You get your routine annual mammogram and, soon after, you receive a call or letter from your doctor’s office. You’re told that a potential abnormality was found on your mammogram and you need to make an appointment for further testing. Although it’s unnerving to get this news, experts say you shouldn’t panic.
"If you’re called back for additional mammogram views or a biopsy, it doesn’t necessarily mean you have cancer," says Sandhya Pruthi, MD, associate professor in the division of general internal medicine at Mayo Clinic in Rochester, Minn., and a breast health specialist. Pruthi also notes that although "the process of getting these additional tests can cause anxiety for some women, it’s short-lived -- in most cases, the work up can be done within two weeks."
According to the American Cancer Society, about 10% of women who have a mammogram will be called back for more tests. But only 8% to 10% of those women will need a biopsy and 80% of those biopsies turn out be benign.
To help you prepare for your follow up appointment, WebMD asked several doctors to describe the tests you may receive and to share their tips on making the process easier.
At Your Follow-Up Appointment
You’re likely to receive another mammogram (called a "diagnostic mammogram") and an ultrasound at your follow-up appointment, says Pruthi. The diagnostic mammogram might take longer than your routine screening mammogram did, because the technician may take more X-rays of the breast. They might, for example, magnify a specific area to get a more detailed picture or repeat the same views from the screening mammogram because those images weren’t clear enough.
Just as you did for the screening mammogram, you’ll need to undress above the waist and stand in front of the mammography machine. The technician will place your breast between two plates. The plates compress the breast to spread out the tissue for a few seconds while the X-ray is taken. These steps are then repeated for any additional X-rays of each breast.
"A mammogram requires that the breast is thinned out for optimal views," says Sylvia Adams, MD, an oncologist and assistant professor of medicine at New York University School of Medicine. "This can be uncomfortable, and if patients are sensitive they may find it helpful to take some over-the-counter pain medicine beforehand and to try to schedule the mammogram after a menstrual period."
For the ultrasound test, you’ll lie on your back on an examination table.
The technician will apply a clear gel to your skin and place a microphone-shaped device called a transducer on the breast. The transducer releases high-frequency sound waves and picks up the echoes from these sound waves, which are translated by a computer into an image of the tissues inside the breast.
The test doesn’t hurt at all, says Adams, but the gel that the technician puts between the skin and the transducer feels cold and wet. Ultrasound is often used to evaluate a specific abnormality that was found on a mammogram or a mass that your doctor can feel but that can’t be seen on the mammogram.
You may also get a magnetic resonance imaging (MRI) test, particularly if your doctor finds that the suspicious area in your breast cannot be evaluated with mammograms and ultrasound alone. MRI scans use magnets and radio waves to create detailed pictures of the breast.
For this test, you lie on your stomach on a table that slides into the MRI machine, which is shaped like a narrow tube. The exam itself is painless, but the machine makes loud buzzing and clicking noises and the technician may give you headphones to mask this noise. Also, a contrast agent may be injected into a vein in your arm and this can cause a tingling sensation.
Talking with Your Doctor
In most cases, the doctor who is interpreting your imaging tests will be able to tell you the results right away, Adams tells WebMD. It’s important to make sure this doctor has the results of your mammograms from the past few years so they can compare them with your new mammograms. An abnormality, such as a mass, that hasn't changed for a number of years may be more likely to be benign.
After reviewing your test results, the doctor may:
- Tell you that the abnormality is not of concern and you should return in a year for your routine mammogram.
- Recommend that you return for another mammogram in six months. Your mammogram and/or ultrasound showed an abnormality that is likely to be benign but should be monitored to see if it changes over time.
- Advise you to get a biopsy to determine whether the suspicious area in your breast is cancerous. For example, microcalcifications (tiny deposits of calcium) in certain patterns and masses that are not cysts often need to be biopsied.
If You Need a Biopsy
A biopsy, if needed, will typically be scheduled for another day within the next week. Many breast biopsies are done on an outpatient basis.
During the biopsy, a small amount of tissue or fluid will be removed from your breast for examination under a microscope. Depending on the size and location of the abnormality and other factors, the doctor will most likely choose one of the following types of biopsies:
• Fine needle aspiration biopsy. The doctor inserts a very thin, hollow needle through the skin to remove a small amount of fluid or tissue from the suspicious area in the breast. You may or may not receive a local anesthetic first. In most cases, the doctor uses ultrasound equipment to help them guide the needle into the area that needs to be biopsied. You might have a little bruising after the procedure, but you won’t need stitches.
• Core needle biopsy. Using a slightly larger, hollow needle, the doctor removes several tissue samples from the suspicious area in the breast. Before inserting this needle, the doctor will numb the targeted area with local anesthetic. You’ll feel a brief stinging sensation when the local anesthetic is injected. The doctor will usually use ultrasound equipment or other imaging equipment to guide the needle to the target area. After a core needle biopsy, you won’t need stitches but you may have a small scar and possibly some bruising.
• Surgical biopsy. The surgeon makes an incision and removes all or part of the abnormal tissue. This procedure may be done under general anesthesia or you may be given a local anesthetic and a medicine that will make you drowsy. (Bring a friend to drive you home afterward.) Typically, stitches will be used to close the skin and you’ll have a small scar. You may feel sore for a few days after the surgery and your doctor may give you a prescription for pain medication. Surgical biopsies aren’t performed as often as needle biopsies, but they’re required in certain situations. "A surgical biopsy might be needed, for example, if the doctor can’t do a core biopsy because the patient has calcifications that are very close to the nipple," says Stephen F. Sener, MD, professor of clinical surgery and chief of the division of breast and soft tissue surgery at the Keck School of Medicine at the University of Southern California.
After the biopsy, your breast tissue will be sent to a lab and a doctor called a pathologist will examine it under a microscope. The pathologist will determine whether or not cancer cells are present. The results of the biopsy are usually available within a week and your doctor will go over them with you. If you need additional tests or treatment, you may be referred to a breast specialist or surgeon.
Putting Your Mind at Ease
Many women feel anxious and uncertain while they’re getting follow-up exams and waiting for test results.
Doctors say that learning about the tests and writing down questions to bring to your appointments can help you feel calmer and more in control. They also recommend asking someone you trust to act as a second set of ears when you talk with your doctor.
"I think it's very helpful to bring a friend or family member with you to your appointments for comfort and also because they can listen to what the physician is saying and take notes," Adams says.