Abnormal Mammogram Results: What They Mean and What Happens Next

Getting a call back after a mammogram can be unsettling. But an abnormal mammogram does not automatically mean you have breast cancer. In fact, many abnormal screening results turn out to be benign. Often, radiologists simply need additional information, such as more detailed images or an ultrasound, to better understand a finding seen on your screening mammogram.

Understanding what an abnormal mammogram means, what happens next and when to seek additional care can help you feel more informed and confident throughout the process.

No. One of the most common misconceptions about mammography is that being called back for additional imaging means cancer has been found. In reality, an abnormal screening mammogram simply means the radiologist needs more information before determining whether a finding is benign or needs further evaluation.

"Most of the time, getting called back does not mean you have cancer," says Rebecca Seidel, MD, a breast imaging radiologist at Emory Healthcare. "It means we need more information."

About 10% of patients who have a screening mammogram are called back for additional imaging. Most of those callbacks do not result in a cancer diagnosis.

While waiting for additional testing can be stressful, it's important to remember that screening mammograms are designed to identify even subtle changes that may warrant a closer look.

When a screening mammogram shows an area that requires a closer look, the radiologist will recommend additional imaging.

Common reasons for a callback include:

• An area of asymmetry, where one area of breast tissue looks different from the surrounding tissue

• Calcifications, which are tiny calcium deposits within the breast

• A possible mass that needs further evaluation

• An area that may simply require additional views to better visualize normal breast tissue

According to Jennifer Wrenn, MD, an OB/GYN at Emory Healthcare, one of the most common callback findings is asymmetry.

"It simply means that when you compare the breasts side by side on the imaging, one is a little bit asymmetric to the other, and they just need to dig further to make sure that it isn't something clinically relevant," Dr. Wrenn says.

Many of these findings turn out to be normal breast tissue or benign changes.

If you read your mammogram report, you may see a term called BI-RADS, which stands for Breast Imaging Reporting and Data System. It is a standardized system radiologists use to describe what they see and recommend the next steps.

A BI-RADS score is not a diagnosis. It simply helps your healthcare team communicate whether additional follow-up is needed.

Understanding your BI-RADS score

For patients who receive a callback after a screening mammogram, the most common result is BI-RADS 0, which simply means additional information is needed. It does not mean cancer has been diagnosed.

The next step is typically a diagnostic mammogram, an ultrasound or both.

Unlike a screening mammogram, which takes the same standard images for every patient, a diagnostic mammogram focuses on a specific area that needs a closer look.

For example:

• Calcifications may be magnified for closer evaluation.

• Areas of asymmetry may be compressed using special views to spread overlapping tissue.

• A mass may be evaluated with ultrasound to determine whether it is solid or fluid filled.

Ultrasound provides information that mammography cannot.

"Using ultrasound, we can tell if something is cystic or solid," Dr. Seidel says. "If something is just water, it's a simple cyst, and that's benign."

After additional imaging, several outcomes are possible:

• The finding is determined to be benign and routine screening resumes.

• The finding is considered probably benign and short-term follow-up imaging is recommended.

• The finding is suspicious and a biopsy is recommended.

No. A biopsy is a tool used to gather more information and establish a definitive diagnosis.

Even when additional imaging suggests a biopsy is needed, many biopsies reveal benign findings.

"Even if you're getting a biopsy, it still doesn't mean you have cancer," Dr. Seidel says. "It just means that we need more information."

Most breast biopsies today are minimally invasive procedures performed using image guidance and a needle rather than surgery.

If cancer is diagnosed, finding it through screening often leads to better outcomes.

"Cancers that are found on screening are the most treatable cancers,” says Dr. Seidel. “They're typically found when they're small, when they haven't spread outside the breast and when they're curable.”

Breast density is one of the most important factors affecting how easily a mammogram can identify cancer.

Dense breast tissue appears white on a mammogram. Breast cancers can also appear white, making them more difficult to detect.

Dr. Seidel compares it to finding a snowball in a snowstorm versus finding a snowball on a sunny day.

Dense breasts are common. While breast tissue often becomes less dense with age, many women continue to have dense breasts throughout their lives.

Patients with dense breasts should not assume mammograms are ineffective.

"We find breast cancer in people with dense breasts all the time," Dr. Seidel says.

However, dense breast tissue may lead to conversations with your healthcare provider about additional risk assessment and, in some cases, supplemental screening.

For some patients with extremely dense breasts, additional risk assessment may be recommended. If their lifetime breast cancer risk is elevated, supplemental screenings such as breast MRI may be considered.

Regular mammograms help detect cancer early but annual women’s wellness visits help ensure you're doing everything possible to protect your breast health throughout your life.

This annual check-up with your OB/GYN gives you an opportunity to review your overall health, discuss any changes in your personal or family history and make sure your screening plan still meets your needs.

"One of the most important thing about the annual exam is getting to know the patient and reviewing whether any risk factors have changed," says Dr. Wrenn.

During a wellness visit, your provider can discuss factors that may affect your breast cancer risk, including:

"Breast health is not just about your mammogram,” says Dr. Wrenn. “It's about understanding your individual risk, recognizing changes and having a healthcare team that helps you make informed decisions throughout your life.”

Staying current on mammograms, paying attention to changes in your breasts and maintaining a relationship with your OB/GYN can help ensure that any concerns are evaluated promptly and that your breast cancer screening plan evolves as your health needs change.