The doctor reading your mammogram will look for different types of changes:
Calcifications
Calcifications are tiny mineral deposits within the breast tissue. They look like small white spots on a mammogram. The calcifications seen on a mammogram may or may not be associated with breast cancer. There mainly are 2 types of calcifications.
Macrocalcifications
Macrocalcifications are coarse (larger) calcium deposits that are most likely associated with changes in the breasts caused by aging of the breast arteries, old injuries, or inflammation. These deposits are related to non-cancerous conditions and usually do not require a biopsy. Macrocalcifications are found in about half the women over 50, and in 1 of 10 women under 50.
Microcalcifications
Microcalcifications are tiny specks of calcium in the breast. They may show up alone or in clusters. Microcalcifications seen on a mammogram are of more concern, but do not always mean that cancer is present. The shape and layout of microcalcifications help the radiologist judge how likely it is that cancer is present. In most cases, the presence of microcalcifications does not mean a biopsy is needed. But if the microcalcifications have a suspicious look and pattern, a biopsy will be recommended. (During a biopsy, the doctor removes a small piece of the suspicious area to be looked at under a microscope. A biopsy is the only way to tell if cancer is really present.)
A mass or cyst
A mass, with or without calcifications, is another important change seen on a mammogram. Masses are areas that look abnormal and they can be many things, including cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors (such as fibroadenomas).
Cysts can be simple fluid-filled sacs (known as simple cysts) or can be partially solid (known as complex cysts). Simple cysts are benign (not cancer) and don’t need to be biopsied. Any other type of mass (such as a complex cyst or a solid tumor) might need to be biopsied to be sure it isn’t cancer.
A cyst and a tumor can feel alike on a physical exam. They can also look the same on a mammogram. To confirm that a mass is really a cyst, a breast ultrasound is often done. Another option is to remove (aspirate) the fluid from the cyst with a thin, hollow needle.
If a mass is not a simple cyst (that is, if it is at least partly solid), more imaging tests may be needed. Some masses can be watched with regular mammograms, while others may need a biopsy. The size, shape, and margins (edges) of the mass may help the radiologist determine if cancer is likely to be present.
Your old mammograms may help show that a mass has not changed for many years. This would mean that the mass is likely not cancer and a biopsy is not needed. Having your prior mammograms available for the radiologist, as discussed above, is very important.
A mammogram may show something suspicious, but by itself it cannot prove that an abnormal area is cancer. If a mammogram raises a suspicion of cancer, tissue must be taken out and looked at under the microscope to tell if it is cancer. See the “Imaging-guided breast biopsy” section for more on this.
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