Abnormal or inconclusive scan or test? 5 things to know when the doctor calls

Thousands of people will get screening exams for breast cancer, cervical cancer and lung cancer this year. Others will get diagnostic tests or scans – such as chest X-rays – for other reasons. Some will be asked to come back for additional scans or testing.

If you’re one of those people, you might have some questions. For instance, what does it mean if your Pap test is “abnormal?” Why would your mammogram be considered “inconclusive?” And what else might be causing a “shadow” to appear on a chest X-ray?

Here are five things to keep in mind, if you get a call back from the doctor’s office that your results are abnormal or inconclusive.

1. Don’t panic.

The first thing to do is remain calm. While it may be alarming to learn you need additional testing, don’t automatically assume the worst. There are many reasons your doctor might have requested it. Here are some of the most common:

• Breasts: If this is your very first mammogram, your doctor may be trying to establish a solid baseline against which all future images can be compared. Dense breast tissue can also make it difficult to identify breast cancer with a regular mammogram. So, your doctor might request a 3D mammogram or an ultrasound to see additional detail.
• Cervix: An abnormal Pap test and/or positive human papillomavirus (HPV) test could be a sign of pre-cancerous changes in your cervix. But bubble baths, vaginal dryness, and intercourse can also cause cells to look distorted or atypical. Additional testing will help your provider clarify whether the initial test results are significant or if treatment is necessary.
• Lungs: “Shadows” in the lungs can be caused by respiratory infections, such as influenza, pneumonia or COVID-19, or by the scar tissue they leave behind. One such type of radiographic finding is known as “ground glass,” because that’s how it appears on scans: as hazy areas that are hard to see through, but not entirely opaque. Additional testing can help determine if one of these infections is the culprit for something unclear on a lung scan.

“Even among patients with a heavy smoking history, the vast majority of the spots we find on screening scans are not ultimately found to be cancers,” says pulmonologist Scott Evans, M.D.

2. The odds are actually in your favor.

Screening tests are designed to detect abnormalities in tissue, such as cervical dysplasia. Their purpose is to rule out cancer as a possible cause or to find it at its earliest stages, when it’s the most treatable.

So, getting called back for additional testing does not necessarily mean that you have cancer; it just means your doctors need more information to clarify what they’ve seen through a microscope or on an image.

“Less than 1% of Pap tests result in a cancer diagnosis each year,” notes gynecologic oncologist Kathleen Schmeler, M.D. “However, women with an abnormal Pap or HPV test may have pre-cancerous cells, which can be treated to prevent progression to cancer.”

3.  Next steps are mostly non-invasive.

Breasts: If you get called back after a screening mammogram, the first step is usually a diagnostic mammogram, which takes a more detailed look at your breast tissue. If additional imaging is needed, your doctor may order an ultrasound. Both of these are non-invasive procedures.

If a tissue sample is needed to make a final determination, a breast biopsy may be called for. But even then, it does not mean you have cancer.

“About 70% of women who have a breast biopsy will NOT be diagnosed with cancer,” says Marion Scoggins, M.D. “Most breast biopsies turn out to be benign.”

Cervix: If a Pap or HPV test comes back abnormal, the next step may be a colposcopy: a simple, in-office procedure that doesn’t require anesthesia. Your doctor will place acetic acid on your cervix to highlight any concerning areas, then examine them more closely with a special instrument called a colposcope.

Anything unusual will be biopsied and sent off to a lab for interpretation. Depending on the results, your doctor may wish to schedule a loop electrosurgical excision procedure (LEEP), another in-office procedure in which a wire loop is heated with an electrical current and used to remove abnormal cells from the cervix, so they don’t progress to cancer.

Lungs: If a chest X-ray shows an area of concern in the lungs, most patients will have a CT scan to get a more detailed image of it. If additional testing is called for, the doctor may recommend a biopsy using a bronchoscope, surgery or a CT-guided needle to obtain tissue for examination under a microscope — but these are rarely necessary.

4. It’s OK to need support.

Most abnormal findings do not result in a cancer diagnosis. But it’s absolutely natural to experience scanxiety, so don’t hesitate to reach out if you need help in dealing with it.

Even if it’s only for moral support, ask a loved one (from your own household, during the pandemic) to drive or ride with you to the subsequent testing, or to sit in on the virtual doctor visits in which you’ll learn the results. Consider having them take notes, too, or even ask questions of their own if you think that might be helpful.

MD Anderson patients can also request a referral to one of our psychiatrists or social work counselors for help in managing their fears.

“Notice if your mind is jumping ahead or catastrophizing,” says psychiatrist Dr. Rachel Lynn. “If you feel your worries building, getting ‘too fast or too loud,’ try to take control back with some intentional breathing, slow and steady. You might also want to consider using one of the many relaxation apps available.”

5. Cancer caught through early detection is the most treatable.

If additional testing does lead to a cancer diagnosis, don’t despair. Screening exams are designed to give doctors the best possible chance of finding cancer early, when it’s the most treatable.

“The earlier we find cancer, the better the odds are of being able to cure it,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center. “That’s why we encourage people to start getting screened at the recommended ages, and then continue being screened regularly after that.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.