The American Cancer Society recommends that women at an average risk for breast cancer have annual screening mammograms between ages 45 and 54. A screening mammogram is done when you don’t have any pain or new symptoms, but you’d like to catch possible breast changes early on. Screening mammograms usually include two X-ray images of each breast, which a radiologist will study carefully for areas of concern.
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After screening mammograms, 10 percent of women are asked to come back for more testing. Getting called back can be frightening, but less than five out of every 1,000 women who have a screening mammogram are diagnosed with cancer.
“Often we’ll look at a spot and say, ‘It’s probably nothing, but we need to prove that it’s nothing,’ so we bring the patient back—the majority of women don’t need to panic,” says Dr. Angela Watt, MD.
At that point, you’ll undergo a second, or diagnostic mammogram, which involves additional images that focus in on specific areas. Many facilities will get in touch with you to schedule a follow-up appointment right away—Dr. Watt recommends using a Breast Imaging Center of Excellence that’s certified by the American College of Radiology because they’ll call you back promptly. These facilities also have specialized breast and women’s radiologists who look at mammograms practically all day, every day—that can make a big difference, she adds.
Even with the quick response time at many breast centers, having to wait for your results can cause a lot of anxiety. Knowing why mammograms can come back positive might help ease your mind.
Reasons for follow-ups after a mammogram
There are a number of explanations for why your radiologist would want more images. If you’re a first-time patient with them and he or she doesn’t have a copy of your records, they may need more information. Without past images to compare against, they won’t know if concerning spots are new, growing or if you’ve always had them. You should try going to the same breast center every time, but if you have to visit a new location, bring a copy of your previous scans with you.
A mammogram could also come back positive because of:
- The buildup of calcium deposits, or calcifications, could be a sign of cancer, but often they’re benign.
- A mass. A mass might be cancerous, but it could also be a benign tumor or a cyst, which is a harmless, fluid-filled pocket.
- Dense breast tissue. Dense tissue can make it harder for radiologists to see breast structures, including tumors.
- Hormone changes. Menopause and hormone replacement therapy (HRT) can cause your breasts to look different from year-to-year. Your breasts may also become denser after HRT.
- Breast implants. Implants can block the view of your actual tissue and make it difficult to position your breasts correctly during a mammogram.
You may also get called back if a long period of time has passed since your last mammogram. Aging, weight changes and menopause all can make your breasts look different over time, but if it’s been years since your last screening, the differences from prior scans may seem drastic or concerning. Letting a long time pass between mammograms also can cause cancer to go undetected during its early stages, says Dr. Watt.
Other tests you might need
In addition to your diagnostic mammogram, your doctor may recommend:
- An ultrasound. During an ultrasound, a technician will apply gel to your breast and then run a tool over your skin, which uses sound waves to create images of breast structures.
- Magnetic resonance imaging (MRI). For an MRI, you’ll lie down inside a large tube that uses powerful magnets to produce detailed pictures of your breasts.
Not every woman will have to go for these tests, says Dr. Watt. It depends on your individual case and the information that your radiologist needs to make a confident diagnosis.
Don’t let a biopsy alarm you
A biopsy involves taking a sample of your breast tissue, which is then placed under a microscope to look for cancer cells. Just because your radiologist recommends a biopsy, doesn’t mean you have cancer-- at least 60 percent of biopsies come back negative, explains Dr. Watt.
How to stay calm while you wait for results
Even if you know that most women who get called back aren’t diagnosed with cancer, waiting for results can be incredibly stressful. These steps might help you pass the time with less worry:
- Make a list of questions for your radiologist. Putting your fears down on paper can help get them off your mind. Writing out your questions will also help you remember them during your appointment.
- Call the American Cancer Society’s hotline at (800) 227-2345. Operators are available 24 hours a day to offer support.
Finally, try to bring a family member or friend with you to appointments. They can distract you while you wait and it’s always helpful to have a second set of ears when your doctor explains your diagnosis.