Could it be cancer? What to do when you get called back for a second mammogram ::


I was supposed to be releasing a little stress on a recent walk through my neighborhood. But when my phone rang, I answered it. And on the other end was the clinic where I’d gotten a mammogram the day before. We need you to come back in, they told me. The radiologist saw something on your left breast.

I knew the numbers. Some 90% of mammogram call backs end up being nothing to be worried about at all. And I knew this from personal experience: I’ve only had five mammograms in my life, and this was my second call back. The last time everything was fine.

But this time, I had some personal history. Two close relatives had recently undergone successful treatment for breast cancer. Two friends were going through it now. Breast cancer was on my mind.

So I scheduled my appointment for two days later, and my mind started wandering to a less than optimistic place. “Everything will be fine,” I told myself.

And it was. They found a cyst, at my follow-up appointment, but that was nothing to worry about.

My experience was far from unusual, said Dr. Monica Reddy, a radiologist at Wake Radiology at UNC Rex Healthcare. Ten percent of women are typically called back after a mammogram, so a radiologist can take a closer look. I checked in with Dr. Reddy to find out why women get called back and what they should do. (Spoiler alert: Go back and get checked out, but don’t freak out.)

Why do women get called back after a mammogram?

Breasts are made of two tissues — fatty tissue, which looks black or really dark on a mammogram, and white breast tissue. Breast cancer presents as white material on a mammogram, but doesn’t have any fat in it. “Normal breast tissue will have fat and breast tissue mixed together,” Dr. Reddy said.

About 50% of women have so-called dense breast tissue, and it can be harder for doctors to see through this kind of tissue and determine what might be cancer. That’s one reason for a call back.

Cysts are the most common mass in a pre-menopausal woman. And if a radiologist is comparing past mammograms with a new one, a newly emerged cyst often will warrant a return, she said. A benign mass is another reason, she said, and has no risk of turning into cancer.

Scar tissue, caused by an accident or some long-ago trauma, could also show up in a mammogram. And if you have fibrocystic breasts, which typically have dense breast tissue and make lots of cysts, you might be more likely to get called back.

And, of course, the radiologist may have spotted breast cancer. But keep these numbers in mind: Of the 10 percent who return for follow-up mammogram, 2 percent are recommended for a biopsy. Of that 2 percent, about 30 percent will come back as cancer. “There are many more benign reasons than cancer to be called back is the important thing to keep in mind,” Dr. Reddy said.

What happens during a diagnostic mammogram?

In my experience, they just take a closer look at the breast in question. In my case, it was the left breast. I had another mammogram where they took specific images of the area where an issue was flagged, along with an ultrasound. That’s typical, Dr. Reddy said. At Wake Radiology, patients come into the breast center where staff has had some extra training in breast imaging. “If it’s a clump of dense breast tissue, we’ll smooth out the tissue and make sure no mass is hiding,” she said.

3D mammograms, which Dr. Reddy recommends, are especially helpful in identifying specific problems. Regular mammograms offer just a handful of views of the breast, but the 3D version is almost like a flip book, allowing a radiologist many more views of what’s inside.

What happens once the diagnostic tests are complete?

There are three outcomes, Dr. Reddy said.

  1. The radiologist will look at the images, determine that there is nothing to worry about and recommend the woman returns in a year for her regular mammogram.
  2. The radiologist determines that whatever is there is most likely benign, but recommends the patient returns in six months for a follow-up.
  3. The radiologist believes that there might be cancer and recommends a biopsy, which could happen that very same day in some cases.

Is there anything you can do to avoid a call back?

Radiologists like to compare current mammograms with mammograms from previous years. It’s actually common to get called back after a first mammogram, simply because the doctor doesn’t have anything to compare it to, Dr. Reddy said. If you’ve recently moved or are changing doctors, Dr. Reddy recommends that you make sure your previous mammograms, if you have them, are sent to your new doctor, so they have a baseline to start from.

If you get the dreaded call back, what should you do?

“Don’t freak out,” Dr. Reddy said. “Normally, what I try to tell patients is when you get called back, take it one step at a time.”

Schedule your follow-up diagnostic as soon as you can, so it’s not weighing on you, she said.

“It creates a lot of anxiety,” she said. “It’s a very tearful experience for some people, but the waiting is the worst part.”

And, about those tears, don’t worry about getting emotional with the radiologist. It’s pretty common.

“We understand,” Dr. Reddy said. “It’s all we do. Everybody has a family member that has had breast cancer. My mom was just diagnosed with breast cancer two years ago. We all know and are very sympathetic and just want to help.”

If it is cancer, what should women keep in mind?

“It’s very treatable and manageable,” Dr. Reddy said. Regular mammograms can catch breast cancer at an early stage. And early stage breast cancer isn’t usually treated with chemotherapy.

“I know it’s very stressful, us telling women that everything will be fine,” Dr. Reddy said. “It’s so hard when you’re in the moment. I personally feel bad when I’m calling people back. … We really are trying to catch things early. And that’s just really the most important thing. If we can treat something with just surgery and radiation, which is the most common treatment, and have it to be considered cured, we would rather catch it early.”

What should women do all year to monitor their breast health?

Daily self exams are so important, Dr. Reddy said. Set a certain time during the day, maybe while you’re in the shower, to check yourself. If you feel a change, bring it to someone’s attention, she said. “Don’t be embarrassed,” she said. “You are your own best health advocate. It’s important to bring to someone. We don’t judge.”

And don’t delay your annual mammogram, which is recommended for women ages 40 and up and earlier for women with family members who had cancer before the age of 50.

At the start of COVID, Wake Radiology was closed from March to May. And even now that its offices are open, some women, Dr. Reddy said, are opting to simply skip their mammogram for a year because of worries about COVID. But they’ve already seen some women whose cancer could have been caught more quickly if they had chosen to come in earlier this year. At Wake Radiology, just like at doctor’s offices across the region, they’ve added a lot of new precautions to keep everybody safe. Face masks are required, there’s no more waiting in the waiting area and most providers have been vaccinated.

“We want you to come in now,” she said. “It’s just important for everybody to return to care.”