November 20, 2023
Receiving an abnormal report on your screening mammogram can be scary, but it doesn’t mean you have cancer. It doesn’t even necessarily mean that you require a biopsy. In this blog post we take an in-depth look at what it means to receive an abnormal mammogram result, and what the next steps might look like.
What does “abnormal” mean on a mammogram report?
There are several reasons why your report might be abnormal.
· The images were unclear or missed some part of your breast tissue
· There is an area that appears different from other parts of your breast
· Imaging detected a suspicious-looking mass or calcifications
Additional testing may cause patients to worry, and the mammogram technicians try to avoid the need for it by being as thorough as possible during initial scans. But in some cases questions do arise, and additional imaging can verify that findings are benign or that there is indeed something concerning that needs to be followed up on.
It may comfort you to know that fewer than one in 10 women who are called back for additional testing are found to have cancer in their breast.
What Happens During Follow-up?
If the radiologist calls you back because of abnormal screening mammogram results, the next step is usually a diagnostic mammogram. The radiologist will guide the technician in capturing specific breast images, ensuring comprehensive coverage. You may also undergo a breast ultrasound or a breast MRI (magnetic resonance imaging) for a more detailed picture. MRIs can detect subtle changes that might elude detection in mammograms or ultrasounds. In the majority of cases, when the area in question is compressed and more closely scrutinized, it is no longer suspicious looking and is not found to be cancerous.
What are the next steps if the area continues to appear suspicious?
If suspicions persist, a biopsy will be performed. This still doesn’t mean you have cancer—the majority of biopsy results are negative. Nevertheless, a biopsy and subsequent analysis are the only way to rule out or confirm cancer.
What do the Results Mean?
It helps to understand your results and how your doctor interprets them. The Breast Imaging Reporting and Data System (BI-RADS) is used to describe what is found on a mammogram. A zero-to-six categorization helps doctors use a common language to describe findings:
Category 0: Incomplete. The radiologist requires clarification. Additional imaging tests are needed, typically a diagnostic mammogram with spot compression and/or different views. The radiologist may request previous mammogram results to compare to the new results. An ultrasound or MRI may be requested.
Category 1: Negative. Nothing new or abnormal was found. Breasts are symmetrical with no distinguishable masses, abnormal structures, or suspicious calcifications. Calcifications are deposits of calcium seen but not felt in the breast tissue. Microcalcifications are tiny calcifications that can become cancerous. They require additional testing as they can become cancerous. Macrocalcifications are larger, coarser areas of calcium commonly found in women over the age of 50. They are the natural result of aging, past breast injury, or buildup that occurs over time.
Category 2: Benign or non-cancerous finding. This is also a negative test, however it is categorized differently because the radiologist records and describes the findings for doctors who will be looking at the report in the future. Recorded findings may be benign calcifications, masses, lymph nodes, or any changes from prior procedures.
Category 3: Probably benign. A finding in this category has no more than a two percent chance of being cancerous. The finding is not expected to change over time but can’t definitively be labeled as benign. Repeat imaging within six to 12 months and regularly thereafter is recommended until the finding is determined to be stable, usually over a period of two years. Category 4: Suspicious or abnormal finding. This finding may not be cancer, but it could be. A surgical biopsy (removal of a small sample of breast tissue) is recommended. There are three subcategories of suspicious or abnormal findings:
4A: Low likelihood of cancer (between two and 10% chance)
4B: Moderate likelihood of cancer (between a 10% and 50% chance)
4C: High likelihood of cancer (between a 50% and 95% chance)
Category 5: Highly suggestive of a malignancy. Your doctor believes this finding is cancer. It looks like cancer and has at least a 95% chance of being cancer. A biopsy is very strongly recommended.
Category 6: Known malignancy proven by biopsy. This describes a finding that has already been determined to be cancerous. At this category level, imaging is being used to monitor the patient’s response to treatment.
What role does breast density play?
Dense breast tissue has a high composition of glandular and fibrous connective tissue and a relatively low percentage of fatty tissue, which can make mammograms more difficult to interpret. Dense breasts are common, and almost half of all women over 40 have them.
Women with dense breasts may be asked to return for follow-up testing more often than women with fatty breasts.
There are four BI-RADS breast density categories:
Category A: Least dense
Category B: Scattered areas of dense tissue
Category C: More density (heterogeneous density)
Category D: Extremely dense
If your breast tissues are in Category C or D, ask your doctor about whether additional testing is recommended.
Waiting for additional results can be unnerving, but most follow-up tests show normal tissue or a benign condition. Try not to worry. Talking with loved ones or other women who have had screenings or biopsies can be helpful. And always speak with your doctor if you have any questions about your findings or screening/testing recommendations.