What Happens After an Abnormal Mammogram?

GREAT BAY--Getting a call that something unusual appeared on a mammogram can be frightening. For many women, the word “abnormal” immediately raises one question: Do I have breast cancer?

An abnormal mammogram, however, does not automatically mean cancer has been found. It means the images showed something that needs a closer look.

As part of The Peoples’ Tribune Breast Cancer Awareness Series, understanding what happens next can help women approach follow-up testing with information rather than fear.

A screening mammogram is designed to look for changes in the breast before symptoms develop. Sometimes the images reveal an area that appears different from surrounding breast tissue. Other times, the radiologist may simply need clearer images because breast tissue overlapped or a particular area was difficult to evaluate.

Women may also be called back because of calcifications, a mass, an area of asymmetry or another finding that requires further examination. Many of these findings ultimately prove to be benign.

The Diagnostic Mammogram

One of the first steps after an abnormal screening mammogram may be a diagnostic mammogram.

Unlike routine screening, where standard images of each breast are taken, a diagnostic mammogram focuses more closely on the area that raised concern. Additional views may be taken from different angles, or the area may be magnified to give the radiologist a clearer picture.

Sometimes these additional images are enough to show that the finding is normal breast tissue or something that does not appear suspicious.

In other cases, more testing may be recommended.

Ultrasound May Be the Next Step

A breast ultrasound uses sound waves to create images of structures inside the breast. It does not use radiation.

Ultrasound can help doctors determine whether an area seen on a mammogram is solid or filled with fluid. For example, some breast lumps are cysts, which are fluid-filled sacs that are usually not cancer.

Ultrasound can also provide additional information about a solid mass and help doctors decide whether it needs to be monitored or investigated further.

When a Biopsy Is Recommended

If imaging shows an area that remains suspicious, a doctor may recommend a breast biopsy.

A biopsy involves removing a small sample of tissue so that it can be examined under a microscope. This is the step that can determine whether cancer cells are present.

One of the most common methods is a core needle biopsy, in which a needle is used to remove small pieces of tissue from the area of concern. Imaging such as ultrasound or mammography may be used to guide the needle to the correct location.

Needing a biopsy still does not mean that a woman has breast cancer. It means imaging alone cannot provide a definite answer.

The tissue sample is sent to a laboratory, where a pathologist examines it. Results can show that the tissue is benign, identify another breast condition or confirm the presence of cancer.

What Does BI-RADS Mean?

Women may also hear their doctor mention a BI-RADS category.

BI-RADS is a system radiologists use to describe mammogram findings and recommend what should happen next. Some categories indicate normal or benign findings. Others may recommend another mammogram after a shorter period of time, additional imaging or a biopsy.

A higher category indicates greater concern, but the final diagnosis still depends on further evaluation when necessary.

Do Not Ignore the Follow-Up

One of the most important steps after an abnormal mammogram is completing the recommended follow-up.

Fear can tempt someone to postpone another appointment. A woman may tell herself that because she feels well, there is no urgency. But breast cancer can exist without pain or other noticeable symptoms.

At the same time, women should remember that being called back is not a diagnosis.

Further imaging may show that there is nothing concerning. A cyst may be found. An area may simply need to be monitored. A biopsy may come back benign.

If cancer is found, completing the follow-up allows doctors to determine what is happening and begin discussing treatment.

For this installment of The Peoples’ Tribune Breast Cancer Awareness Series, the message is simple: an abnormal mammogram is a reason to investigate, not a reason to assume the worst.

Ask questions. Attend the follow-up appointment. Complete the recommended tests. Understand what your doctor has found and what needs to happen next.

The purpose of screening is not only to find abnormalities. It is to make sure those abnormalities are properly investigated, so that women can get answers and, when necessary, treatment as early as possible.

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