Breast microcalcifications as indicators of bone metastasis risk in early-stage breast cancer

Bone metastasis is a leading cause of reduced survival in patients with advanced breast cancer. Therefore, identifying prognostic markers for bone metastasis at early disease stages is crucial. Microcalcifications are common findings in mammographic imaging and often serve as early diagnostic indicators. Certain types of microcalcifications have been linked to unfavorable genetic and molecular tumor profiles and are associated with poor prognosis. In particular, calcifications located within large ducts-such as casting-type, duct-centric patterns-have been described as independent markers of adverse outcome when compared to tumors with other calcification types or without calcifications. This study evaluated the prognostic significance of anarchic microcalcifications, defined as calcifications with irregular borders and/or disorganized patterns, in patients with early-stage breast cancer. Hematoxylin and eosin staining was used to assess the presence of these microcalcifications in invasive ductal carcinoma samples (n = 350). Their association with clinical and pathological characteristics was analyzed, including local relapse and bone metastasis occurrence. The presence of tumor microcalcifications was significantly associated with an increased risk of local relapse (p = 0.0360) and bone metastasis (p = 0.0020). Moreover, patients with microcalcifications exhibited shorter local relapse-free survival and bone metastasis-free survival (p = 0.0080 and p = 0.0020, respectively). Importantly, multivariate analysis confirmed that microcalcifications were an independent prognostic factor for both outcomes (p = 0.0150 and p = 0.0020, respectively). These findings suggest that the presence of tumor microcalcifications may serve as an independent prognostic marker for bone metastasis in early-stage breast cancer. Incorporating the evaluation of microcalcifications into routine pathological assessments could improve prognostic precision and support personalized treatment strategies. Further research is needed to elucidate the molecular mechanisms underlying the association between tumor microcalcifications and breast cancer progression.