Abstract
Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) are known to develop metastatic soft-tissue calcification, secondary to hyperparathyroidism, in tissues including the breast. Such calcifications in women could pose a problem for interpretation of mammograms, since they are thought to mimic malignant lesions and interfere with differentiation of benign from malignant disease. Investigation of this issue is important to provide high-quality, accurate breast care to women with CKD or ESRD, but little evidence is so far available. In a systematic review of the literature on the types and patterns of breast calcifications, we found only three studies that examined metastatic soft-tissue calcifications of the breast. The studies did, however, confirm that women with CKD or ESRD have a higher frequency of breast calcification than women with normal kidney function. The two older studies reported that these breast calcifications are not associated with malignancy, but the later study reported a raised rate of suspicious breast calcification among women with ESRD receiving hemodialysis, leading to an increased biopsy referral rate. In this Review we discuss the strengths and limitations of the available data and whether mammography is recommended in women with CKD or ESRD.
Key Points
-
Metastatic soft-tissue calcification can occur in the breast tissue of women with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and might interfere with screening mammography
-
Women with CKD or ESRD have a higher frequency of breast calcification than women without these conditions
-
Most breast calcifications detected on screening mammography in women with CKD or ESRD are pathognomonically benign; however, there is a slightly but significantly increased prevalence of potentially malignant calcification patterns that require further work-up
-
Until the clinical consequences of the increased prevalence of suspicious calcifications in women with CKD or ESRD have been established, these women should be referred for screening mammography if eligible
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
US Renal Data System (online 2004) USRDS 2004 Annual Data Report: Atlas of End-stage Renal Disease in the United States [http://www.usrds.org/adr_2004.htm] (accessed 12 February 2008)
Gilbertson DT et al. (2005) Projecting the number of patients with end-stage renal disease in the United States to the year 2015. J Am Soc Nephrol 16: 3736–3741
American Cancer Society (online 2007) American Cancer Society Guidelines for the Early Detection of Cancer. [http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_ guidelines_36.asp] (accessed 8 June 2007)
Walter LC et al. (2006) Targeting screening mammography according to life expectancy among women undergoing dialysis. Arch Intern Med 166: 1203–1208
Chertow GM et al. (1996) Cost-effectiveness of cancer screening in end-stage renal disease. Arch Intern Med 156: 1345–1350
LeBrun C et al. (2000) Life expectancy benefits of cancer screening in the end-stage renal disease population. Am J Kidney Dis 35: 237–243
Maisonneuve P et al. (1999) Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 354: 93–99
Conger JD et al. (1975) Pulmonary calcification in chronic dialysis patients. Clinical and pathologic studies. Ann Intern Med 83: 330–336
Parfitt AM (1969) Soft-tissue calcification in uremia. Arch Intern Med 124: 544–556
Strumia R et al. (1998) Benign nodular calcification and calciphylaxis in a haemodialysed patient. J Eur Acad Dermatol Venereol 11: 69–71
Drüeke TB et al. (2000) Extraskeletal calcification in patients with chronic kidney failure. Adv Nephrol Necker Hosp 30: 333–356
Alfrey AC (2004) The role of abnormal phosphorus metabolism in the progression of chronic kidney disease and metastatic calcification. Kidney Int Suppl 90: S13–S17
Han SY and Witten DM (1977) Diffuse calcification of the breast in chronic renal failure. AJR Am J Roentgenol 129: 341–342
American College of Radiology (2003) Breast imaging reporting and data system (BI-RADS), edn 4. Reston, VA: American College of Radiology
Cooper RA and Berman S (1988) Extensive breast calcification in renal failure. J Thorac Imaging 3: 81–82
Resnikoff LB et al. (1996) Breast imaging case of the day. Metastatic calcification in the breast from secondary hyperparathyroidism induced by chronic renal failure. Radiographics 16: 1512–1513
Sommer G et al. (1987) Breast calcifications in renal hyperparathyroidism. AJR Am J Roentgenol 148: 855–857
Evans AJ et al. (1992) Patterns of breast calcification in patients on renal dialysis. Clin Radiol 45: 343–344
Castellanos M et al. (2006) Increased breast calcifications in women with ESRD on dialysis: implications for breast cancer screening. Am J Kidney Dis 48: 301–306
Millis RR et al. (1976) The detection and significance of calcifications in the breast: a radiological and pathological study. Br J Radiol 49: 12–26
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Castellanos, M., Paramanathan, K., El-Sayegh, S. et al. Breast cancer screening in women with chronic kidney disease: the unrecognized effects of metastatic soft-tissue calcification. Nat Rev Nephrol 4, 337–341 (2008). https://doi.org/10.1038/ncpneph0804
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0804
This article is cited by
-
Rationales Tumorscreening beim Dialysepatienten
Der Nephrologe (2016)
-
Tumoren nach Nierentransplantation
Der Nephrologe (2009)