Microcalcifications weren’t going to kill me. The process of diagnosing their cause was still stressful.

My memory of breast biopsies in 2001 and 2006 is foggy. Any anxiety must have been wiped out by hearing “benign.” 

This time I tried to tamp down anxiety with knowledge. When a screening mammogram results in a callback for which you have to wait three weeks, and then the diagnostic mammogram results in a biopsy appointment for which you have to wait another four weeks, there’s plenty of time to research the situation.

Sharing what I learned may reduce the stress of women headed for biopsies because they, like me, have suspicious-looking microcalcifications. It calmed me somewhat beforehand to know that whatever the biopsy finding (it was benign), microcalcifications are not going to kill me.

The number of biopsies has increased with more accurate mammography, which is especially good at detecting microcalcifications. Unfortunately, radiologists can’t always tell benign from cancerous microcalcifications by looking at images, so they order biopsies. About half of the million breast biopsies performed in the United States each year are for microcalcifications, and about 80 percent of these are benign. 

Even if microcalcifications are cancerous, they are not life threatening. They likely indicate ductal carcinoma in situ, a stage 0 cancer in the breast’s milk ducts. An estimated 50 to 80 percent of DCIS cases will never leave there. Unfortunately (again), doctors can’t tell which DCIS will and which won’t progress, so most cases are treated with surgical removal and, often, radiation and hormone treatment. That means at least half the women with DCIS are treated for a condition that would never harm them. 

As you might expect, researchers are looking for how to reduce the number of biopsies and the unnecessary treatment of stage 0 breast cancer. “[W]e’re treating all patients as if they have a life-threatening illness . . . and not giving them the full range of options,” said Duke University professor Shelley Hwang, principal investigator of the COMET (Comparing an Operation to Monitoring, with or without Endocrine Therapy) study.

A small minority of women diagnosed with DCIS are already choosing watchful waiting, with mammograms every six months instead of immediate treatment. That isn’t foolish. If DCIS were to progress to stage 1 cancer, the survival rate is still more than 99 percent.

For older women, the breast cancer picture is further complicated by different recommendations about when to stop having mammograms. It is known that many breast cancers in older women are slow growing, but screening and treatment advice is limited because this population has been underrepresented in research. Two medical societies make no recommendation for mammograms after age 74 “due to insufficient evidence” about benefits and harms, and three more say that the decision to continue mammograms should depend on health status and life expectancy. 

In the past, breast cancer screening was standardized as if every woman had the same risk for the same type of breast cancer. Medical science now knows that breast cancer varies tremendously. By looking to tailor screening and treatment to each woman’s risk and age, doctors hope to reduce the harms from overcare, not the least of which is patient anxiety. 

Judging from how relieved I felt to hear “benign,” I had been anxious, despite loading myself with information. Cancer is scary, even if it’s stage 0, and treatment isn’t a cakewalk. As the medical community works on research breakthroughs, it might also work on reducing waiting time. A screening process of nearly two months is too long. 

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