Do I really need to go for a mammogram since my ultrasound was normal?

This is a common questions asked by my patients. And I'll share a story encountered with one such patient of mine!

This patient, let's call her Michelle (not her real name of course), went for an ultrasound for her breasts, which picked up some nodules/cysts and came in to see me for a consultation.

While the ultrasound did not show any suspicious lesions, we were unable to rule out early breast cancer. This is because breast ultrasound and mammograms are different modalities of breast imaging. They are complementary to each other but not interchangeable. A breast ultrasound does not replace a mammogram or vice versa.

Mammograms help detect early breast cancer which show up as microcalcifications. Microcalcifications are tiny deposits of calcium salts that are too small to be felt or seen on ultrasound but can be detected by mammogram. They appear as white spots or flecks on a mammogram.

Breast calcifications are common on mammograms, especially in ladies after the age of 50. Although most breast calcifications are usually benign (non-cancerous), certain patterns of calcifications may indicate breast cancer or pre-cancerous changes in the breast tissue.

Possible causes of breast calcifications include:

1. Breast cancer and/or Ductal carcinoma in situ (DCIS)

2. Pre-cancerous changes such as atypical ductal hyperplasia (ADH)

3. Breast cysts

4. Cell secretions or debris

5. Fibroadenoma

6. Mammary duct ectasia

7. Fat necrosis caused by previous injury or surgery to the breast

8. Previous radiation therapy for cancer

9. Skin (dermal) or blood vessel (vascular) calcification

Products that contain radiopaque materials or metals, such as deodorants, creams or powders, may mimic calcifications on a mammogram, making it more difficult to interpret whether the calcifications are due to benign or cancerous changes.

Because of this, skin products of any kind should not be worn during a mammogram.

Source: Mount Elizabeth Hospital

On a mammogram, breast calcifications can appear as macrocalcifications or microcalcifications.

• Macrocalcifications. These show up as large white dots or dashes. They're almost always noncancerous and require no further testing or follow-up.

• Microcalcifications. These show up as fine, white specks, similar to grains of salt. They're usually non-cancerous, but certain patterns can be an early sign of cancer.

If the initial mammogram shows suspicious breast calcifications, further actions such as additional mammogram to have a closer look, repeat mammogram in 6 months to monitor or biopsy (taking a tissue sample) may be necessary to evaluate the cause of the calcifications.

Once cancer is ruled out as a cause of breast calcifications, there is no need for treatment for the breast calcifications itself. This is because the breast calcifications are a sign of an underlying cause, rather than a disease in itself.

It is important that you go for a mammogram because it will detect calcifications that an ultrasound can't, and with the help of our doctor, rule out any of the more serious conditions.

Book an appointment with us today to get your breasts checked!