Seeing Spots on Your Mammogram

Updated May 28, 2023

Not all people assigned female at birth have calcifications in their breasts—but most do. These deposits show up as tiny white spots on a mammogram, and there may be only one or two, or too many to count, said Jay Baker, MD, a breast imaging specialist at the Duke Cancer Center. “Most people assume that what doctors are looking for on a mammogram are lumps,” Dr. Baker remarked. “That’s only half the story.”

“Calcifications are flecks of calcium salts that are deposited in the breast tissue—as well as other tissues in the body, including the skin or blood vessels,” Dr. Baker explained. “You can’t feel them in your breast, the way you can a cyst. We only know they’re there when they show up on your mammogram.”

Breast imaging specialists like Dr. Baker determine if calcifications are worrisome by looking at the size, shape, and distribution of the flecks and at any associated mass that might appear in the breast tissue at the same time.

Benign and Probably Benign

The good news is that the vast majority of calcifications are quite clearly harmless—nothing for you to worry about, ever. For that reason, their presence may never have been mentioned to you or included in your mammogram report. “When I talk to people about their calcifications, by and large they haven’t heard of them,” Dr. Baker says.

These harmless kinds of calcifications are called “benign.” The term was established by the American College of Radiology, which came up with a standardized way of describing mammogram findings and results—and what to do next. This system is called the Breast Imaging Reporting and Data System (BI-R ADS).

The next BI-R ADS category is “probably benign.” Again, not much to worry about. “The calcifications in this category have less than two percent chance of being precancerous cells or cancer,” Dr. Baker said. “And the small number that do turn out to be malignant are typically very early stage cancer.”

At Duke, calcifications deemed “probably benign” are reviewed on a diagnostic mammogram in six months to see if there has been any change. The calcifications are followed carefully over two years, and if they remain stable, you can return to routine screening mammograms without ever having a biopsy.

Recommending a Biopsy

If your radiologist determines that the size, shape, or distribution of calcifications could indicate cancer, they might be put in one of the “suspicious” BI-R ADS categories. In short, that means a biopsy is necessary for your doctor to learn more about the spot or spots.

“Still, even when the calcifications are a concern, there is still likely a silver lining,” Dr. Baker stated. “When I see calcifications only, I am usually less worried about breast cancer, but I might be concerned about DCIS.” 

Ductal carcinoma in situ (DCIS) is a precancerous state in which cells lining the milk ducts look like cancer cells, but the cells have not spread through the walls of the ducts. Usually, DCIS will be removed through surgery. “If we find these precancerous cells, we can essentially prevent cancer,” Baker said.

Calcification Myths

To people concerned about benign calcifications someday morphing into cancer, Dr. Baker said, don’t worry. “Benign calcifications will never turn into breast cancer. If it’s benign today, you can forget about it,” he explained. “And characteristically benign calcifications alone don’t mean you have to get mammograms more often.” (Currently, Duke recommends most women of average risk get mammograms once a year, beginning at age 40.) 

Also, drinking milk or eating yogurt isn’t a problem. “Breast calcifications have nothing to do with your diet,” Dr. Baker said. “Take your calcium supplements.”

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To make it as easy as possible to get your mammogram, Duke Health has several locations in the Triangle. To make an appointment, call 855-855-6484.

Who is Reading Your Scan?

Does it make a difference if the doctor who looks at your mammogram only does breast imaging, all day long? Like any job, the more you do it, the better you get at it. “It’s valuable to know whether your scans are being read by a dedicated breast imager,” remarked Dr. Baker. Images taken at the Duke Cancer Center, Duke Health Center at Southpoint, Duke Radiology at Patterson Place, and Duke Health locations in Wake County are read by a dedicated breast imager.

Likewise, it can make for a better mammogram experience if your technologist only does breast imaging. “It makes a huge difference,” Dr. Baker said. “They know how to make it comfortable for you while getting the best images possible.”