- An abnormal mammogram doesn’t necessarily mean you have cancer.
- Your mammogram results could come back abnormal because of cysts, dense breast tissue, or microcalcification, among other things.
- Follow-up tests for an abnormal mammogram may include a diagnostic mammogram, ultrasound, or biopsy.
- 3D mammograms have been shown to increase cancer detection rates.
When you hear that your mammogram results are abnormal, it’s normal for panic to set in as your mind immediately jumps to cancer. However, you don’t need to worry.
Not that you should ignore your imaging results. One in eight women, according to statistics, will be diagnosed with breast cancer in their lifetime. But an abnormal finding on a mammogram may simply be due to dense breasts, a harmless cyst, or image distortions.
If you do have an abnormal mammogram result, your clinician will likely want to take a closer look to rule out cancer.
Does an abnormal mammogram mean I have breast cancer?
The short answer is no, not usually. Of all women who receive regular mammograms, about 10 percent will get called back for further testing, and from those, only about 0.5 percent will be found to have cancer.
Most likely, something harmless is causing the mammogram to trigger further investigation, and you’ll be called in for additional screening. It does feel scary, we know, but additional screening may help you learn quickly that nothing is wrong.
However, if your medical provider finds breast cancer, the chances are good that early diagnoses will save your life and prevent you from overly invasive measures.
This is why regular screening mammograms are so important; early detection is the key to avoiding late-stage breast cancer discovery.
What are some non-cancerous causes of an abnormal mammogram?
Many causes of abnormal mammograms are benign and harmless. Your medical team may request a follow-up if they find one of the following::
- Microcalcifications: Microcalcifications are tiny calcium deposits. They are not usually a result of cancer.
- Cysts: Cysts are among the most common causes of a breast lump, and they can develop in either one or both breasts. Often filled with fluid, they grow naturally and are usually associated with age and hormonal changes.
- Benign tumors: Benign tumors are masses of tissue that are not cancerous. Two of the most common types of benign single breast lumps are cysts and fibroadenomas.
- Dense breast tissue areas: A prevalent finding, dense breast tissue is sometimes associated with menopausal hormone therapy (MHT).
What follow-up tests can I expect after an abnormal mammogram?
The type of follow-up exams your healthcare provider will recommend will depend on their initial findings from your screening mammogram.
Your physician may start by ordering one of the following tests:
While the technology of a diagnostic mammogram and a screening mammogram both use low-dose X-rays, there are some differences:
Screening mammograms are pretty quick, typically taking 10-15 minutes to complete. In contrast, diagnostic mammography takes longer because the radiologist will likely take more pictures of your breast and focus on specific areas of interest.
While screening mammograms are typically done by a radiology technician, an interpreting clinician will monitor a diagnostic mammogram.
A diagnostic mammogram may be performed by an X-ray 2D digital mammogram machine (2D) or a 3D mammogram (also called tomosynthesis). 3D mammography is often used in combination with 2D digital mammography and will soon be offered by Ezra.
Tomosynthesis is the newest technology in mammogram machines. When combined with 2D mammography, it can detect breast cancer with nearly 30% higher accuracy.
A breast ultrasound uses high-frequency sound waves to look at the inside of your breasts. It can help distinguish between a benign cyst and a solid mass that may become cancerous.
This ultrasound also allows your healthcare provider to see how well blood is flowing to areas in your breasts.
A breast MRI (magnetic resonance imaging) is a powerful diagnostic tool that uses strong magnets rather than radiation to create detailed, cross-sectional images of your breast. The machine will take pictures of your breast from many angles and make soft tissue images that might otherwise be difficult to see.
Similar to how mammograms are done with X-ray machines specifically designed for imaging the breasts, a breast MRI also uses special equipment — dedicated breast coils. This allows high-resolution and high-quality imaging of one or both breasts.
A biopsy is a minimally intrusive procedure in which a needle takes a small portion of the tissue from the area of your breast that is of concern. A pathologist then examines the tissue to determine if the tissue is cancerous or benign. Breast biopsies usually recommended for follow-up mammogram tests include fine needle biopsy, core needle biopsy, and surgical biopsy.
5 follow-up questions to ask about your abnormal mammogram.
When your mammogram results came back abnormal, you may ask yourself in a panic, “What does that mean?!” When you’re feeling overwhelmed by this, it can be easy to forget what to ask about the next steps.
Here are few questions you can ask your medical provider:
1. Did you compare my previous mammogram results to this mammogram, and how far back did you go?
It’s essential to compare your mammograms, because there may have been significant changes in your breasts over time. Comparing earlier mammograms gives your medical provider a baseline and could alert them to a problem that requires further investigation.
2. Do I have dense breasts or dense breast tissue?
Some younger, pre-menopausal women often have dense breast tissue. Older women, usually post-menopausal, often have fattier breast tissues.
Milk glands and ducts and fibrous tissue make up areas of dense breast tissue. You need to know about your breast density for two important reasons:
- Dense breast tissue provides a white background, and the lumps or lesions will also appear white. This makes it hard to see a nodule or lump on a mammogram image.
- Dense breasts are also a cancer risk factor.
In 38 states, the law requires that women be advised of their breast density. If you have dense breast tissue, you and your medical provider may choose to do follow-up exams such as breast MRI, ultrasound, or biopsy to be sure about your diagnosis.
When women reach menopause, dense breast tissue is often replaced by fattier tissue because estrogen is in low supply. This makes mammograms in post-menopausal women easier to read.
3. Is the nodule in my breast a cyst or a lump?
When there are liquid cysts or solid lumps in your breast, it can cause an abnormal mammogram.
If new nodules show up on your mammogram, or if your clinician can feel lumps, you’ll need an ultrasound to evaluate them.
While cysts are usually benign, solid lumps could be cancerous. This is why a core needle breast biopsy is generally recommended.
4. My radiologist said I have calcium deposits in my breast. What does this mean?
The radiology technician may see calcium deposits (microcalcifications) on a screening mammogram.
Microcalcifications typically aren’t a result of cancer. But if they appear in patterns and are clustered together, they may be a sign of precancerous cells or early breast cancer.
If microcalcifications are found during your screening mammogram, you may be called in for further investigation. A breast biopsy will likely be recommended.
Radiologists sometimes ask patients to return for magnification views. A magnification view is performed to evaluate and count microcalcifications and their extension by using a magnification device. This device brings the breast away from the film plate and closer to the x-ray source.
If the calcifications are suspicious, the radiologist will recommend a breast biopsy.
5. What does my BI-RADS score mean?
Federal law in the United States requires radiologists to give each mammogram a BI-RADS (Breast Imaging and Reporting Data System) rating based on your mammogram results. The lower the score, the better. Here’s what the scores mean:
- 1: This is a benign finding (no abnormalities).
- 2: There is a finding, but it is harmless.
- 3: This indicates a tumor. It’s likely benign, but it may require further testing and should be monitored.
- 4: This means that your breast’s findings are suspicious, and a biopsy is required.
- 5: The abnormality found on your mammogram is likely malignant—a biopsy can confirm this.
What to do if you have abnormal mammogram results.
If you get an abnormal mammogram report back, don’t panic. But also, don’t ignore it.
While it is important to follow up as recommended by your healthcare provider, abnormalities show up all the time in mammogram results due to many factors.
When booking your mammogram, it’s important to know that 3D mammograms find more cancers than traditional 2D mammograms. They take three-dimensional pictures from varying angles to uncover cancers hidden by dense breast tissue. As a result, the radiologist can see up to 300 pictures, as compared to just four from a regular 2D mammogram.
At Ezra, we’ll be launching our New York mammogram screening program later this year. Be sure to join our waitlist so you can book your 3D mammogram.
If you’re worried that you might be at risk for breast cancer, take Ezra’s five-minute risk assessment.