Breast Microcalcification in Women Under 40 Years of Age

This study examines the results of vacuum-assisted biopsy (VAB) for suspicious microcalcification as the only significant mammographic finding, with particular reference to women under age 40 years.

The study cohort comprised symptomatic or asymptomatic women who had full-field digital mammography at the Wesley Breast Clinic over a 9-year period (2013- 2021). Suspicious microcalcification was subjected to vacuum-assisted biopsy (VAB). The histological results were classified as: (a) invasive cancer, (b) ductal carcinoma-in situ (DCIS), (c) atypia, (d) papillary lesions or (e) benign tissue.

Of the 139,911 women examined by mammography, 5967 were under 40 and had mammography because of symptoms or significant risk factors for breast cancer. Overall, 1748 (1.2% of mammograms) revealed a suspicious cluster of microcalcification as the only abnormality. 68 of these were in women under 40 (1.1% of mammograms in these women). A positive result for malignancy, (DCIS or invasive cancer) was obtained in 20.8% of VABs overall, including 16.1% of women under 40 (2 invasive, 9 DCIS). Women under 50 had about half the risk of a malignant result on VAB compared with women aged 50 and over. B3 lesions (of uncertain malignant potential) were uncommon in women under 40.

The small number of women under 40 who had suspicious microcalcification requiring VAB, and of cancers thus found, suggests that, unless significant risk factors are present, it is difficult to justify mammography in women prior to age 35 with the sole aim of detecting microcalcification which could be, for example, DCIS.