5 reasons you might get called back after a screening mammogram

If you’ve ever been asked to come back for additional testing after a routine mammogram, you know that the experience can be nerve-wracking. What did the radiologist find? Does this mean you have breast cancer?

The good news: most irregular findings turn out to be nothing, and additional testing is often a precautionary measure. 

But to better understand why you’re being called back, here are five terms you might be given as the reason.

Focal asymmetry

Focal asymmetry is the most common reason for needing a repeat mammogram. It describes an abnormality or small area of concern in your breast.

Breasts are made up of glandular tissues, fat, blood vessels, and fibrous tissues that hold everything together. Changes of density in one of these could be so subtle that they don’t quite meet the criteria to be called a mass, a cyst or any other type of nameable lesion. But they still need a closer look.

Based on data from the 1990s, up to 3% of all women have at least one area of focal asymmetry in their breasts. But with the increased sensitivity of current imaging, that figure is much higher today.

Radical scar appearing

If you haven’t had surgery or been in an accident recently, this term might sound pretty alarming. But scar tissue can occur naturally, for no good reason.

Scar tissue may also be the result of a surgical procedure, of course, such as a breast biopsy or a mastectomy. But it’s not always the result of trauma.  

Global asymmetry 

Doctors aren’t surprised when one of your breasts is slightly larger than the other. Minor size differences are totally normal. So, needing a “C” cup on one side and maybe a “C+” cup on the other is nothing unusual.

But if a radiologist notices a large area of increased density in a particular portion of your breast, there’s a higher risk of something brewing there. Volume differences are expected. Changes in density are more concerning.

Calcification pattern changes

Tiny deposits of calcium develop naturally in breast tissue over time. Called “calcifications,” they look like tiny white specks on a screening mammogram. 

But breast calcifications are more common in women over age 50, and changes in their patterns can be a sign of early ductal carcinoma in situ (DCIS), or stage 0 breast cancer. So, if you’re younger than 50 and your radiologist notices calcification pattern changes between your last mammogram and your most recent one, you might need an ultrasound or other additional testing.

Even if you are over age 50, if doctors notice a change in a previously seen calcification, it may require another look to make sure nothing more is brewing.

If this is your very first screening mammogram, on the other hand, and it shows unusual calcification patterns right away, your doctor may just order another mammogram in six months. This is to make sure the pattern is normal for you and that nothing is growing rapidly. 

Architectural distortion

Architectural distortion is a term most often seen with inflammatory breast cancer (IBC) and lobular carcinoma. As the name suggests, it indicates a change in the actual structure of the breast. On imaging, it looks like someone is pinching a napkin or pulling down a curtain. 

This condition can be the result of a previous surgical procedure. But in IBC and lobular carcinoma, it can also be a sign of inflammation. In these cases, the cytokines created by the body to fight the cancer are weighing down the tissue, creating distortions in its appearance.

Remember the purpose of screenings: to avoid missing anything

It can be alarming to get a call from your doctor, saying you need to come back for additional tests or scans after a routine mammogram. But only about 5-10% of mammogram callbacks result in a breast cancer diagnosis. That means more than 90% of the time, this call results in nothing in the end.

It might help to think of it this way: If your regular doctor notices your blood pressure running high during your annual physical, he or she will likely say, “Let’s check it again another time, so we can see if something is going on.” 

They won’t rush to diagnose you with hypertension or prescribe medication because your first high reading is a single data point. Instead, they’ll probably ask you to start measuring your blood pressure at home and keep a log, or come back in a few weeks for another reading.

Mammograms are slightly different, but the idea is the same. The purpose of any screening protocol is to make sure we’re not missing anything. So, try not to be too concerned if you get called back; you might just need a single follow-up.

Bora Lim, M.D., is a medical oncologist who specializes in the treatment of inflammatory breast cancer.   

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