Many women are asked to return for additional imaging of the breast following a screening mammogram. In fact, 10% of all women undergoing a 2D screening mammogram will be asked to return for additional imaging (the percentage is lower with 3D mammography). This is referred to as a call back. A call back is not as scary or dire as it appears on the surface, and here are 4 reasons why: (Data presented from Performance Benchmarks for Screening Mammography, Rosenberg et al, Radiology 2006 241:1, 55-66. This data is considered the gold standard for which each mammography practice is compared to ensure the quality of care. This data is based on 2D screening mammography, and does not take into account the more sensitive screening test of 3D mammography- where we are already noting fewer callbacks when compared with 2D mammography.)
Fact One: The chances of being called back for additional imaging are even higher than the overall average of 10% if this is your first mammogram, referred to as a baseline mammogram.
Think of your breast tissue as a thumbprint. The mammographic appearance of each woman’s breast tissue stays relatively constant with only a very gradual loss in glandular tissue over time as we age. Since glandular tissue and cancer can look similar, and we do not make new glandular tissue over time, it is important to have a clear picture of “normal” for each patient. Without the benefit of prior mammograms for comparison, the breast radiologist will be more likely to ask a woman to return for additional imaging as it can be a challenge to know with certainty that a finding is normal breast tissue versus small cancer, particularly in women with dense breast tissue. With prior mammograms, the breast radiologist is more confident that a study is normal when the mammographic appearance of the breast does not change over time.
Fact Two: The chance or probability of being diagnosed with cancer after being called back from a screening mammogram is approximately 5%.
Yes, cancer is possible, but being called back does not generally correlate with the imminent cancer diagnosis many women fear when asked to return for additional imaging.
Fact Three: Approximately 15% of women with an “abnormal” screening mammogram interpretation will be asked to return for a breast biopsy.
Fact Four: The chance or probability of being diagnosed with cancer after a biopsy is recommended is approximately 25%.
Putting all of this together, the cancer detection rate from screening mammography is approximately 5 cancers diagnosed per every 1000 women screened. This equates to an overall 0.5% chance of being diagnosed with cancer after undergoing a screening mammogram. Even women who are recommended for breast biopsy after an abnormal screening mammogram result, have a 75% chance of NOT being diagnosed with cancer.
It is important to understand that the likelihood of an eventual breast cancer diagnosis is low when called back from a screening mammogram. So take a deep breath, realize breast imaging is not an exact science, and in most cases, the initial “abnormal” screening mammogram result will end up being no big deal after all.
About Danielle M. Carroll, M.D
Written by Danielle Carroll, M.D.
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