Breast microcalcifications--right worse than left

Hi all,

I am 11 days post-op hysterectomy, but in mid-March I was found to have suspicious microcalcifications in both breasts. The right breast was much worse, a grade IV, and I had spot compressions of both breasts later that month.

I also had what was thought to be an enlarged suprasternal lymph node at that time, and was already scheduled for removal of this in April...when the breast biopsy came back as it was, the general surgeon proceeded with a combined procedure and also did an excisional biopsy of the right breast the third week in April (under general anesthesia).

The node turned out to be a large teratoma, thankfully, and the breast biposy was benign, with all microcalcifications removed. I couldn't have been happier! But on Thursday, I got a letter from my doctor telling me that I need to repeat the spot compressions in both breasts in September, and to be prepared for another biopsy of the left breast this time...the only reason it was not biopsied the first time was because the microcalcifications proved to do something called "tea-cupping." Is anyone familiar with this term and what it means?

I am a bit upset, as I feel that by early September I will just be on the road to recovery from my hysterectomy, and not up for any more procedures...

Any info on microcalcifications, tea-cupping, and any advice/support would be very, greatly appreciated...I thank all of you in advance for reading this post.

I wish all of you the very best, and please take care.

Sincerely, Trish

I too have had an ongoing breast saga. Because of suspicious microcalcs., I had a core-needle biopsy in March of '07. It showed a sclerotic papilloma, which was benign, but required removal. So, I had an excisional biopsy later in March. Went for my 6-mo. post-op mammo in Sept. of '07--and there were still calcs.!! Even though the radiologist and 2 surgeons (including the one who did the March surgical biopsy) said I probably didn't need to have these removed, my gut was telling me I did. So, I had the same surgeon remove these calcs. in Dec. This time they found atypical ductal hyperplasia. It's NOT cancer, but a strong risk factor, so the surgeon put me on tamoxifen as a preventative. All I can say is thank God I listened to my gut and not to the doctors. The reality is, I was at high risk. Because of these calcs., my ADH was found, and I am now able to do something to try to reduce my risk. So, I know how concerned you are. From what I've read, 80-85% of these things are benign. (Even mine proved to be benign!) Try not to worry--and trust your gut regarding how you want to be treated. (As an aside, I went back for my post-op mammo on Wed., and there are STILL calcs. in there. But, this time I'm comfortable leaving them alone, because I'm already being treated for my increased risk.)

I have a friend who is a radiologist, and I remember him telling me that if the calcs. were teacup-shaped they weren't likely to be a problem, but if they were amorphous (shapeless blobs), the were more likely to be problematic. However, that's just what I remember hearing and it might not be accurate since it didn't pertain to my situation. (Mine were amorphous.)

I also can relate to your feelings that you're on a merry-go-round with this. Every time I go for a mammo I keep waiting for the other shoe to fall. I'm seeing my breast surgeon every six months, an oncologist on the alternating six months (so I have an exam every 3 mos.), getting annual mammos, and will be getting annual MRI's from now on. Not sure how long I need to see the onc., but the surgeon told me I'd be seeing him for the rest of my life, although less frequently once I get off tamoxifen.

Having to have a hysterectomy this year certainly didn't help! Seems like every time I go to a doctor, I'm having to get undressed either from the waist up or waist down!! And I had foot surgery in Oct., so I have had 4 surgeries in 15 mos., and I'm TIRED of it!! (I have to remember to stay fully clothed when I see the foot doc! LOL!!)

Good luck in Sept. Hopefully everything will turn out fine. And good luck as you continue your recovery from the hyster!

Hi there Susan,

Wow am I ever sorry for my delayed reply...shorly after making this post, I wound up in the ER and then the hospital with some sort of pelvic infection/sigmoid colon inflammation and a fever. I hope you wouldn't think that I would just ignore such a kind, considerate & informative reply I just got home from the hospital last night.

And wow, I must say you have been through quite an ordeal--I cannot thank you enough for sharing you story and wisdom with me...and for adding a touch humor to this as well--I like the part about staying dressed at the foot docs You are one strong lady to go through all that you have, and still make someone laugh in the end...

I too am so very glad that you followed your gut instinct and got the correct diagnosis of ADH with the second biopsy. Am just curious, do you have any family history of this? There is none in my family at all, in fact to my knowledge no one had ever even had a biopsy done.

It was all foreign language for me, but I do recall reading my mammo and it did say "amorphous" for the right breast only...the "tea-cupping" is a term that the mammo tech used to exlpain why the left breast looked okay for now. She'd said that when the breast was compressed, these microcalc's "fell down like leaves into the bottom of a teacup" rather than remaining blob-like. I guess that makes more sense to me now.

I am going to keep a positive attitude on this one, and just hope & pray that it does not progress into anything when I am re-checked in September...I have my hands full with this hysterectomy, to be sure! I do know that, when I am in there for the repeat mammo, I will try picture someone getting undressed from the waist up for the foot doc, and just try to smile

Thanks again so very much for your kind reply, support, and info--I wish you all the very best in your ongoing treatment and recovery as well. Please take care.

Sincerely, Trish

PS--on a serious note about the foot, I do hope that the surgery went well and you are fully recovered from that.

Hi Trish-I am a mammographer and do stereotactic breast biopsy procedures. Tea cupping is a description they use for what can also be known as milk of calcium, which is benign. Sometimes when we biopsy these, they just disintigrate (best way to describe it). Because they are "liquid" and we image the breast from side to side, the "liquid" settles and it looks like a "tea cup" on the image. Also it's not unusual to follow up after 6 months. We really can't see "cancer" on mammograms unless it is so far gone such as a patient who had a lump for years and ignored it and her breast is now deformed, etc. As I tell my patients this is the reason you have a yearly mammogram. If you do find something and it turns out to be a cancer, you have caught it early and the cure rate is excellent. Also 80%-85% of all breast biopsies are benign. Unless you take some tissue and have the pathologist examine it under a microscope, you don't really know. There are some calcium deposits that are large and round that we see and we know these are benign. It's the small ones that look like grains of sand that should be biopsied. A radiologist will not let something go 6 months if they are really concerned. Like I said we do 6 month f/u often. If anything changes, they will biopsy. If not they may have you return another 6 months (time for yearly anyway). They will always continue to watch the area for changes. When you talk about grade IV that is a code used in addition to the wording of the report. It is called the Birads system and is mandatory with the American College of Radiology. The Birads are as follows:
Birads 1-Negative
Birads 2-Benign-may have cyst, stable calcifications, dense tissue, etc.
Birads 3-Probably Benign-may see one of the above but would like to follow
up in 6 months to check if anything changes
Birads 4-Suspicious-consider biopsy to rule out pathology
Birads 5-Highly Suspicious-biopsy or surgical excision
Birads 6-Known Malignancy
I hope this helps. If you have any other questions, feel free to ask. Good luck. By September you should be able to tolerate the mammogram. If you don't think you can, we tell our patients with sensitive breasts to take Motrin about 1 hour prior to their appointment. It does help.

Trish,

So sorry you ended up in the ER and hospital! That couldn't have been pleasant!! Glad you're out now. Are you feeling better?

Nope, no real family history of BC--my grandmother was diagnosed at age 79, but I understand that has minimal impact on my risk.

The foot surgery went OK. I still have some discomfort when I walk, and it will apparently be there for life. But, it's not unbearable, and there are so many others out there who are suffering with so much worse stuff than I am.

By the way, where are you in NC? I lived there for about 8 years prior to coming to Virginia. Loved it

Hi again!

For Debbie--wow, what a delicate & demanding job you have--I cannot thank you enough for all of the info and clarification regarding the microcalcs, teacupping and the BIRADS...you sure have been a huge help to me here on the forums in so many ways, and I am so very grateful that you replied. Those spot compressions were uncomfortable, but more than anything, out of the blue I had a panic attack of sorts while slipping into the paper gown during the original mammogram...I had no reason to be upset, or remotely concerened--just hit me like a train! I was, however, calm for the spot compressions--a bit odd, huh? I will take your advice, however, and take a Motrin shortly before I leave home for the one in Sept...thanks again for all your info, advice & support.

For Susan--I am feeling much better today, thanks for asking--am taking antibiotics now, and they are keeping my fever at bay for the most part I am so very sorry that you are troubled still after your foot surgery, but you seem to have a great outlook on things. I live near Pinehurst--was born and raised here, but have also lived in Dallas, TX and Kauai, HI--I sure did miss all the pine trees and the feeling of home while I was away, though...

Take care, both of you--I wish you the very best!

Sincerely, Trish

Trish,

I lived in Goldsboro for 4.5 years, then moved to New Bern for 3.5.

Please post again in Sept. and let us know how your follow up goes.

Keep healing!

Trish-you are so welcome. Glad I could be of some help. Good luck with your follow up in Sept. Please let me know how you do. If there is anything else, don't hesitate to ask.

Hi again all!

So very sorry that it has taken me this long to follow-up...I did indeed have my repeat mammo in September, and this time it was an entirely different experience. The lovely lady who did my last mammo was off for the day, and during my last visit she had explained every detail of what was happening and even showed me films (after they had been shown to the radiologist).

Well, this visit, they wound up needing spot compressions x 4 on my right breast, and I still have no clue why Nothing was explained that day, just that there was "something there" and the radiologist kept asking for new compressions. It was a very long, stressful day. I did see my surgeon about a week later, and all he said was that everything looked great! When I questioned him, then why all the repeats, he took a closer look at the right, and said "Oh, looks like a new suspicious area in the right breast, but it's more of a lump--not microcalcifications." The area of biposy apparently looked good, with no microcalcs, and the left breast is unchanged.

So, am I to be concerned if he only told me to follow-up in 4-6 months for a repeat mammo of the right breast only? He wouldn't have even looked at it had I not pointed it out ackkk No one told me where this suspicious area is located, or if it would be something I could feel and check on myself.

I have another appt. with that same surgeon, for a different reason, on Thursday--should I dare ask him to drag those films out and show me where on my breast this is, so that I may be more aware of what to check? I am just a bit dazed by all of it, and the lack of explanation...any and all advice would be greatly appreciated. Please take care, and I wish you all the very best. s

Sincerely, Trish

Hi (((Trish))) So sorry you're having to keep going back for follow-ups. Actually, this tech behaved properly regarding giving you information... they are not permitted to do that. You might try calling the radiologist's office and asking to have the radiologist call you and explain the findings.

Just the fact that they have a new area they are following doesn't mean much by itself. As we age, we develop all sorts of calcifications, cysts, and other variations in our breast tissue with much greater frequency than when we were younger, and the radiologists will follow any new areas that show up. Most times they either disappear or just stay the same... they only become concerned if they observe an increase in density in one particular spot over time.

You can certainly ask the surgeon to show you on the films and on your breast where the new area they are following is; just don't expect to ever be able to feel anything. I've had breast cancer twice, and while I am very aware of where it was, I never felt a thing either time. The important thing is to keep getting your regular mammograms. In fact, I am having one this afternoon!

s,
-Linda