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Centers for Breast Health

Density and Calcifications

Density and Architectural Distortions

What is a density?

On a mammogram, breast tissue appears white, and fatty tissue appears black. A density is an area that appears more white than on prior mammograms or whiter than expected. Often the radiologist requests additional mammogram views called spot compression views. These special views target the density and help the Radiologist determine the significance of the density. Usually a density is determined to be a normal finding.

What causes changes in density of the breast?

Many factors can lead to changes in density. Breasts may become less dense as women age. Changes also occur in relationship to the effects of hormones. Changes in the breast tissue density occur with changes in oral contraceptives, hormonal replacement therapy, and changes in weight.

How is a density different from a mass?

A density which is seen on the mammogram is typically not anything which can be felt. A density does not have clear borders or a definite shape that would suggest a mass or tumor.

Densities, like any changes in the breast, are evaluated to determine their significance and are followed over time to determine stability.

What is architectural distortion?

Architectural distortion on a mammogram describes when the normal pattern or shape inside the breast has changed without a definite mass present.

How is architectural distortion found?

  • A mammogram shows that the normal pattern of breast tissue is either different from one breast to another, or one view to another, or from prior mammograms.
  • A change in the usual way the breast tissue is arranged.

What does it mean?

  • Additional imaging studies (mammograms and ultrasound) help the radiologist determine the significance.
  • Architectural distortion associated with other findings, or progressive architectural distortion may require tissue biopsy.


Calcifications and Microcalcifications

What are calcifications?

Calcifications are tiny calcium deposits within the breast tissue, which appear as small white spots on the mammography film. Calcifications are so small they look like grains of salt on the mammogram. They are too small to be felt, and so small that a magnifying glass is often needed to see them. Calcifications usually represent changes that occur as a result of aging of the breast tissue, old injuries, old cysts, or inflammation. Calcifications are common and are found in most women over the age of forty and in many younger women. Most calcifications are associated with benign breast tissue changes. However, because many calcifications are so small, the Radiologist often requests that patients have additional imaging. This may consist of close-up views (spot compression and/or magnified views) to study the shape, number, and arrangement of the calcifications.

Why are calcifications a concern?

While the great majority of calcifications are benign, a small number of them may represent an early breast cancer. The Radiologist studies the calcifications, reviews the surrounding breast tissue on the mammogram, compares the tissue in both breasts, and compares your prior mammogram films. After careful review, the Radiologist may recommend another mammogram in several months and regular follow-up to determine that the calcifications have not increased in number or changed. If there is greater concern, the Radiologist may recommend a biopsy of the calcifications
to determine that they are not associated with early cancerous changes. Even those calcifications that require biopsy are usually benign.

Does dietary calcium or calcium supplements influence the development of calcifications?

Calcium deposits in the breast occur primarily as a natural process. Dietary and calcium supplements are not thought to be related to the formation of calcifications that are found during mammography.

Is hormone replacement therapy related to the development of calcifications?

Hormones are known to increase the density of breast tissue, which could affect the mammography findings. The development of calcifications is not directly associated with hormone replacement therapy. Hormone replacement therapy reduces osteoporosis (bone thinning) and bone fractures in women after menopause. Recently, a large women’s research study suggests that long-term use of hormone replacement therapy may increase the risk of breast cancer. Each woman and her physician must decide about the use of hormone replacement therapy and the risk and benefits for you as an individual. We advise you to discuss this with your physician. If you have further questions, or for more information, call one of our nurse navigators at 284-LADY (5239).