D2Bea 26 Aug 2004

A Well, most calcifications are not going to be cancer. However, some patterns of calcifications can be a clue to cancer.

The radiologist reporting your mammograms would have looked at your calcifications and may have classified them into benign, probably benign (or indeterminate), slightly suspicious or highly suspicious.

In the categories from indeterminate to suspicious - a biopsy (usually needle or a guided surgical biopsy - i.e. tissue sample) is taken. Sometimes for those in the indeterminate or probably benign category, they may choose to observe with close follow up mammogram in 6 months.

The surgical consultation is important so that you can be examined and also seen in total including discussing with you the options and what is needed in the next step of evaluation.

There is no need to worry prematurely although it is natural to have anxiety. Most calcifications where no "lump" can be felt, even if it turns out to be cancer would be at the earliest stage - where treatment is going to be very highly successful. The results could also be benign.

Biopsy - if using the needle will only require local anaesthetic. It is not usually terribly painful and if it is a surgical biopsy - this will normally be under general anaesthesia. The "pain" is normally very tolerable for those under local anaesthesia (needle biopsy) but then, if you are very anxious, your heart rate will rise and you might feel cold and clammy, therefore, making your experience unpleasant. It is best to psyche yourself to stay calm and be positive.

The purpose of regular mammograms is to detect cancer at its earliest stages, before it can be felt. Therefore, the purpose of this biopsy exercise is to check out the suspicion.

You might find the series of articles in this subsection of Articles in The Breast Health Info Centre useful.
http://www.radiologymalaysia.org/breasthealth/BreastImaging/index.htm

You can also read up from the A to Z of breast health/cancer in the Articles section.

Meantime, try to relax, think positive, hope for the best but be practical about the need to check your calcifications out further. That was the reason you went for your mammogram - early detection.

Editor
 

Q Saya berumur 37 tahun dan sudah berumahtangga tetapi belum mempunyai anak. Saya sekarang dalam kekeliruan kerana baru-baru ini, saya ada membuat pemeriksaan payudara di Hospital Besar Kuala Lumpur. Setelah membuat ultrasound dan FNAC, doktor mendapati tiada tanda-tanda saya mengalami barah. Ia hanya ketulan yang tidak membahayakan.  

Tetapi, yang mengelirukan saya ialah setelah doktor melihat ujian tisu ketulan itu, dia mengatakan hanya didapati darah sahaja. Katanya lagi mungkin mereka tidak mendapat tisu ketulan yang sebenarnya. Lalu doktor itu mencadangkan saya melakukan pembedahan membuang ketulan itu.  

Saya meminta doktor itu membuat sekali lagi ujian FNAC kerana saya tak mahu terburu-buru. Jadual temujanji saya untuk fnac itu pada bulan depan. Jikalau keputusan ini kelak bukan membahayakan, adakah saya patut membuang ketulan itu atau tidak perlu? Kerana pada pendapat saya, ia hanyalah ketulan biasa saja.

RH, 10 Okt 2003 

A Buat sementara, sebelum berjumpa dengan doktor di Klinik Payudara Hospital Besar, sila baca artikel ini:

http://www.radiologymalaysia.org/breasthealth/BM/PenyakitPayudara/kelainan.htm

http://www.radiologymalaysia.org/breasthealth/BM/UmurBawah35/index.htm

http://www.radiologymalaysia.org/breasthealth/BM/Mamografi/abnormal.htm 

Setiap pemeriksaan menggunakan jarum sahaja untuk mengambil sedikit tisu tidak semestinya berjaya mengambil sel-sel dalam ketulan tersebut yang mencukupi untuk pemeriksaan patologi yang munasabah. Kadang-kadang, FNAC perlu dilakukan dua kali sebelum spesimen yang mencukupi diperolehi.  

Oleh itu, di pusat pusat yang tertentu, jarum yang lebih besar kalibernya digunakan untuk memastikan tisu yang diambil cukup untuk interpretasi pakar patologi/sitologi.  

Pembuangan ketulan merupakan satunya cara biopsi juga, tetapi ini memerlukan pembedahan kecil. Apabila spesimen biopsi cara jarum tidak munasabah ataupun, puan terasa terlalu risau - doktor klinik payudara puan mungkin akan mensyorkan biopsi secara bedah untuk mengeluarkan ketulan tersebut (lebih-lebih lagi kalau keputusan pengimejan ketulan ini mensyakki kanser). Yang penting adalah komunikasi di antara puan dengan doktor puan. Tanyalah kalau keraguan supaya puan berasa yakin pada prosidur yang seterusnya.  

Kalau lapuran pengimejan adalah ketulan yang tidak merbahayakan, tidak perlu Puan Rosnah bimbang sangat. Peratusan ketulan ini bukan merbahaya adalah tinggi. Bacalah Artikel-artikel di atas dan artikel lain di Pusat Sumber Kanser Payudara untuk mendapat maklumat yang lebih menyeluruh mengenai kesihatan payudara dan bagaimana puan boleh menolong menjaga kesihatan payudara puan. 

Pengarang
 

Q Isn't it true that mammograms destroy breast tissue? I had a friend that asked that very question when she went in for one and the technician told her that the destruction of tissue doesn't concern women over 35 because they are married and don't care about their figures anymore. That attitude angers me. I am 46 and care a great deal about my figure. Also, if a man required a preventative measure for testicular cancer, undoubtedly there would never be a machine he would be hooked up to, to squish his private parts.

RP, 29 July 2003

A I am a clinical medical physicist specialising on the application of radiation in medicine and its biological effects. I just wish to reinforce and enlarge what Dr Ho had commented in her earlier post.

My group at the university has just published a paper (Jamal et. al. British Journal of Radiology 2003 p 1-8, Vol 76) on the mean glandular dose (MGD) to the breast during mammography in Malaysia. We found that the mean patient based MGD per film was 1.54 mGy and 1.82 mGy for the craniocaudal and mediolateral oblique views respectively. This was within the guidelines set by the American College of Radiology and other international organisations.

The clinical benefit derived from a mammographic examination far outweighs the minimal 'risk' that it incurs (the only downside is the pain resulting from the compression of the breast). Furthermore the radiation that the breasts received has nothing to do with one's figure.

Mammography is still the best modality to detect early breast cancer non-invasively. Currently a lot of research is being carried out by radiologists, medical physicists and biomedical engineers to improve on the accuracy of this technique and to develop alternative imaging modalities.

Note: MGD is a standard way of measurement of the radiation dose that the breast receives during mammography. mGy is a unit of radiation dose absorbed in the tissue.

More on Compression in mammography

Effective breast compression is important to enhance the image quality and minimise radiation dose in mammography. However these desirable objectives involve some discomfort and pain. Traditionally the amount of compression applied is under the control of the radiographer up to a specified maximum force. Thus periodic calibration and adjustment of the compression device is important.

A small number of mammograms is affected by patient movement, which suggests that the compression was not effective in keeping the breast still during the exposure. A few manufacturers have attempted to reduce the incidence of image blurring and make compression much more comfortable by redesigning the compression mechanism to allow some tilting of compression plates.

All would agree that there is room for improvement on the traditional design of compression systems. Meanwhile research is making fine progress.

KH Ng
Consultant Medical Physicist
University of Malaya

Editor: Further discussion on this topic can be found at the Radiology Malaysia Forum
 

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