A mammogram is an x-ray picture of the breast. It is used to check for breast cancer in women who have no signs or symptoms of the disease. Mammograms can find breast cancer that is too small for you or your doctor to feel. Finding breast cancer early using mammography can improve treatment options and save lives.
Sometimes, after the mammogram is done, you may be asked to return for a follow-up mammogram or an ultrasound. Being called back for more testing can be stressful, but it does not mean you have breast cancer. Here are some common reasons why you may be recalled after a routine screening mammogram and what it typically means.
Additional Views are Needed
One of the most common reasons for being called back after a mammogram is that the radiologist wants additional views of the breast tissue. During the initial mammogram, two views are taken of each breast – one from the top and one from the side. If the radiologist sees an area of tissue that is unclear or questionable, they may want to take additional views of that specific spot from other angles.
This allows the radiologist to further evaluate that area of tissue and ensure there are no signs of cancer. The radiologist may request spot compression views, which compress and flatten the breast tissue to get a clearer image. Or they may request magnification views to zoom in on an area. In most cases, these additional mammogram views show that the area of question is normal breast tissue.
Reasons for needing additional views:
- Overlap of breast tissue on the images
- An area of asymmetry between breasts
- Small calcifications clustered together
- Distorted breast architecture
Being called back for these extra views can be alarming, but it does not mean cancer was found. This is just part of the thorough evaluation to be certain the mammogram is as clear and detailed as possible.
Ultrasound
Another common reason for being recalled after a mammogram is to get an ultrasound. An ultrasound uses soundwaves to create images of the breast tissue. It can sometimes provide a better look at changes or abnormalities seen on the mammogram.
Reasons you may need an ultrasound after a mammogram include:
- Cysts – Fluid-filled sacs are common in breasts and look suspicious on mammograms. An ultrasound can confirm if they are simple cysts.
- Solid mass – An ultrasound helps differentiate between a benign mass like a fibroid versus a concerning cancerous mass.
- Calcifications – Calcium deposits can be signs of cancer. An ultrasound checks the surrounding tissue.
Ultrasound is also sometimes used to guide a needle biopsy if one is needed to sample abnormal tissue. Being called back for an ultrasound after your mammogram may be frightening, but try to stay calm. In most cases, the ultrasound will show normal breast changes rather than cancer.
Need for Additional Imaging
If screening mammography detects an abnormality, but it is still unclear after additional mammogram views and ultrasound, your doctor may recommend further diagnostic imaging. This may include:
- Diagnostic mammography – This uses specialized mammography views to further examine abnormalities.
- Breast MRI – A breast MRI can help characterize abnormal findings seen on mammography and ultrasound.
- Breast tomosynthesis – This technique takes multiple images of the breast at different angles to reconstruct detailed 3D images.
These additional tests are meant to get a more complete picture of any abnormalities found on screening mammography and determine if they are cancerous or benign. The uncertainty of being called back for more testing can make a patient understandably anxious. But additional imaging allows doctors to thoroughly assess any areas of concern.
Need for Biopsy
If screening mammography detects an area of suspicion that remains questionable even after additional imaging, your doctor may recommend a breast biopsy. This involves removing a small sample of breast tissue or fluid to be examined under a microscope by a pathologist.
Types of breast biopsies include:
- Fine needle aspiration – A thin needle removes fluid or cells from a breast lump.
- Core needle biopsy – A hollow needle removes several small cores of tissue.
- Surgical biopsy – An incision is made to remove part or all of a suspicious breast growth.
Being called back for a breast biopsy can understandably make patients feel very anxious. However, most biopsied breast abnormalities turn out to be benign rather than cancerous. If cancer is found, having it diagnosed at an early stage improves the chances of successful treatment.
Your Breast Density
Breast density refers to the amount of glandular and connective breast tissue compared to fatty tissue. Women with dense breasts have more glandular and connective tissue and less fat. Unfortunately, dense breast tissue can make abnormalities harder to detect on mammography.
Breasts are classified into 4 density categories:
- Almost entirely fatty
- Scattered fibroglandular densities
- Heterogeneously dense
- Extremely dense
Women with heterogeneously or extremely dense breasts have a higher risk of being recalled for additional testing because of difficult to interpret mammogram findings. If you are recalled and have dense breasts, it does not mean you have breast cancer. It simply means the radiologist wants to err on the side of caution and ensure nothing is missed.
Some options for women with dense breasts include:
- Have ultrasound screening along with your mammogram
- Have breast MRI screening along with mammograms
- Discuss the benefits and risks of additional screening with your doctor
Your Previous Mammogram Results
If previous mammogram results or breast exams showed areas of suspicion, those areas will be carefully re-evaluated in follow-up. This may lead to being called back for additional imaging tests or procedures even if your most recent mammogram looks clear.
For example, if a breast lump was found on your last exam 6 months ago, the radiologist will look closely to ensure the lump has not changed or grown before giving you the all clear. Or if your last mammogram showed small calcifications, those same spots will be checked again to make sure they appear stable. When prior exams showed abnormalities, it warrants a closer inspection.
You Have Breast Cancer Symptoms
While mammograms are used to screen women with no overt breast cancer symptoms, they can also be used as a diagnostic tool in women who do have concerning symptoms. Symptoms like:
- A new breast lump
- Thickening or swelling of part of the breast
- Irritation or dimpling of breast skin
- Redness or flaky skin in the nipple area
- Pulling in of the nipple
- Nipple discharge other than breast milk
- Pain in the breast or nipple
If you have any new or unusual breast changes, your doctor may order a diagnostic mammogram to thoroughly evaluate the area of concern. It is quite common to need additional mammogram views, ultrasound, or even biopsy when dealing with abnormal symptoms that could potentially indicate breast cancer. Being called back for more tests does not confirm breast cancer, but it does allow for appropriate diagnosis and treatment if cancer is found.
Your Personal Risk Factors
Certain personal risk factors may increase the chances of being recalled after a mammogram for further testing:
- Previous breast cancer or family history – Patients with a personal or family history of breast cancer are at higher lifetime risk of the disease. Radiologists will examine their mammograms very closely.
- Previous breast biopsy – Women who have had a prior breast biopsy have an increased risk of a future cancer. The biopsy site will be carefully examined on follow-up mammograms.
- BRCA gene mutations – These genetic mutations drastically increase breast cancer risk. Radiologists will be extra diligent when reading mammograms in these patients.
- Radiation treatment history – Prior chest radiation increases breast cancer risk. Treated areas will require enhanced scrutiny on mammography.
If you have any of these risk factors, you are more likely to be called back for additional evaluation of suspicious findings. While this is anxiety-provoking, it allows for early detection of any cancers that develop.
You’re on Hormone Therapy
Postmenopausal women on hormone replacement therapy or birth control pills that contain estrogen have increased breast density. This can make abnormalities harder to detect on mammograms and lead to more recalls. The same is true for women undergoing fertility treatment with hormones. The hormonal effects on breast tissue lead radiologists to be extra cautious when interpreting mammogram results in these patients.
You’re Pregnant or Breastfeeding
Pregnancy and lactation cause changes in breast tissue that can affect mammogram images. If you are recalled with normal follow-up test results, you may need to get reimaged 6 months after breastfeeding ends when the breasts return to a non-lactating state. The initial mammogram still serves as an important baseline for comparison to post-weaning images.
You’re Perimenopausal or Menopausal
Women in perimenopause have fluctuating hormones as they approach menopause. Postmenopausal women have declining estrogen levels. These hormonal changes can prompt development of benign lumps or cysts that may be visible on mammograms and require additional evaluation. They can also increase breast density and tissue irregularities that warrant a closer look.
You Had Breast Surgery
Any type of breast surgery, including breast augmentation or reduction, can distort normal breast anatomy and tissue patterns. Post-surgical scarring and other changes can show up as questionable findings on mammograms. If you had prior breast surgery, be aware that you may be more likely to need extra imaging tests or biopsies when abnormalities are seen.
You Have Breast Implants
Breast implants can interfere with mammogram imaging and breast cancer detection. Implants may hide suspicious tissue by compressing, displacing, or obscuring breast tissue. Special displaced implant views are often needed along with ultrasound, MRI, or surgical biopsy to fully evaluate the breasts in women with implants. More recalls in this group are simply part of the screening process to be as thorough as possible.
What Should You Do If You’re Recalled?
Being called back for more testing after you thought your mammogram was clear can be an extremely stressful experience. Understandably, your mind may jump to frightening conclusions. While the majority of recalled patients will have normal follow-up results, some key steps can help you through this difficult period of uncertainty:
- Try to stay calm. Additional testing does not mean you definitively have cancer.
- Speak to your doctor about what additional tests you need and why they are recommended.
- Schedule any needed appointments promptly to get quicker answers.
- Call your doctor if you have any urgent concerns while awaiting results.
- Avoid searching mammogram recalls online as this may increase anxiety.
- Confide in a loved one about your concerns so you don’t feel alone.
- Focus your mind on day-to-day activities and things you enjoy.
- Be understanding if you feel more worried or short-tempered until this passes.
While the period between your recall and final results can feel agonizingly long, additional testing is meant to provide maximum reassurance rather than reasons to worry. In most cases, the final outcome is normal breast tissue rather than breast cancer. However, if cancer is found, you have the best opportunity for successful treatment at an early stage.
Conclusion
Being called back for further testing after your mammogram can be a very stressful experience. However, it is fairly common. Up to 10% of women screened annually get an initial mammogram recall. There are many valid reasons for being recalled that do not necessarily indicate breast cancer.
Try to stay positive while you await answers, knowing the recall system is designed to be overly cautious. This ensures any abnormalities get fully evaluated. While waiting is difficult, most recalled women are found to have normal exam results. If breast cancer is detected, the early diagnosis makes treatment more effective. Being well-informed about all the possible reasons for recall can help you manage anxiety.