Dr. Jenn Simmons explains breast calcifications: calcium deposits usually found on mammograms. Benign patterns include layering from cysts and coarse deposits from fat necrosis. Pleomorphic calcifications that are irregular and clustered along ducts suggest DCIS and need biopsy.
Chapters
Hi there, it's Dr. Jen and welcome to you asked and I answered. Today we are going to be talking about calcifications because I've been getting tons of questions about what are calcifications. So let's break it down, let's talk about it. First of all, calcifications themselves are deposits of calcium into the breast tissue. The calcium is not good. The calcium is not bad. The calcium is due to some kind of process. So remember that the calcium itself is never the issue. Now, there are a number of reasons why we put calcifications in our breast, and most of them are completely benign reasons that do not require or need any further information. So generally, these calcifications are found on a mammogram. They are not seen on ultrasound, and the only other modality that can reliably detect calcifications is QT imaging. But calcifications that are seen on mammogram generally form a pattern. It's the pattern that they form that make us more or less suspicious of what's happening underneath, what the underlying process is. So calcifications that are seen to kind of layer out and form a meniscus. Those are generally due to cysts, little micro cysts, tiny cysts, tiny fluid filled masses of the breast. And those are always benign and we never have to worry about them, and we never have to sample them. The other thing that we always know is benign are very coarse calcifications. These tend to be like a number of calcifications meshed into one another. And they usually are kind of fluffy in their appearance. And they are generally associated with a process that we call fat necrosis. So fat necrosis happens whenever you disturb the blood supply to fat. The breast is made up of four primary tissues. It's glandular tissue, fat connective tissue, and a skin envelope. And the fat of the breast does not have a very good blood supply. So whenever we do something to damage that blood supply to the breast, we can often get calcium deposits there associated with what we call fat necrosis. And this is a benign condition. This happens commonly after a trauma to the breast. It happens commonly after breast surgery, especially breast reductions or mass lifts, that kind of thing. So calcifications associated with cysts are always benign. Calcifications associated with fat necrosis is always benign. Sometimes we see fat. I'm sorry. Sometimes we see calcifications associated with a fibroadenoma, which is a benign tumor of the breast. The calcifications that we worry about are what we call pleomorphic calcifications. So they all look a little different to one another. It's not a, it's not a regular appearance, a homogeneous appearance, a consistent appearance. So we, we describe them as heterogeneous calcifications, different shapes, different sizes, and they tend to be in a linear or branching distribution. And when we describe them like that, when we use that language to describe them, we are generally describing the distribution of the ducts of the breast. And when calcifications are lining the ducts of the breast, we worry that this is due to a process called DCIS or ductal carcinoma in situ. Now this itself is not cancer. You can maybe call it a pre cancerous condition, but I just hate to even associate the word cancer with it because it is very anxiety provoking and leads to over diagnosis and over treatment. But in this instance, when we see these pleomorphic calcifications in a linear distribution or a branching distribution, that is what we're worried about. We're most concerned about dcis. The only way to get a diagnosis is to do a biopsy. There is no other way to get a diagnosis. But you don't have to have a biopsy. So at that point, if you have that appearance, you can use it as an indication that you may have something happening in your breast and take this opportunity to double down on your health. You can always follow this. This is not an emergency in any way, shape or form. And this is something that certainly can be reversed when you take the appropriate steps. So I hope that that helps to clarify. It's Dr. Jen, keep the questions coming.
