What is Benign Breast Calcifications?
Breast calcifications, or tiny deposits of calcium in the breast tissue, are very common. It’s vital to tell the difference between harmless and harmful calcifications since nearly half of all breast cancers that can’t be felt in a physical exam are linked with calcifications. Correctly identifying harmless calcifications can prevent unnecessary medical procedures and better utilize medical resources.
A tool called The Breast Imaging Reporting and Data System (BI-RADS) by the American College of Radiology is commonly used to categorize calcifications found in mammograms as either “typically harmless” or “suspicious”. In this article we are only focusing on the “typically harmless” calcifications. This classification works best with mammograms since other techniques like MRI or ultrasound can sometimes make it hard to see the true details of calcifications.
The standard system for calcifications describes their shape and distribution within the breast. The “typically harmless” category includes skin, vascular, coarse or popcorn-like, large rod-like, round, rim, dystrophic, milk of calcium, and suture calcifications. Once the calcifications have been identified, their spread within the breast should be noted. Options for describing the spread of calcifications include diffuse, regional, grouped, linear, and segmental. When the calcifications are spread diffusely and across both breasts, they are generally harmless. The other categories vary in their likelihood of being linked to breast cancer, which is beyond the topic of this article.
What Causes Benign Breast Calcifications?
Breast calcifications that are mostly harmless can be caused by a variety of conditions.
Skin calcifications are found in the skin, especially the layer beneath the topmost skin, known as the dermis. They can occur due to inflammation of hair follicles or clogged sweat glands.
Vascular calcifications are linked with getting older, heart diseases, high blood pressure, pregnancy and breastfeeding. These calcifications usually show a pattern that looks like parallel tram lines.
Coarse or popcorn-like calcifications are linked with the shrinking of non-cancerous lumps in the breasts, such fibroadenomas or papillomas.
Large rod-like calcifications are signs of a condition called ductal ectasia, which is the widening of the milk ducts inside the breasts.
Round calcifications could be seen in blood vessel growths called hemangiomas.
Rim calcifications might be a result of the death of fatty tissue, frequently found after fat transfer procedures. Rim calcification can also be seen around breast implants or at the edges of silicone or other materials injected into the breasts for enlargement.
Benign dystrophic calcifications, which are typically harmless, could indicate changes after an injury or surgery, or the death of fatty tissue. These types of calcifications are also linked with a condition where the parathyroid glands produce too much hormone.
Milk-of-calcium calcifications represent calcium sediment within cysts. These calcifications show a layering or a “tea-cupping” appearance on a sideways view.
Suture calcification happens because of the formation of small knots of inflamed tissue around a surgical stitch or suture.
Other causes of typically benign breast calcifications can include blood vessel lesions, tuberculosis, and parasitic infections.
Risk Factors and Frequency for Benign Breast Calcifications
Calcifications, or tiny build-ups of calcium, can occur in several parts of the body. They are often harmless, but in some cases, they may signify the presence of disease. In women, benign breast calcifications can be quite common, with about 50% experiencing it. However, these can also appear in other places such as in blood vessels. Vascular calcifications are seen in around 0.1% of women under 45, going up to 50% in women over 70. Women with kidney disease also have a high prevalence of benign breast calcifications, at around 68%.
Particular types of calcifications can occur like Milk of calcium, which is found in about 4% to 6% of women, and large rod-like calcifications are found in approximately 3% of women. After surgery or radiation, dystrophic, rim, and suture calcifications, a kind of harmless post-operative calcifications, occur in about 28% of cases within 6 to 12 months.
Compared to women, breast calcifications are rare in men. Current data mainly focus on calcifications associated with breast cancer in men, which makes up a small fraction of overall cases. However, it’s important to note that most lesions in the male breast are benign, and since calcifications linked with male breast cancer only comprise less than a third of the less than 1% of breast cancers in men, calcifications observed within a male breast are more likely to be harmless than harmful.
Signs and Symptoms of Benign Breast Calcifications
Breast calcifications are often a secondary concern or found by accident during medical exams. These calcifications are usually harmless and too small to feel. But if they are large enough, a patient might notice a physical lump in their breast. This lump could be due to a type of calcification called dystrophic, rim, or suture.
If these types of calcifications are spotted on a mammogram, it’s important to ask the patient about any past experiences of physical trauma, infection, surgery, or radiation.
Testing for Benign Breast Calcifications
Mammography is the go-to method for checking breast calcifications. There are several kinds available, including digital breast tomosynthesis, full-field digital mammography, and screen-film mammography. Typically, a mammogram will include two main x-ray images (or “projections”) of each breast. These are called cranial-caudal (CC, taken from top to bottom) and medial-lateral-oblique (MLO, taken diagonally).
For tomosynthesis (sort of a 3D-type mammogram), besides the regular 2D CC and MLO images, there are also tomosynthesis CC and MLO views.
Calcifications that are usually harmless can often be identified as such on the mammogram or tomosynthesis because they tend to be larger (more than 2 mm) and are thus called macrocalcifications. But sometimes, it can be harder to tell what kind of calcification it is, and extra images may be helpful. This is especially true if the calcifications are small and hard to see on the regular CC and MLO projections or on tomosynthesis.
For example, a kind of calcification called “milk of calcium” requires a true side view to be diagnosed properly. As for calcifications on the skin, special shots from a tangent angle might be needed, but often, these skin calcifications can be identified just fine in a tomosynthesis.
Treatment Options for Benign Breast Calcifications
Usually, when a breast calcification is found to be mostly harmless, there’s no real need to do anything. However, it can get tricky when a suspicious-looking calcification may look like it’s not harmful (or benign) at its early stages. In these cases, a tissue sample or biopsy could be needed. On top of that, if one feels a big benign calcification that’s causing discomfort, they could choose to get it removed surgically.
Even though these calcifications aren’t directly linked to breast cancer, they are often associated with other diseases like diabetes, coronary artery disease, or chronic kidney disease. Therefore, it might be a good idea to get checked for these diseases if you have breast arterial calcifications.
What else can Benign Breast Calcifications be?
Most types of benign, or non-dangerous, calcifications—calcium deposits that form in the body— usually have a recognizable form that helps physicians identify the cause. These can look like stitches, edges of a disk, or popcorn-like structures. However, there are a few types that can be difficult to distinguish from potentially harmful calcifications, such as ‘milk of calcium’, early stages of fat cell death, or coarse calcifications.
In these tricky cases, doctors have to rule out serious conditions like ductal or invasive carcinoma (types of breast cancer), sclerosing adenosis (an uncommon benign breast condition), lobular neoplasia (abnormal growth in the milk-producing glands), atypical ductal or lobular hyperplasia (non-cancerous breast disease), and papilloma (a generally harmless, wart-like growth).
It’s also worth noting that deodorant or other topical medications applied to the skin can create an image on the mammogram that looks like calcification—a deceptive detail doctors have to consider.
If they can’t confirm that the calcifications are harmless, the next step could be a biopsy; a sample of tissue is taken from the body and examined. Alternatively, they may suggest a follow-up mammogram after a short while to see if the calcifications have changed.
What to expect with Benign Breast Calcifications
Benign breast calcifications, which are not harmful, don’t alter a patient’s expected health outcome or future wellbeing. The importance of correctly identifying these harmless calcifications is that it can prevent needless medical procedures and also allow for the better use of healthcare resources.
Possible Complications When Diagnosed with Benign Breast Calcifications
Simply put, if you have benign breast calcifications, which are tiny mineral deposits in the breast tissue, they won’t cause any health problems.
Preventing Benign Breast Calcifications
Patients should be comforted with the knowledge that breast calcifications, or tiny calcium deposits in the breast, are a very common occurrence. It’s important for patients to understand that even if they are advised to undergo a biopsy, there’s no need to panic. In fact, roughly 80% of these biopsy results come back benign, meaning they are not cancerous.
