Abnormal mammogram? It’s probably not a cause for concern.

October 14, 2022

Providence Women's Health Team

[5MIN READ]

A follow-up mammogram can help provide additional information to a radiologist about an abnormality found on a screening mammogram.
Most of the time, findings aren’t cancerous. They may be caused by unclear images, cysts or other issues.
Mammograms have helped save countless lives since becoming widely available in the 1980s.

Most of the time a mammogram is uneventful. Sure, it can be a little uncomfortable but it’s something you’re able to check off your list and not think about until the next year. For some, though, there is the nerve-wracking call to find out you need to come back for another mammogram.

“Being called back just means that the radiologist wants to take a closer look,” explains Paula Hallam, MD, diagnostic radiologist at Swedish. “The good news is that most of the time, the closer look shows nothing to worry about.”

The American College of Radiology (ACR) backs this up. They found that out of 100 mammograms, only 10 women are asked back for additional mammograms or ultrasound. And, out of those 10 women:

Six are reassured their results are normal
Two will be asked to return in 6 months
Two will be recommended to have a needle biopsy

We understand that even if you know those odds, it can still be overwhelming to return for a mammogram. Dr. Hallam answered some commonly asked questions about abnormal mammograms to help ease your mind.

What are some reasons a repeat mammogram is needed?

There are many reasons why you may need additional imaging after a screening mammogram – most of which are not related to cancer. A callback may be due to:

Unclear images. Radiology technicians are specially trained to capture the best image, but like with any technology, issues can arise. You may have to return just to ensure the radiologist has the clearest image possible of your breast tissue.
Dense breast tissue. There are three kinds of breast tissue – fibrous tissue, glandular tissue and fatty tissue. Women with more fibrous and glandular tissue than fatty tissue have dense breasts, which can make it harder to spot abnormalities and puts them at a higher risk of breast cancer.
Calcifications. These tiny calcium deposits within breast tissue can (but not always) signal breast cancer. A closer look will allow your radiologist to make an accurate diagnosis.
Masses. A mass on a breast mammogram can mean many different things. It may be a simple cyst (a fluid-filled cyst with thin walls) or a solid mass. A simple cyst is not cancerous, and most solid masses aren’t cancer either. Your radiologist will want to take a closer look at your breast tissue, typically with an ultrasound. This will provide a clearer picture and help your doctor evaluate the mass.

“Our breast tissue is in a constant state of flux from pregnancy, breastfeeding, hormonal changes, weight changes and simply aging,” reassures Dr. Hallam. “Any abnormality could be caused by these normal changes. It’s important that your radiologist take another look so that you have the best information possible.”

What happens at the follow-up appointment?

Your follow-up appointment is a diagnostic exam. It typically includes special mammogram views that focus on the area of concern. A diagnostic mammogram can take longer than a screening mammogram because the radiologist is capturing additional images and angles.

Sometimes, you may also have an ultrasound during the appointment. This helps the radiologist determine if an abnormality is a cyst or a solid mass.

A diagnostic mammogram can be stressful. The radiologist or provider will be on hand to review your exam results at the end of your appointment. Together, they’ll answer any questions you have and discuss the next steps.

If your results were normal, you’ll be asked to return for routine screening mammograms every year. Sometimes, the radiologist may recommend a short-term follow-up exam in 6 months.

“The chances of finding cancer during a follow-up mammogram are very low,” says Dr. Hallam. “Only a small number of women are recommended for biopsy. Among those women, 70 to 80% of the biopsy results are benign – which means they are not cancer.”

If your biopsy results came back benign, then you may be asked to return for a 6- or 12-month follow-up exam to check the biopsy site.

What if I have cancer?

Learning your biopsy results showed signs of cancer cells is very overwhelming. Our team is here to walk you through the next steps, which typically include meeting with a breast surgeon or oncologist.

“There have been extraordinary advances in diagnosing and treating breast cancer,” Dr. Hallam reassures. “Today, more and more people are living with breast cancer, and even after completing treatment. Your care team will find a treatment plan that’s right for you – your cancer type, your lifestyle and your goals.”

The importance of a mammogram

Oddly enough, finding breast cancer from a mammogram is proof of how far we’ve come in diagnosing and fighting this disease.

The National Institutes of Health (NIH) estimates that once mammograms became widely available in the 1980s, the death rate from breast cancer dropped more than 40%. Before mammograms, the death rate had largely stayed the same for 50 years.

Recently, the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) updated their mammogram screening guidelines. The first step is to have a breast cancer risk assessment by age 30. This assessment is a simple and straightforward conversation with your doctor about your risk factors for developing breast cancer. If you are found to be high risk, your doctor may recommend that you start having regular mammograms before age 40.

For women with an average risk of developing breast cancer, ACR and SBI recommend the following

Screening mammography once a year beginning at age 40
There is no upper limit to stopping annual mammograms in healthy women.

[link to download]

“The most important thing you can do is talk to your doctor about what makes sense for you,” explains Dr. Hallam. “You can discuss the pros and cons of your recommended screening schedule and get clear answers on what and why a certain screening schedule works for you.”

A screening for all

A mammogram isn’t just for cis women. Individuals assigned female at birth (AFAB) may still need a screening mammogram if they haven’t had top surgery or are not taking gender-affirming hormone therapy.

Transgender women should also talk to their doctor about their risk of developing breast cancer, especially if they have been using estrogen long-term or developed breast buds.

Schedule your mammogram

You don’t need a referral to schedule your mammogram if you’re at least 40 years old and haven’t had a mammogram in the past year. Swedish offers seven convenient locations with extended and weekend hours. Our mobile mammography units routinely visit primary care offices, workplaces, and other places in the community to make it easy to get the care you need.

Call 206-215-8100 or schedule your mammogram with MyChart.

Find a doctor

Talk to your doctor if you’re not sure when to start mammogram screenings or if you have any questions about breast cancer screenings. If you need to find a doctor, you can use our provider directory. Through Providence Express Care Virtual, you can also access a full range of health care services.

Download the Providence App

We’re with you, wherever you are. Make Providence’s app your personalized connection to your health. Schedule appointments, conduct virtual visits, message your provider, view your health records, and more. Learn more and download the app.