Over the past two years, the Centers for Disease Control and Prevention (CDC) report that nearly 67 percent of American women have had a mammogram. Of those women, roughly 10 percent were called back for additional imaging testing.
“I always explain to patients that a mammogram is a 2-D image of a 3-D structure,” says Dr. Patricia Poole, a radiologist with Sharp Memorial Hospital. “So, essentially, it is a limited screening study. A small percentage of patients will have to be brought back for additional evaluation to make sure that any area of concern noted in the initial mammogram is normal tissue and not a true abnormality.”
Dr. Poole says that it is most common that a woman is asked to return for further testing due to an area of concern that is either new on the mammogram — when compared to prior mammograms — or because tissue on the inside and outside of the breast overlap during testing and masquerade as a mass on the mammogram images.
While mammographers often educate women that they may need to return for a second screening, Sharon Stromme, an imaging manager with Sharp Memorial, knows that patients can feel very unsure when they are called back.
“Of course there is an increased anxiety as women contemplate the possible results,” says Stromme. “Even the very reassuring statistics about recall mammograms have a hard time supplanting our natural tendency to think of the negative outcomes versus the positive.”
According to Dr. Poole, patients will have an additional mammogram or ultrasound during their call-back appointment. The additional mammogram images offer different views than the initial screening exam.
Mammographers try to press the tissue out more to better see small lesions or roll the breast so overlying tissue displaces. The ultrasound is done to better characterize any true mass seen on the mammogram.
At the time of the call-back appointment, patients will learn the results of the follow-up screening.
Possible results include:
- The patient is found to have no abnormality — it was just normal tissue or a benign finding, such as a cyst, and the patient returns to annual screening mammograms.
- There is an abnormality that is likely benign, such as a complicated cyst or characteristically benign solid mass, and the patient is recommended to follow up in six months.
- If there is an abnormality that is suspicious, biopsy is recommended or the patient is sent for a breast MRI.
According to Stromme, the majority of patients who return for a secondary mammogram find that the additional testing helps radiologists better determine that their breast tissue is normal.
“Call-backs happen in roughly 10 percent of screening mammograms, but most are not found to be cancer,” says Stromme. “The images ensure that our radiologist has all the necessary information to make an accurate diagnosis. Patients have an opportunity to discuss the results with our doctor and ask questions before leaving, so that their anxieties are reduced and they leave feeling reassured.”