Recall to Assessment Clinic for Calcification

You have been recalled after breast screening or from our follow-up mammogram service for further tests at an assessment clinic. You will find general information in your invitation letter. This leaflet provides more specific information for you and your family/carers because your recent mammogram shows some calcification.

Calcifications are tiny chalky dots which show up on a mammogram. These calcifications can appear for a number of reasons, including benign (non-cancerous) causes but in some cases the calcifications can indicate a problem such as underlying cancer or pre-cancerous cells.

In very general terms, 2 in 3 women who have a biopsy for calcification have innocent (benign) changes and do not have underlying cancer cells.

About 1 in 3 women who have a biopsy for calcification do have cancer cells, but there is a wide spectrum in type and number of cells, from very slow-growing forms that might not actually need treatment, to what we more usually understand as breast cancer.

After taking extra mammograms the team will decide if you should be offered a needle biopsy.

Every woman is different and we will discuss our findings with you before you decide on the next step, but in more than 9 out of 10 cases you will be offered a needle biopsy so we can make a definite diagnosis. There are alternatives to needle biopsy and we will discuss them with you in the clinic.

Anticoagulants or disorders of bleeding/ clotting

Blood thinning medications such as warfarin, rivaroxaban and clopidogrel can increase the risk of bleeding during a biopsy. If you are taking a blood thinner, or have a known bleeding disorder, please phone the Breast Care Nursing team on 01223 586960 prior to your appointment as additional arrangements may be necessary.

Alternative procedures that are available

A surgical operation could be performed to remove the potentially abnormal area. This involves coming into hospital for the day and a general anaesthetic. The operation would leave a surgical scar. To guide the surgeon to the correct site a needle would need to be placed in the breast before the operation.

Alternatively, we could decide to actively monitor the area for any changes using regular mammography. We will discuss with you the implications of not having a biopsy.

About the biopsy

Most calcification cannot be seen on ultrasound so we need to use the mammography machine to guide and insert a special needle. The procedure is called a diagnostic vacuum-assisted breast biopsy under x-ray guidance.

What is a vacuum biopsy?

After an injection of local anaesthetic a hollow probe connected to a vacuum device is inserted through a small hole in the skin. Using a mammogram as a guide, breast tissue is sucked through the probe by the vacuum into a collecting chamber.

During this procedure you will lie on your side or sit at a special x-ray table with your breast compressed as for a mammogram. We will take a number of low-dose x-rays to help guide and confirm the correct needle position. The clinician and radiographers will explain what they are doing as they go along. You will need to keep as still as possible in order for us to take accurate samples of the area.

The needle is only in the breast for a few minutes but whole procedure can take more than half an hour.

Who will perform my procedure?

This will be done, or be very closely supervised, by an expert clinician.

Will the procedure hurt?

The compression can be uncomfortable and the local anaesthetic might sting for a few seconds until it takes effect. Most patients report that this procedure is straightforward and tolerated well.

How much breast tissue will be removed?

We will remove several small pieces of breast tissue to be sure we have enough for an accurate diagnosis. Once collected, the samples are x-rayed using a separate machine to check that we have successfully removed some of the calcification. If we have not obtained enough calcification, we will talk to you about continuing to take more tissue.

What if all of the area with calcified tissue is removed?

We insert a titanium marker clip into the biopsied area after taking all the samples. This is in case we need to find this area again later. This marker can remain in your breast without causing future problems, for example with subsequent MRI scans or metal detector systems.

After the procedure

The team who perform the biopsy will see you before you go home. You will be able to discuss any questions or concerns. The final answer will not be available until the specimen has been examined in the laboratory.

You will be able eat and drink as normal following this procedure, and can leave hospital shortly after the procedure. Normally, usual activities can resume immediately.

All details will be explained during and after the procedure.

Are there any side-effects?

This is a very safe procedure. The commonest side-effect is some bruising or bleeding around the area. We try to reduce this by applying some hand pressure at the time.

More severe side-effects or problems such as infection are extremely rare.

When will I get the result?

We try to get the result of this test ready for you within ten days. You will be given an

appointment before you leave us on the day of the procedure. This next appointment could be by telephone or face to face.