What to expect if you are called back after a mammogram

Being called back for further testing after a routine screening mammogram can seem alarming. While it’s very important to follow up and have the recommended tests, being called back after a mammogram doesn’t necessarily mean there is anything wrong.

“In most cases it means the radiologist wants to take a closer look at something so they can determine if it’s something to be concerned about or not,” says Helen Mark, a registered nurse at the Henrietta Banting Breast Centre at Women’s College Hospital.

This is especially true if it’s your first mammogram. When reading your first mammogram, the radiologist has no previous images for comparison. That means she can’t tell if something on the image is new, or has changed. Calcifications are a good example.

Calcifications are tiny specks of calcium that are sometimes benign, but are sometimes thrown off by tumours. Calcifications that are new, that have increased in number, or that are clustered together would warrant a call back for a closer look.

“But if it’s a woman’s first screening and we see calcifications, that person would be called back because we don’t know if the calcifications were there before,” Mark explains.

Other reasons for following up on a mammogram include lesions or masses that warrant a closer look, or areas that appear denser than the rest of the breast.

“As women age, the breast tissue gets displaced with fat, but it doesn’t always happen at the exact same rate in both breasts,” Mark explains. “So one breast may look a little denser than the other breast. They would want to call them back in to make sure that there are no problems.”

What to expect

A call back to follow up on mammogram results usually means additional imaging.

“Usually what they want to do is to take a magnified view: a closer look at an area using a mammogram and possibly adding in an ultrasound,” Mark says. “An ultrasound will tell us additional information, like if that area is solid or if there’s fluid in it. If it’s fluid, then it’s often a cyst, which is nothing to worry about.”

If those images don’t provide enough information, a biopsy might be requested. A biopsy is done by inserting a needle into the area and drawing out a sample to be tested. Ultrasound imaging – or in some cases mammography – is used to guide the needle to the correct spot in the breast. Another appointment may need to be booked in order to do the biopsy.

Results from followup breast screenings must be available within three weeks under Ontario Breast Screening Program guidelines. Mark notes that patients at Women’s College Hospital often get their results on the spot.

“Women’s College is unique in that our radiologists are very hands-on,” she says. “The radiologist will often come out after the images have been read and discuss it with the patient. So many of our patients go home knowing what the result is, and if they have to be called back. That’s very, very reassuring.”

Why not use MRI?

Magnetic resonance imaging, or MRI, is sometimes used for diagnostic breast imaging, but it isn’t used for screening except in high-risk women, such as those with BRCA1 or BRCA2 mutations. It is used for high-risk women because they often begin screening at a much younger age. Because breast tissue is displaced by fat as women get older, young women’s breasts are often much denser than older women’s.

“Our high-risk group starts imaging at age 30, and their breasts are so dense that mammogram isn’t very effective. That’s why we added MRI for that group,” Mark says.

Because of the level of detail on an MRI, call backs are very common after an initial breast MRI in the high-risk group.

“That’s something that I caution our high-risk group about when they come in for their first MRI,” Mark says. “Without a previous MRI to compare to, I tell them to expect a call back. It’s so common for the radiologist to want to look at some areas more closely before saying that everything is ok.”

Ask questions

It’s understandable that women may be concerned and have questions when they are called back after a mammogram. Mark encourages women to ask for information at every step of the process, starting with arranging the callback appointment. However, the staff member at the clinic who makes the followup appointment may not know the reason for the call back.

“It may be a clinic secretary who just got a message to book a followup appointment with this patient. That might be frustrating for the woman to just get the call and not understand what it’s for,” Mark says. “I would encourage her to call her family doctor, or call the clinic to speak with someone else if she wants more information about the call back.”

Don’t hesitate to ask questions during the appointment, either.

“I would encourage women to speak with the radiologist or speak with their technician and try to get as much information as possible,” Mark says.