Being called back after a mammogram can be stressful, but an abnormal mammogram does not mean that you have breast cancer. Many patients are asked to return simply because the radiologist needs additional images to look more closely at a particular area.
The next step depends on what was seen on your mammogram. You may be asked to have additional mammogram images, a breast ultrasound, or occasionally another type of breast imaging.
If additional imaging is recommended, the breast imaging center will typically contact you to schedule the appropriate follow-up study. The radiologist determines which additional images are needed based on your mammogram findings.
Depending on the finding, this may include:
Diagnostic mammogram – Additional or more focused mammogram images allow the radiologist to look more closely at a particular area.
Breast ultrasound – Ultrasound uses sound waves rather than radiation and can help determine whether an area is solid or fluid-filled and provide additional information about a finding seen on mammography.
Breast MRI – MRI provides very detailed images of breast tissue and may be recommended in certain situations, although it is not needed for most mammogram callbacks.
The word “diagnostic” can sound frightening, but it simply means that the imaging is being performed to evaluate a specific finding rather than as routine screening.
Sometimes imaging shows an area that cannot be confidently identified as benign based on the pictures alone. In that situation, a breast biopsy may be recommended to collect a small sample of tissue so it can be examined under a microscope. Being referred for a biopsy does not mean that you have breast cancer. Many breast biopsies ultimately show benign (noncancerous) findings.
Most biopsies performed after an abnormal mammogram are core needle biopsies. The area is numbed with local anesthetic, and the radiologist uses imaging to guide the biopsy needle precisely to the area of concern. Several small samples of tissue are then collected and sent to a pathologist for evaluation.
The type of imaging used to guide the biopsy depends on where the finding is best seen. Your biopsy may be:
Ultrasound-guided – The radiologist uses ultrasound to locate the area during the biopsy.
Stereotactic or mammogram-guided – Mammogram images are used to precisely locate the area. This is commonly used for findings such as calcifications.
MRI-guided – MRI is used when the area of concern is best seen on breast MRI.
A tiny marker clip is often placed at the biopsy site so the area can be easily identified on future breast imaging. The clip is very small and generally stays in place permanently.
You may feel pressure during the procedure, but the local anesthetic should prevent sharp pain. Some bruising, tenderness, or swelling afterward is common. The breast imaging team will give you instructions about caring for the biopsy site and when you can return to your usual activities.
The tissue samples are sent to a pathologist, and results usually take several days. Waiting for pathology can understandably be stressful. Your healthcare team will contact you when the results are available and help explain what they mean and whether any additional care is needed.
Waiting for additional imaging, a biopsy, or pathology results can be one of the hardest parts of this process. It is very normal to feel anxious while you're waiting.
Try to remember that most abnormal mammograms and mammogram callbacks do not ultimately result in a breast cancer diagnosis. Additional testing is how the breast imaging team carefully determines which findings are benign and which need further evaluation.
If you're having a particularly hard time with anxiety or worry while you're waiting, please reach out to our office.You don't have to navigate this part of the process alone. We're available to answer questions, help you understand what to expect, and talk about ways we can support you while you wait.
If a biopsy does show breast cancer, remember that there are many effective treatments for breast cancer, and outcomes are excellent for many patients, particularly when breast cancer is detected early.
Your breast care team will help guide you through the next steps. You will typically be connected with a breast cancer nurse navigator, who can help explain your results, coordinate appointments, and answer questions as you move through the process. You will also be referred to a breast surgeon, who will review your imaging and pathology in detail and discuss your treatment options and whether additional testing is needed.
There can be a lot of information to absorb at that first appointment. I often encourage patients to bring a family member, friend, or other support person who can listen, take notes, and help remember questions you want to ask.
A breast cancer diagnosis can feel overwhelming, especially in the first few days when there are still many unanswered questions. You do not have to understand everything at once. Your care team will help you take the process one step at a time.