What Does an Abnormal Mammogram Mean?
More testing follows to determine if it’s breast cancer
More testing follows to determine if it’s breast cancer
An abnormal mammogram doesn‘t always mean breast cancer – but it can be very worrying. Follow up testing is crucial to know for certain. It may include a diagnostic mammogram, ultrasound or biopsy to diagnose or rule out breast cancer.
Most follow up tests reveal benign conditions. If cancer is found, a team of breast cancer specialists will work together to decide the best treatment.
“Fortunately for the majority of women who have breast cancer in the modern era, the potential for survival after the diagnosis well exceeds 85 to 90 percent,” says Louis Rivera, MD, a surgical oncologist at Scripps Clinic. “A lot of that is attributable to screening mammography because the cancer is detected early at a stage where it can be readily treated.”
There’s no question that mammograms save lives. Since 1989, more than 500,000 breast cancer deaths have been prevented in the United States thanks to early detection and advanced treatment options.
Types of additional testing after abnormal mammogram
Mammogram results are categorized using a number system called BI-RADS, which stands for Breast Imaging Reporting and Data System.
Most screenings find nothing wrong. But in some cases, patients are called back for more testing because something abnormal was found on the mammogram. This too doesn‘t mean you have cancer. Only a few women, less than 1 in 10, who are called back are diagnosed with cancer, according to the American Cancer Society.
Being called back is more common for women who are having their first mammogram or who have not gone through menopause.
An abnormal mammogram can happen due to an unclear picture, a missed area, a non-cancerous tumor, or cyst. Having dense breast tissue can make abnormal findings hard to see. Younger women tend to have dense breast tissue.
If a mammogram shows something unusual, the next step is a more detailed X-ray called a diagnostic mammogram. It captures images from various angles and magnifies them.
A diagnostic mammogram often includes a breast ultrasound. An ultrasound uses sound waves to make pictures, called sonograms, to look at suspicious areas inside the breast.
“Many people are familiar with sonography during pregnancy,” says Dr. Rivera. “The exact same instrumentation is used to create a picture of the breast.
Sometimes, a breast biopsy is needed to make a clear diagnosis. The type of biopsy, either with a needle or through surgery, depends on the patient‘s health and mammogram results. Tissue samples are taken from a breast lump or suspicious area and examined with a microscope during the procedure. Most biopsy results are not cancer.
If cancer is found, it‘s crucial to understand your diagnosis and work closely with your care team on your treatment plan.
How is breast cancer treated?
Doctors treat breast cancer in several ways. Surgery, chemotherapy and radiation therapy are the most common treatment methods.
Doctors from different specialties work together to treat breast cancer using a multidisciplinary approach. They collaborate to decide the best plan based on the cancer stage, aggressiveness and hormone receptors in the cells. Drugs can be used to shrink the tumor by targeting these receptors.
Chemotherapy is the use of special drugs to shrink or kill cancer cells. Surgery is another option and involves removal of the cancer.
Lumpectomy vs mastectomy
There are two types of breast surgery: lumpectomy, which conserves the breast, and mastectomy, which removes the breast.
Lumpectomy is more common. “Overall, the recovery is measured in days to maybe a week or two,” says Dr. Rivera.
By comparison, recovery from a mastectomy ranges from a few weeks to two months. Mastectomy may be more beneficial for larger or multiple tumor and certain other situations.
What does radiation therapy do?
Following breast surgery, some patients may undergo radiation therapy as part of their treatment plan. Radiation therapy uses high-energy X-rays to target and destroy any remaining cancer cells in the breast area.
“Most patients who get breast-conserving surgery will benefit from the addition of radiation therapy to prevent the cancer from coming back,” says Dr. Rivera. “On the other hand, patients who get breast removal don‘t require radiation, unless there’s something concerning about their cancer.”
“Tumors over 5 cm, involvement of the breast skin or the chest wall and the presence of cancer in the lymph nodes can trigger a recommendation for radiation after mastectomy,” Dr. Rivera says. “If these issues are not present radiation is not typically recommended and that's a bit of an advantage over lumpectomy.”
Can breast cancer return?
Cancer coming back is different for everyone. It depends on things like the type of breast cancer, how advanced it was and the treatment given.
Regular follow-up appointments and ongoing monitoring are essential for early detection of any signs of breast cancer recurrence.
The highest risk of recurrence is within the first three years. At Scripps, doctors actively monitor patients for the first five years, sometimes longer, depending on their stage of disease.
Once there’s no longer evidence of disease, most patients will remain cancer free for the rest of their lives. In some cases, breast cancer can come back after a long period. Patients should stay alert for any signs or symptoms.
“Survival with breast cancer in this day and age is very good,” Dr. Rivera says.