A notice to return for more imaging after a screening mammogram can be a frightening experience. When I received the letter days after my annual exam, I was scared, then puzzled. Did some of the digital images blur? Did the radiologist see something suspicious? What was the “finding” that required supplementary studies? I called within five minutes to make another appointment.
Screening vs. Diagnostic Mammograms
All my prior studies were screening mammograms. Essentially, a mammogram is a type of X-ray of the breast. I was surprised when the radiologic technician explained that many men undergo them, too.
A screening mammogram checks for breast cancer in individuals without any signs of the disease. Mammography scans both breasts to find tumors that neither the patient nor the doctor can feel. According to the National Cancer Institute (NCI), this type of imaging is also useful to detect microscopic bits of calcium associated with some malignancies.
A diagnostic mammogram checks for the presence of cancer in a patient who has some signs of the disease, such as a lump, pain, change in breast size, discharge or skin thickening. It is sometimes used instead of a screening mammogram when a woman has breast implants. The diagnostic process requires more images and lasts longer than the screening type.
While doctors advise that mammograms save thousands of lives every year, some risks are associated with them, the Mayo Clinic suggests. These include exposure to low-dose radiation, potential inaccuracy, difficulty of interpretation in younger women and a detection failure rate of around 20 percent. Certain aggressive tumors identified by a mammogram are incurable. A woman who has a mammogram has a 1 in 10 chance of being called back for more studies, based on initial findings.
The Second Appointment
I was able to get an appointment for more studies two days after receiving the letter. At that point, I felt like a car scheduled for a recall for faulty brakes or some other mechanical problem.
The notice said my doctor had already received a report. I called his office as a courtesy to let him know that I had already scheduled a second appointment. It was disconcerting when the computer showed the practice had no notice of a radiologist’s report for the screening mammogram.
The second set of studies was a diagnostic mammogram. While my health insurance coverage includes one free mammogram each year, this doesn’t apply to diagnostic imaging.
After I changed into an exam robe, the technician said that the radiologist would explain the results of the second study and give me the written diagnosis before I left. This was a huge relief. She then escorted me into the mammography room and showed me an image of the area of concern, a shadow about the size of a dime.
The actual studies took only about 10 minutes. I waited another 15 minutes for the radiologist to finish with another patient and give me the good news that I was fine. Repositioning my body for the second study showed that there was no problem.
The Reporting Scale
For a woman about to undergo a screening mammogram, particularly her first, it’s important to know what the diagnosis means if she receives results in a form letter. NCI states that the American College of Radiology uses a reporting scale to describe mammogram findings. The seven standard categories include:
0 – Additional imaging evaluation, more studies necessary before assigning a category.
1 – Negative, continued annual screenings for women over 40 recommended.
2 – Benign, noncancerous finding, continued annual screenings for women over 40 recommended.
3 – Probably benign, recommend follow-up mammogram in six months.
4 – Suspicious abnormality, might require a biopsy.
5 – Highly suggestive of cancer, biopsy required.
6 – Known biopsy-proven malignancy, biopsy has confirmed cancer.
I was fortunate that the radiology center sent out a text letter rather than only a diagnosis marked “0.”
Further Diagnostic Steps
When a woman is recalled after a screening mammogram and a second imaging series suggests a potential problem, healthcare providers recommend more testing. This might include additional mammography, an ultrasound study and/or a biopsy.