Being called back from your annual screening mammogram can be stressful. Many questions may race through your mind: Do I have breast cancer? What will happen now? “Why me?” It is normal to wonder if something is wrong.
There are many reasons that you may be called back. Here are some of the major reasons:
- Technical Issues. You may be called back due to technical issues like motion, image quality, or a mole or skin lesion that was not marked. A benign finding of a cyst or lymph node may show up as a mass on a mammogram requiring an ultrasound for further evaluation.
- Perceived Asymmetry or a Mass. This is the most common reason for being called back. This occurs when normal tissue overlaps on a mammogram and may be perceived as a mass. Tomosynthesis, also known as a three dimensional mammogram (To learn more about tomosynthesis, read “Breast Health: Mammography Has Gone 3D”), has greatly decreased the number of call backs, although they still do occur even with 3D. Using tomosynthesis, multiple low dose x-rays are acquired to create a three dimensional image. This has been shown to decrease call-backs and improve the detection rate of cancer.
It is important to understand that the vast majority of call-backs turn out to be normal and require no further work-up. Less than 10 percent require further additional imaging, such as an ultrasound, and the majority of these patients will have benign findings, such as cysts or a lymph node. A small percentage of patients may require a 6-12 month follow-up exam. Less than 5 percent of patients who are called back will go on to biopsy and of these patients only 25-30 percent will have cancer.
If you are called back you may be asked to return for more mammographic images or an ultrasound. If you are concerned, you should feel free to ask about the reason for the call back and what exam may be performed next. Once additional imaging has been performed, you will receive news about the outcome, whether you will need a short interval follow-up exam to ensure stability or possibly require a biopsy. Always feel free to ask plenty of questions.
Understanding the reasons for being called back and what to expect may help you cope with the situation. So, what should you do if you get called back?
- Come in for the additional recommended imaging and don’t procrastinate.
- Ask questions about results and the reason you are being called back; you may wish to speak with the radiologist to find out more.
- Get a clear understanding of the recommended follow-up.
- Remain calm: most call backs are normal or benign.
Elise Hotaling, MD, is a radiologist at the University of Vermont Medical Center. She is also an assistant professor at the Larner College of Medicine at UVM. She is fellowship-trained in women’s imaging and practice breast and body imaging.