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Published on June 11, 2014

Abnormal Mammogram? Get follow-up testing, but don’t panic

SIOUX FALLS (June 1, 2014) The vast majority of women can button up their blouses after an annual screening mammogram, knowing they’re “done” for another year. Yet there are those few who get that call recommending follow-up testing.

If that happens to you, don’t panic. “According to the American Cancer Society, only about 10 percent of those who are called back need a biopsy, and of those biopsies, 70 percent are not cancer,” said Josie Alpers, MD, with Avera Medical Group Radiology Sioux Falls.

Patients can be quick to jump to conclusions, but there are many reasons why results of a screening mammogram need to be investigated further. “It could be overlapping, dense tissue. It could be a cyst or a fluid-filled pocket. If it is a mass or tumor, there are far more benign tumors than cancerous tumors,” Dr. Alpers said.

The first follow-up test will likely be a diagnostic mammogram, which involves additional images of the breast. Diagnostic mammograms are also ordered when a woman or her physician feels a lump, or there is localized pain in the breast.

A breast ultrasound is often conducted at the same visit as the diagnostic mammogram. “The ultrasound often will clearly indicate if the lump is a benign cyst or solid tumor,” Dr. Alpers said. If it is a benign cyst, no further testing is needed.

Contrast enhanced spectrum mammography, or CESM, is another imaging tool that may help evaluate whether the condition is benign or malignant.

For this test, patients have an injection of contrast prior to the mammogram. Through a combination of low- and high-energy X-rays, the contrast agent highlights areas where there is increased blood flow – a sign that’s associated with cancer.

If CESM indicates an area of suspicion, a biopsy is the next step. Most biopsies are performed using ultrasound as a guide. “We start with a 30-gauge needle, which is smaller than a flu shot,” Dr. Alpers said. The area is numbed locally.

If the area of suspicion is not visible on the ultrasound or involves calcifications, another option is a stereotactic breast biopsy. This test also involves a local anesthetic. The patient lies on her abdomen, while the breast goes through an opening on the table and is gently compressed between two plates to hold the breast in position. X-rays are used to produce stereo images – images of the same area from different angles – to determine the exact location of the biopsy.

Whenever a breast biopsy is performed, the physician will leave a clip, marking the area to indicate that it has already been biopsied, so it is not flagged on future mammograms. “The vast majority are benign – not cancerous,” Dr. Alpers said.

The more regularly a woman gets screening mammograms, the less likely she is to be called back, because radiologists compare past mammograms to present images, looking for changes. Women with dense breast tissue also tend to get called back more often. That tends to lessen with age, as the denser tissue is gradually replaced with fat.

“If you are called back for more testing, come back realizing that it’s probably nothing,” Dr. Alpers suggested. It’s not worth “borrowing trouble,” and becoming overly anxious. Even if you are one of the very few who is diagnosed with breast cancer, the disease is very treatable, and according to the American Cancer Society, five-year survival for localized disease is 99 percent.

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