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What to expect if you are called back after a mammogram

Routine screening 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.

Bridgette Lord, a nurse practitioner at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital, works closely with patients undergoing additional radiological testing for breast concerns. She understands that it is common for patients to experience anxiety and uncertainty during this time period. Helen Mark who has also worked as a nurse navigator at the Henrietta Banting Breast Centre also agrees that it can be helpful to know what to expect after being called back after a mammogram.

When you’re called back after a screening mammogram, “in most cases it means the radiologist wants to take a closer look at something so they can determine if there is something to be concerned about or not,” says Mark. This is especially true if it’s your first mammogram. When reading your first test result, the radiologist has no previous images for comparison. That means they can’t tell if something on the image is new, or if it has changed. Calcifications are a good example.

Calcifications are tiny specks of calcium that are sometimes benign, but are sometimes associated with tumors. Calcifications that are new, that have increased in number, or that are clustered together in a concerning pattern would warrant a call back for a closer look. “If it’s a woman’s first screening and we see calcifications, that person would be called back because we don’t know if they 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. We 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 filled, 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 follow-up 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 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 when the callback appointment is arranged.

Aside from the radiologists, there are several people in the Breast Centre who can help patients gain a better understanding of why they are being called back. At Women’s College Hospital, there is both a nurse navigator and nurse practitioner available to support patients during this process. Primary care providers also have results sent to them and can explain why patients are being called back. It’s important to draw on the expertise of everyone inside the circle of care to gain access to education and help with navigating the process.

 

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Sept. 27, 2018

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