I Had a Mammogram Come Back Positive... Should I Be Worried?

I Had a Mammogram Come Back Positive... Should I Be Worried?

Tips for staying calm if you’re called back for more testing.

The American Cancer Society recommends women at an average risk for breast cancer have annual screening mammograms between ages 45 and 54. A screening mammogram is done when you don’t have any pain or new symptoms, but you’d like to catch possible breast changes early on. It usually includes two X-ray images of each breast, which a radiologist will study carefully for areas of concern.

After screening mammograms, 10 percent of people are asked to come back for more testing. Getting called back can be frightening, but fewer than 5 of every 1,000 people who have a screening mammogram are diagnosed with cancer. 

“We’ll often look at a spot and say, ‘It’s probably nothing, but we need to prove it’s nothing,’ so we bring the person back," says Angela Watt, MD, a radiologist specializing in women’s imaging at the Advanced Imaging Center in Ocala, Florida, part of the Ocala Health Group. "The majority of women don’t need to panic."

At that point, you’ll undergo a second, diagnostic mammogram, which involves additional images that focus in on specific areas. Many facilities will contact you to schedule that follow-up appointment right away.

Dr. Watt recommends using a Breast Imaging Center of Excellence certified by the American College of Radiology, because they’ll call you back promptly. These facilities also have specialized breast and women’s radiologists who look at mammograms all day, every day, she adds, and that can make a big difference.

Even with the quick response time at many breast centers, waiting for your results can cause a lot of anxiety. Knowing why mammograms can come back positive might help ease your mind.

Why you might get called back 
There are a number of explanations for why your radiologist would want more images. For example, if you’re a first-time patient and they don't have a copy of your records, they may need more information. Without past images to compare to, they won’t know if concerning spots are new, growing or if you’ve always had them. You should try going to the same breast center every time, but if you have to visit a new location, bring a copy of your previous scans. 

An initial mammogram might also come back positive because of:

  • Calcifications: The buildup of calcium deposits, or calcifications, could be a sign of cancer, but they’re often benign.
  • A mass: It might be cancerous, but it could also be a benign tumor or a cyst, which is a harmless, fluid-filled pocket.
  • Dense breast tissue: This tissue can make it harder for radiologists to see breast structures, including tumors. 
  • Hormone changes: Menopause and hormone replacement therapy (HRT) can cause your breasts to look different from year to year.
  • Breast implants: Implants can block the view of your actual tissue and make it difficult to position your breasts correctly during a mammogram.

You might also get called back if a long time has passed since your last mammogram. Aging, weight changes and menopause can all make your breasts look different over time. If it’s been years since your last screening, the differences from prior scans may seem drastic or concerning.

"Letting a long time pass between mammograms can also cause cancer to go undetected during early stages," says Dr. Watt. Following the American Cancer Society’s screening guidelines allows your doctor to monitor your breasts over time and can help them recognize changes sooner.

Other tests you might need
In addition to a diagnostic mammogram, your doctor may recommend:

  • An ultrasound: During an ultrasound, a technician will apply gel to your breast and then run a tool over your skin, which uses sound waves to create images of breast structures.
  • Magnetic resonance imaging (MRI): For an MRI, you’ll lie down inside a large tube that uses powerful magnets to produce detailed pictures of your breasts.

Not every person will have to go for these tests, says Dr. Watt. It depends on your individual case and the information your radiologist needs to make a confident diagnosis.

If you need a biopsy
A biopsy involves taking a sample of your breast tissue, which is then placed under a microscope to look for cancer cells. Just because your radiologist recommends a biopsy, doesn’t mean you have cancer. At least 60 percent of biopsies come back negative, explains Dr. Watt.

How to stay calm while you wait for results 
Even if you know most people who get called back aren’t diagnosed with cancer, waiting for results can be nerve-wracking. These steps might help you pass the time with less worry:

  • Make a list of questions for your radiologist; putting your fears down on paper can help get them off your mind. Writing questions can also help you remember them later during your appointment.
  • Call the American Cancer Society’s hotline at 1-800-227-2345. Operators are available 24 hours a day to offer support.

Finally, bring a family member or friend with you to appointments. They can distract you while you wait, and it’s always helpful to have a second set of ears when your doctor explains your diagnosis.

Dont skip future mammograms  
After experiencing the stress that comes with a false positive, you might hesitate to book your next routine screening. You wouldn't be alone—women who received false positives were more likely to delay or skip their next screening mammogram than those who learned their test was negative right away, according to a 2017 study in Cancer Epidemiology, Biomarkers & Prevention. 

They put it off by around 13 months on average, compared to 6 months for women who had negative mammograms. Women who had a false positive were also more likely to be diagnosed with advanced cancer later on. The researchers think the delay in testing could be the reason.

If you experience a false alarm, don’t brush off future mammograms. They’re a powerful, life-saving tool all women can benefit from.

Read more from Dr. Watt.

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