For week 10, we are to discuss the possible diagnosis of 59-year-old women who presents to the office for a health maintenance exam.

NSG 550 Response post 10

For week 10, we are to discuss the possible diagnosis of 59-year-old women who presents to the office for a health maintenance exam. During her exam, it is noted that her breasts are nontender and without any masses. However, a mammography revealed a small cluster of calcifications. In this particular case study, I believe the patient either has precancerous cells or has breast cancer.

Screening for breast cancer is an important component to a woman’s health. As the leading cause of death of women between ages 35-49 years of age, screening is responsible for helping to reduce mortality rates (DuBenske et al., 2018). A mammogram, or x-ray of the breast, is often used to help assess for early signs of breast cancer (Centers for Disease Control and Prevention [CDC], 2021). Besides mammograms, biopsy’s, ultrasounds and/or magnetic resonance imaging (MRIs) may be used for further evaluation in patients with suspicious lesions or dense breast tissue. Risk factors for developing breast cancer includes those with a family history, use alcohol, are obese, have an exposure to estrogen and test positive for the BRCA1 or BRCA2 gene (Klevos et al., 2017).

Providers need to ensure accuracy when evaluating a patient with breast calcifications as they are extremely common. As an incidental finding, or as a chief complaint, calcifications do not typically require further action once they are discovered. However, in those with suspicious morphology, a biopsy should be considered. Referrals to a specialist should also be made if there is uncertainty in order to avoid unnecessary interventions, patient anxiety and use of additional resources (Bell & Gossweiler, 2022).  Calcifications can be classified as either micro or macro. Microcalcifications are very small and often emerge in clusters. Generally, they do not cause concern however, they should be monitored for changes. Macrocalcifications, on the other hand, are large and round and are not associated with the development of cancer. Generally speaking, since the majority of calcifications discovered are begin, treatment would be individualized based on findings (Chaudhury et al., 2021). According to Azam et al. (2021), macrocalcifications are small calcium deposits that are found in breast tissue. Caused by numerous factors, microcalcifications can arise from skin calcifications, vascular calcifications, fibroadenomas, papilloma’s, ductal ectasia, hemangiomas, fat necrosis, post-traumatic/surgical changes, cysts or granulomas. Additional causes of benign calcifications include vascular lesions, tuberculosis and parasitic infections. It is noteworthy to mention that several systemic diseases such as diabetes, coronary artery disease and chronic kidney disease may be associated with the development of arterial calcifications (Bell & Gosswiler, 2022). Calcifications can sometimes act as a warning sign. A times, calcifications can be related to an underlying malignant process that may be occurring. “Presence of microcalcifications is associated with both ductal carcinoma in situ and invasive breast cancers” (Azam et al., 2021, para 2). Other differential diagnoses include sclerosis adenosis, lobular neoplasia, atypical ductal hyperplasia, atypical ductal hyperplasia, pleomorphic lobular carcinoma in situ, atypical lobular hyperplasia and papilloma (Bell & Gosswiler, 2022). Diagnostic tools that may be used to help detect the presence of abnormalities include:

  • Automated breast ultrasound: This tool is best used in women with dense breast tissue and for individuals who have a history of breast surgery and/or previous biopsies. “This approach incorporates algorithms that aid in tumor categorization and cell detection more precisely and efficiently” (Chaudhury et al., 2021).
  • Beast-specific gamma imaging (BSGI): Radioactive tracers are administered to patients intravenously which help detect abnormalities (Chaudhury et al., 2021).
  • Scintimammography: This is a type of breast imaging test that can be used in individuals with suspicious findings, have dense breast tissue, post-operative scars or breast implants. This procedure is completed through the use of radioactive substances to help detect cancer cells (Chaudhury et al., 2021).
  • Sonography: This tool uses sound waves to gather data as echoes bounce off body tissue (Chaudhury et al., 2021).
  • Computer-aided detection with MRI (medical resonance imaging): This test can be performed in place of a mammogram. It is extremely helpful in identifying breast lesions due to its high efficiency. Providers can easily assess height, form, strength, and position of possible masses (Chaudhury et al., 2021).
  • Electrical impedance scanning (EIS): Through small electrical currents, this device is helpful in detecting abnormal breast tissue and can be used in conjunction with a mammogram (Chaudhury et al., 2021).
  • Magnetic resonance elastography (MRE): This type of test combines MRI imaging with low-frequency vibrations that show abnormal tissue (Chaudhury et al., 20201).
  • Magnetic resonance imaging (MRI): MRIs are noninvasive procedures that can be used to help better visualize body tissues through magnetic and radio frequency waves (Chaudhury et al., 2021).
  • Computer-aided tactile breast imaging: This procedure reconstructs a 3-D imagine of the breast tissue to assist the provider in analyzing abnormalities (Chaudhury et al., 2021).
  • Diagnostic/radiologic mammography: Typically used after suspicious results are discovered, this procedure can be completed in individuals who have a strong indicator for breast cancer (Chaudhury et al., 2021).
  • Digital mammography: These exams are replacing the traditional mammography x-rays. This technique allows data be obtained, displayed, transmitted and stored as digital data for providers to easily access (Chaudhury et al., 2021).

 

References

Azam, S., Eriksson, M., Sjolander, A., Garielson, M., Hellgren, R., Czene, K., & Hall, P. (2020). Predictors of mammographic macrocalcifications. International Journal of Cancer, 148(5). 1132-1143. doi: 10.1002/ijc.33302

Bell, B., & Gossweiler, M. (2022). Benign breast calcifications. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557567/

Centers for Disease Control and Prevention [CDC]. (2021). What is a mammogram? U.S Department of Health and Services. https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm

Chaudhury, S., Rakhra, M., Sau, K., & Ayana, M. (2021). Breast cancer calicifications: identification using a novel segmentation approach. Computational and Mathematical Methods in Medicine. doi: 10.1155/2021/9905808

DuBenske, L., Schrager, S., Hitchcock, M., Kane, A., Little, T., McDowell, H., & Burnside, E. (2018). Key elements of mammography shared decision-making: A scoping review of the literature. Springer Link, 33. 1805-1814. doi.org/10.1007/s11606-018-4576-6

Klevos, G., Ezuddin, N., Vinyard, A., Ghaddar, T., Gort, T., Almuna, A., Abisch, A….(2017). A breast cancer review: Through the eyes of the doctor, nurse and patient. Journal of Radiology Nursing, 36(3). 158-165. doi.org/10.1016/j.jradnu.2017.07.001

 

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