If you’re told your mammogram is abnormal, Rule #1 is: there’s no need to panic.
According to the American Cancer Society, less than 10 percent of women called back for more tests after a screening mammogram are found to have breast cancer.
“Of 1,000 women who get a screening mammogram, 100 will come back for additional imaging. Of those 100, only about five will end up being diagnosed with breast cancer,” says Brett Parkinson, MD, radiologist and director of the breast care program at Intermountain Medical Center in Salt Lake City.
“It’s important to complete further diagnostic testing to determine if the abnormality in the breast is non-cancerous or cancerous,” says Dr. Parkinson. “Doing additional breast imaging provides more detailed information about your case and helps you and your physician make decisions about further evaluation.”
If your screening mammogram is abnormal, a radiologist will likely recommend further imaging such as:
- Diagnostic mammogram
- Breast ultrasound
- Breast MRI for high-risk patients
“Waiting for the results of a diagnostic mammogram and other tests can be frightening,” says Nancy Smith, a mammography manager for Intermountain Healthcare. “Many women have strong emotions when their screening mammogram comes back as abnormal, including disbelief, anxiety, fear, anger, and sadness. It’s very common to have those feelings.”
You may also need a biopsy, which means getting a sample of tissue from the abnormal area and sending it to a pathologist for diagnosis. Approximately 15 percent of women who are called back for further imaging will undergo a biopsy, according to the American College of Radiology.
Types of breast biopsies include a needle core biopsy or surgical biopsy, depending on your case. “In 95 percent of cases a needle biopsy is sufficient,” says Dr. Parkinson. “Of the women who undergo a needle biopsy, just 30 percent will have cancer.”
- A needle biopsy produces minimal scarring, allows diagnosis of breast cancer without taking a patient to the operating room, and allows all options of breast cancer treatment to still be considered, including clinical trials.
- A surgical biopsy may be recommended due to the location or type of the lesion, or if previous imaging or needle biopsy results are inconclusive.
If it’s cancer, you’ll usually be referred to a general surgeon, who will discuss treatment options with you, which may include surgery to remove the tumor, radiation, chemotherapy, and/or hormone therapy. Depending on the individual case, one or more of these options is recommended.
Complete breast cancer care is best provided by a team of specialists
Typically, your general surgeon will talk over your case with a multi-disciplinary breast cancer tumor board to reach consensus on the order and type of treatment recommended. The board usually includes surgeons, pathologists, oncologists, radiation oncologists, breast care coordinators, genetic counselors, and lymphedema specialists who’ve treated a wide range of breast cancer patients.
“In my experience, most breast cancer patients get surgery first to remove the cancerous mass and check for spread to the lymph nodes, but each case is different,” says general surgeon Alice Chung, MD, who does breast cancer surgery at Intermountain Riverton Hospital.
“There are research-based guidelines for breast care, but each case presents subtle differences that should be discussed individually. Eligibility to participate in clinical research trials can also be addressed,” she adds.
Typically, general surgeons perform breast surgery to remove cancerous tissue and plastic surgeons perform reconstructive breast surgery.
“Many general surgeons do breast surgery to remove cancerous tissue and some specialize in it,” says Teresa Reading, MD, a general surgeon who specializes in breast surgery at Intermountain Healthcare. “Depending on the surgery recommended, reconstructive options can also be discussed with a plastic surgeon.”
If you’re considering breast cancer surgery, see the American Society of Breast Surgeons Foundation website:
Important breast cancer facts:
- One in eight women will develop breast cancer over the course of her lifetime.
- 75 percent of breast cancers occur in women with no known risk factors.
- Screening mammography is the best method of early breast cancer detection.
- If women aren’t screened early and regularly for breast cancer, the treatment becomes complicated and survival rates decrease.
When should you get your first mammogram and how often do you need them?
“If you’re a woman of average risk, you should begin annual screening mammography at age 40,” says Dr. Parkinson. “However, if you have a family history of breast cancer or have the breast cancer gene BRCA-1 or BRCA-2, you should begin screening earlier, and may be a candidate for MRI screening.” Talk to your physician for recommendations if you have a mother, sister, or daughter who’s had breast cancer. If you have one of the breast cancer genes, you may consider consulting with a genetics counselor at a breast care center.
3D digital mammography or tomosynthesis provides a more detailed picture
Tomosynthesis provides a 3D image of the breast that can be viewed in thin slices to more accurately show breast abnormalities. Screening mammograms may or may not include tomosynthesis and some insurance plans may not cover it. If it’s available and is covered by your insurance, you may want to request tomosynthesis, since it provides much more detailed pictures. All Intermountain breast care centers have tomosynthesis available. Tomosynthesis has been shown to slightly increase the cancer detection rate and decrease false positive results from screening.
In addition to mammograms, the American Cancer Society recommends women should be familiar with how their breasts normally look and feel and report any changes to their healthcare provider right away.
All Intermountain Healthcare breast cancer centers meet national benchmark guidelines for breast cancer detection.