Let’s face it — mammograms are uncomfortable and awkward. The last thing you want to hear after having one is that something is “abnormal,” and the doctor wants a repeat mammogram or a more complete “work-up”. But don’t panic — this doesn’t mean you have breast cancer, it simply means there is something more to look at.
If you’ve been told there are concerns with your mammogram, here are some things to do:
- Keep breathing
- Ask questions, gather information
- Find a support person to be with you
Once you’ve done those things, you’ll want to know a little more about what might be going on. First of all, sometimes the films just don’t come out right and they need be repeated.
But if there’s more at play, here are the three three most common issues that radiologists see in mammograms that they’d like more information on:
- A new nodule
- An asymmetric density — (the breast tissue doesn’t look the same in each breast)
- A new cluster of calcifications (little white specks)
So what should happen next? In the first two cases, you should have an additional spot compression film to see if it is real, and an ultrasound to see if the area is fluid or solid and to have a better look at its shape. Nodules that are irregular or spiculated (like a star) are more worrisome.
With calcifications, you should have special magnification views done, which can help determine if they are normal or worrisome. Most calcifications are normal and associated with aging, not from taking too much calcium.
If someone tells you to wait 6 months and recheck, it is usually because they think it is benign. However, if you don’t want to wait 6 months you have the right to ask for a second opinion.
If someone tells you that you need to have something biopsied, don’t be afraid to keep asking questions until you understand why, and are sure that the mammogram has been worked up sufficiently. It’s important, as well, that someone examine your breasts and correlate them with the mammogram to be sure that nothing is palpable. Remember, the point of getting a mammogram is to find lesions early enough that they are too small to feel.
Even if you do need a biopsy, you probably don’t need a trip to an operating room. Most breast centers today have equipment to biopsy mammographic findings with a needle. This is called a stereotactic biopsy, or a mammotone-core biopsy. This type of biopsy has been shown to be as accurate as a surgical biopsy and much less invasive. I recommend you try to find a center which does these biopsies frequently — our breast center does 2 to 4 stereotactic biopsies a day.
Another way to biopsy is with ultrasound guidance — this is sometimes a bit easier because your breast does not have to be compressed. Most mammographic problems, except calcifications, can be identified on ultrasound. Most breast centers have accredited mammography and ultrasound units and specialized breast-imaging radiologists.
Now that you know some more information, an “abnormal” mammogram may not feel as scary. Remember, the doctor’s are looking for more information on anything that looks suspicious, and that’s a good thing. Wouldn’t you rather know right away if there’s something you need to take a closer look at?
