|Repeat Mammography: An Unwelcome Call Back|
Mammography is the most widely used method to screen for breast cancer, but if you talk about it with any woman, most likely you’ll get the same unenthusiastic response, and perhaps even a sense of dread.
Most women know, either from personal experience or from hearing about it from another woman who’s been through it, that mammography is not the most comfortable procedure, albeit necessary. Many women have to psych themselves up for their annual test. But it is even worse if you are told that you have to return for a second one because of an “abnormal” finding.
That phone call can be downright frightening.
However, experts say just because you are getting called back for a repeat mammogram, you shouldn’t assume you have cancer, and don’t panic.
Over the past decade, health centers have begun to use new digital, or computerized, technology, which gives more detailed images than traditional x-ray mammographies. Many women who have been screened with both methods during this transition may feel as if they are being asked to come in for a second mammogram more often now. However, a large study published in the New England Journal of Medicine proved that isn’t the case.
Etta D. Pisano, MD, and her colleagues looked at the mammograms of about 50,000 women in the United States and Canada and found no difference in the call-back rate among women who had a digital mammogram versus those who had a traditional film mammogram.
“We saw little difference in the way radiologists evaluated the two technologies,” says Pisano, a radiologist at the University of North Carolina at Chapel Hill.
All women have a 5% to 15% chance of being recalled. It doesn’t mean you have breast cancer. In fact, the odds are against it. In fact, estimates show that women between ages 40 and 49 years who have yearly screening mammograms have a 30% chance of having false-positive results sometime within that 10-year period.
If this occurs, you will be sent for additional testing, perhaps a repeat, or diagnostic, mammogram or an ultrasound, and quite often these tests yield normal results. Other times a biopsy might also be needed, where a needle is inserted into the lump and a tissue sample removed and sent to a laboratory for testing.
If you are recalled for more testing, experts suggest you try to reschedule the exam as quickly as possible so that you don’t have to spend months worrying about whether you have cancer. The health center should try to get you scheduled for repeat mammograms as soon as possible.
Reasons for Recall
The purpose of a screening mammogram is to find cancer at its earliest stages, before it becomes advanced and can be felt on breast exam, so that your chances of a cure are much higher. According to the American Cancer Society, the death rate from breast cancer in women has decreased by 2.2% annually since 1990. These declines have been attributed to both early detection and improvements in treatment.
“Our goal at screening mammography is to find breast cancers early, before they can be detected clinically. Women who undergo treatment for breast cancers that are found at the earliest stage have a greater than 98% survival rate at 5 years” says Michelle Lee, MD, a radiologist at Lake Forest Hospital in Illinois.
Radiologists are looking for two main signs of cancer: mass (tumors) and calcifications. When a woman gets regular mammograms—usually once a year—the radiologist compares the current year’s views with last year’s. If anything looks different or develops, your doctor might ask you to come back to have additional views or studies taken to tease out what is being seen.
If you have ever seen a mammogram, there are white parts and dark parts. The white parts are what doctors call “density,” the black parts are fat. Every woman, no matter how thin she is, has fat in her breast. As you age, the dense part is replaced by fatty tissue.
If you have very dense breasts, your risk of breast cancer is higher than if you had completely fatty breasts.
And having dense breasts makes mammograms more difficult to read because the tumors tend to blend into the white background; on a mammogram, tumors appear white and breast density appears white. It’s like looking for a softball lying in the snow.
Women develop benign (noncancerous) masses and calcifications all the time. These are quite common and include cysts, fibroadenomas, and solid masses. Some women have dense breast tissue, fatty deposits, or scarring from old injuries or inflammations. Calcifications occur most often simply as a result of the natural aging process from the degeneration of tissue.
A calcification in the breast can be compared with a mole on the skin: some are malignant; some are benign. Dermatologists can usually look at the mole and tell you whether or not it is skin cancer, but sometimes they need to do a biopsy to make sure. Sometimes radiologists reading the results of a mammogram cannot tell whether these masses and calcifications are benign or malignant (cancerous) without further evaluation, which is why you get called back.
“Calcifications are like skin moles; they are that common, almost everyone has them. The radiologist’s job is to say which ones are cancers,” Pisano says.
Here are some tips to get the “best” mammogram: