DEAR DR. DONOHUE: In the past six months, I have had three mammograms. The findings are always the same – microcalcifications in the upper outer quadrant of the left breast.

No one has told me what microcalcifications in the breast are. I had a biopsy years ago, and it was revealed that the calcifications were benign. I have occasional sharp pains in that breast. I would appreciate your help. – J.C.

ANSWER: Microcalcifications are tiny specks of calcium. Calcifications don’t always sound the cancer alarm. The body patches up many things by plastering calcium over them. Past breast trauma – a bump that didn’t even register on your consciousness – might have led to calcifications in your breast. Calcium in minute breast blood vessels is another possibility. Benign breast growths can become calcified.

On the other hand, microcalcifications can be a warning sign of cancer. The doctors who interpret mammograms evaluate such calcium specks by their size, the pattern of their arrangement, their shape and their location in order to distinguish harmless calcifications from the harmful ones. Sometimes the call is difficult and no clearly positive statement can be made. In order not to make a tragic mistake, follow-up evaluations are needed to spot any changes. If doubt still exists, a biopsy might be able to resolve the question.

Did you have a mammogram at the time your biopsy was taken in the past? If you did, that mammogram would be most informative in interpreting your current mammograms.

Stick with the program. It’s better to err on the side of caution than to miss a serious condition.

Breast pain is not a common indication of cancer. I don’t know what your occasional sharp pain is, but it’s not likely to be a cancer sign.

The booklet on breast cancer goes into the diagnosis and treatment of this common cancer. Readers can obtain a copy by writing: Dr. Donohue – No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I get a pain at the bottom of my rear end that lasts from 30 minutes to an hour. It happens about two or three times a month. It can come on in the middle of the night or in the day. I have been examined by two doctors without a diagnosis. This has been going on for 15 years. I am 58 and in good physical condition. What do you suggest? – C.G.

ANSWER: Proctalgia fugax (prock-TALE-juh FEW-jacks) is sudden, severe anal pain that lasts for only a short while – 15 minutes or less. Its cause and treatment are unclear. Firm upward pressure on the painful site can sometimes stop it. Sitting in a tub of warm water is another remedy. Nitroglycerin, the same under-the-tongue medicine used for angina, has put an end to it for some.

Levator ani syndrome is another possibility. The levator ani is a muscle that forms a sling to support the rectum and anus. Spasms of that muscle provoke recurring anal-rectal pain that lasts longer than proctalgia fugax. The upper-hand pressure can work for levator ani syndrome too. So can muscle relaxants. Flexeril is an example.

Something that has been going on for 15 years without change is unlikely to constitute a serious health threat.

DEAR DR. DONOHUE: Will you explain arthroscopic knee surgery? Much pain? How long is one laid up? – K.M.

ANSWER: An arthroscope is a pencil-thick scope through which the surgeon gets a good view of the knee joint. It’s inserted through a small incision. Two other small incisions are made – one for instruments and another for an irrigation device. The doctor can perform corrective surgery without making a large cut into the knee. Pain is much less than the pain of traditional surgery. A person can return to work in a week or less and is doing everything he or she ever did within six weeks of the procedure.

DEAR DR. DONOHUE: My grandson, a fireman, was injured while working. He was on a 10-foot wall. Somehow, a hose was wrapped around his feet. The hose was pulled, and he fell off the wall onto his back. He continues to have back pain, and therapy isn’t helping. A doctor now says he has ankylosing spondylitis. The concurrence of an injury with this new diagnosis is puzzling. He is only 25 and has three young ones. Please address this in your column. — D.S.

ANSWER: The concurrence puzzles me too. Let me describe ankylosing (ANG-kuh-LOW-sing) spondylitis (SPAWN-duh-LIE-tiss), and you and your grandson can judge whether it applies to him.

“Anklyosing” indicates a fusing of bones, as though someone welded them together so that they have little movement. Spondylitis is an inflammation of the vertebrae, the backbones. So this is a special kind of arthritis that affects primarily the back, is more prevalent in men and usually begins in the 20s.

Criteria for a diagnosis include back pain lasting for more than three months, along with early-morning back stiffness that responds to exercise but worsens with rest. An affected person finds it hard to take a deep breath because the chest can’t expand.

The hips might also have some arthritis, and the back pain often spreads to the buttocks. With the passage of time, back stiffness can be so great that the person cannot bend the neck and often walks with a forward tilt to the spine.

Many times, there’s a family history of this arthritis. A blood test that is positive for HLA-B27 reflects this genetic component.

X-rays, when done early in the illness, show inflammation of the joint where the spine joins the pelvic bone. If they do not, a bone scan does so.

Nonsteroidal anti-inflammatory drugs are the usual starting medicines. Physical therapy is essential to maintaining spinal mobility.

It seems to me your grandson’s back problem has to be related to his accident. If I were he, I would consult an orthopedic surgeon. If he already has, I’d get a second opinion.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com