may signal breast cancer. Macrocalcifications are coarse calcium deposits usually due to aging, old injuries or inflammations.


The following information about breast calcifications was taken from a very current (year 2000 copyright) and extremely informative and reliable resource (see credit below)*:

Analysis of Breast Calcifications

Analyzing breast calcifications includes an evaluation of their size, location, number, distribution and morphology. (Morphology is the science of structure and form of organisms without regard to function.) A very important factor is determining whether or not the calcifications are truly intramammary (within the breast) or in the skin.


Size of Calcifications

Breast cancers rarely produce calcifications larger than 1mm and the majority of calcifications associated with breast cancer are smaller than 0.5mm in diameter.


Number of Calcifications

Using a threshold number to classify suspicious groupings of breast calcifications has been the subject of much discussion. On a statistical basis, the likelihood of malignancy increases with the number of calcifications. The number 5 in a cubic centimeter has been arrived at from general experience and from a large series published by Egan et al., which determined that the probability of malignancy was zero (0) when there were less than 5 calcific particles in a volume of tissue. This does not mean that fewer than 5 calcifications always indicates benign pathology. The distribution and morphology of breast calcifications must be considered when determining their significance.


Distribution of Calcifications

Typically, geographically distributed and diffusely scattered calcifications are usually benign.

There are 3 main categories of distribution when analyzing breast calcifications:

1. Regionally or Diffusely Scattered Calcifications Distribution: Breast calcifications which appear randomly distributed throughout large volumes or throughout the breast are almost always benign. While breast cancer can be extensive, this is very uncommon.

2. Clustered Distribution: Many malignant calcifications form in nonspecific clusters. A cluster of calcifications is very often defined as a group of 5 or more particles in a cubic centimeter of tissue. Biopsy is used to establish an accurate diagnosis. These types of calcifications are the most challenging to analyze accurately and are the cause of the majority of benign biopsies.

3. Segmental Distribution: Thought to represent calcifications within a single duct network. Calcifications whose distribution suggests a duct network are of concern; many believe that breast cancer is a disease process that is initially confined to a single duct network.

*Source and Suggested Resource: Diseases of the Breast, Second Edition; Editors: Jay R. Harris, Marc E. Lippman, Monica Morrow, C. Kent Osborne; Publisher: Lippincott Williams & Wilkins; 2000; ISBN #: 0-7817-1839-2.



The following is some additional 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.


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

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? Did you receive the radiologist’s written report from your previous mammograms? It is always a good idea to get copies, and maintain a file of all such studies.

7. Did you physician(s) discuss the possibility of a breast ultrasound for both breasts?

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 will 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.


The following is some information regarding various breast imaging techniques.

Excerpts from: Breast Imaging Questions

Source: Richard L. Ellis, M.D.
Memorial Medical Center, Department of Radiology
Division of Breast Imaging. Springfield, Illinois 62794


Q: Why is ultrasound performed in addition to mammography?

Ultrasound is an excellent adjunctive examination to mammography, but it cannot be a substitute for the screening mammogram. As noted above, ultrasound is the primary examination in young, pregnant, or lactating women with palpable abnormalities. It is also routinely performed on women with clinical findings whose mammograms are unrevealing and on those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle localization, fine needle aspiration, core biopsy, and percutaneous ductography.

A reliable aid in the diagnoses of most breast cysts, ultrasound can be used to guide benign cyst puncture for those who are symptomatic or do not meet stringent criteria for diagnosis of a benign cyst on ultrasound. In addition, it can provide reassurance that no mass underlies a questionable palpable area. According to recent evidence, ultrasound can aid in the benign-malignant differentiation of solid breast masses and prevent biopsy for many noncancerous masses, such as fibroadenomas.


Q: What other diagnostic procedures are performed in mammography?

Once an abnormality (abnormal mass, calcifications, distortions, etc.) is detected on the screening mammogram, a diagnostic mammographic examination is generally performed in order to obtain special views of the abnormality allowing a more detailed evaluation. This additional mammographic examination may include the use of special X-ray maneuvers and magnification of the abnormality in question as mentioned previously.

Ductography is an examination that allows detailed evaluation of the breast milk duct and is indicated when there is a bloody nipple discharge or persistent discharge from a single duct in the nipple. There are approximately 15 to 20 major milk ducts that converge to the nipple. If the discharge is noted from multiple ducts or from both nipples, a ductogram is not indicated. The cause for multiduct discharge is usually related to a systemic cause (hormonal effect, pituitary disorder, etc.) and is not cancerous. The examination is usually performed by inserting a small cannula (thin tube) directly inside the duct ostium in the nipple and contrast (X-ray dye) is injected to fill the duct. If the cannula cannot be placed through the ostium, the abnormal duct (which is usually enlarged) can frequently be filled percutaneously with ultrasound guidance.

Magnetic resonance imaging is a special radiologic scanning method that is extremely accurate for evaluation of breast implants when there is a suspicion of implant rupture or leakage due to trauma or implant breakdown due to age. In addition, MRI is beginning to show promise as a tool that in the future may allow differentiation of benign and malignant lesions in the breast and provide better demarcation of the size of the lesion to assist surgery. In addition, MRI may help determine recurrence of cancer in the breast after treatment.

Nuclear Medicine Imaging, using sestimibi (Miraluma), is currently available as an additional diagnostic examination for selective patients. We are also using monoclonal antibodies for breast cancer under clinical research trials to evaluate their efficacy in selected patients with the hope of helping to differentiate between benign and malignant breast lesions.


The following resource looks great (I have provided a link for you below this message), and I know one of the physicians, Richard Edlich, M.D., who created the site. He is a plastic and reconstructive surgeon from the University of Virginia, who happens to know my personal plastic surgeon! This looks like a great site and hopefully a helpful resource to you.

Breast Biopsy.com: http://www.breastbiopsy.com/

"OUR GOAL: Answer questions that arise with discovery of breast abnormality. Explain breast findings, mammography, updated biopsy techniques (stereotactic, ABBI, MIBB, Mammotome).

There is a natural anxiety that occurs in a woman upon finding an abnormality in her breast. From the moment she, her physician, or the radiologist makes the discovery to the time of diagnosis, there is a period of misery.

In an effort to help, this site is intended to provide women with answers to questions that may arise during this interim as well as serve a resource in general because this is an issue that will affect nearly everyone, be it personally or through a loved one.

Throughout this site you will find definitions and simple explanations of breast findings and updated breast biopsy techniques (including stereotactic techniques such as ABBI, MIBB, and Mammotome). We will also discuss breast examination and address mammography. For your convenience, there is an interactive map that will allow you to locate a comprehensive breast care center near you."


Additional Informational Resources and Suggested Reading


Books about Breast Health and Breast Cancer


There is a great book out entitled "Be a Survivor, Your Guide to Breast Cancer Treatment " written by Vladimir Lange, M.D. You can purchase the book through our site’s bookstore.

An additional book that I highly recommend for you was written by Michael Lerner, the Founder of Commonweal. There is a link to Commonweal in the Resources Section of this site as well. The book is entitled "Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer".

Additional good books that extensively cover breast health, breast cancer and reconstruction are entitled "A Woman’s Decision, Breast Care Treatment and Reconstruction, 3rd Edition" and the newest edition of "Dr. Susan Love’s Breast Book" which are also available in our "virtual bookstore".

Another book I think will be helpful to you is entitled "The Road to Immunity: How to Survive and Thrive in a Toxic World" by Kenneth Bock, MD and Nellie Sabin. It covers in depth information about the immune system and how to keep our immune systems functioning at peak capacity.

We have another book in the WIN ABC library that good that is entitled "Assess Your True Risk of Breast Cancer" by Patricia T. Kelly, Ph.D., copyright 2000. It discusses what statistics really mean, evaluation of heredity and lifestyle risks and What You Need to Know About Genetic Testing (BRCA1 and BRCA2 gene testing).

The Complete Book of Breast Care by Niels H. Lauerson, MD, PhD and Eileen Stukane is also a very good resource with comprehensive and easy to understand information.

Another great resource about breast health is: Diseases of the Breast, Second Edition; Editors: Jay R. Harris, Marc E. Lippman, Monica Morrow, C. Kent Osborne; Publisher: Lippincott Williams & Wilkins; 2000; ISBN #: 0-7817-1839-2. Most medical libraries should carry it; I’m not sure about regular public libraries.

The books can be purchased on line in our virtual bookstore via Amazon.com and should be available in most public libraries.


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.


Here are some closing thoughts that I would like to share with you:

I have a saying that I personally put into practice: "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.


And from an anonymous author:


What is COURAGE?

Confronting the dragons

Overcoming the obstacles

Understanding the risks

Really living

Always believing

Going the distance

Expecting the BEST!


Diane, I am holding you in my thoughts and look forward to hearing from you with an update on how you are doing and how we can help you.


My best regards,
Betsy


Elizabeth ("Betsy") Mullen
Founder, President/CEO
WIN Against Breast Cancer
Main Office:
536 S. Second Avenue, Suite K
Covina, California 91723
Telephone: 626-332-2255 Fax: 626-332-2585
San Diego Office:
Telephone: (619) 284-4900 Fax: (619) 284-7900
Web Site: www.winabc.org

• Breast Biopsy.com

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