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Abnormal Mammograms Often Terrify Women Unneccesarily

A dear friend of mine sent me a panicked, cryptic email late on a Friday night: “call me immediately” (followed by her cell phone). As a doctor, I usually know that these kinds of requests are triggered my medical emergencies, so I anxiously picked up the phone and called my friend, hoping that I wasn’t going to hear some alarming story about a tragic accident.

And low and behold the story was this: “I got home from work late and picked up the mail. There was a letter in there from the radiologist’s office. It said that my mammogram was abnormal. Do you think I have breast cancer? Am I going to die?”

Remaining calm, I asked what sort of abnormality was described. She read the letter to me over the phone:

“Dear [patient],

Your recent mammogram and/or breast ultrasound examination showed a finding that requires additional studies. This does not mean that you have cancer, but that an area needs further evaluation. Your doctor has received the report of your examination. Please call us at XXX to schedule the additional examinations.”

I knew immediately that this was a form letter (heck the letter didn’t even distinguish between whether or not my friend had had a mammogram or an ultrasound) and it made me angry that it had frightened her unnecessarily. I knew that as many as 40% of women who have mammograms have some sort of “finding” that requires further testing. Usually it’s because the films are too dark or too light, the breasts are particularly large or dense, or there is some cyst, calcification, lymph node, or shadow that the radiologist picks up. And in a litigious society, a hint of anything out of the ordinary must be reported as an abnormal “finding” until proven otherwise.

I did my very best to reassure my friend – to tell her that if the radiologist were truly concerned about what he or she saw on the mammogram s/he would have called the physician who ordered the test right away. Receiving a vague letter like this is reassuring, because it’s an indication of a low index of suspicion for a malignancy. I also told my friend that if a true mass were found on the mammogram, that a biopsy of that mass still has an 80% chance of being normal tissue.

But even though I did my very best to reassure her, my poor friend didn’t sleep well that night, and worried all weekend until she could speak to her physician on Monday. As I thought about her experience, and the unnecessary fright that she was given… I began to wonder about how common this experience must be. How many other women out there have lived through such anxiety?

Personally, I think that women who get mammograms should be warned up front that there is a high chance that the radiologist will find something “abnormal” on the test, and that these abnormalities usually turn out to be any number of typical breast characteristics. They should be told not to worry when they receive a letter about the abnormality, but come back for further testing in the rare event that the finding is concerning.

I decided to do a little research about this phenomenon (women receiving scary letters out of the blue about their mammogram results) and interviewed Dr. Iffath Hoskins (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) about her experiences.

Please listen to the audio file for the full conversation. I will summarize her opinions here:

Q:  How common are abnormal mammograms?

Mammograms are considered “abnormal” in some way in up to 40% of cases.

Q:  What sorts of things are picked up as abnormal without being true pathology?

Overlapping tissues in women with larger or heavier breasts, fibrocystic breast tissue, calcium deposits or the radiologist doesn’t have the last mammogram to compare the new one to and sees some potential densities.

Q:  What happens next when a woman has an abnormal mammogram?

It may take a week or two for the patient to get scheduled for follow up tests. Usually the physician will choose to either repeat the mammogram with targeted views of the area in question, request a breast ultrasound, biopsy the mass, or remove the concerning portion of the breast tissue surgically.

Q:  When would a physician choose a biopsy?

A biopsy is indicated if the mammogram and follow up tests all are consistent with the appearance of a concerning lesion. Sometimes the physician will do a biopsy on a lump if a woman says that it’s unusual, new, or tender and the mammogram result is equivocal.

Q:  What percent of biopsies confirm a malignancy?

It varies from physician to physician because some have a lower threshold for performing biopsies (so therefore the percent of biopsies that are malignant is lower). But on average only 10% of biopsies pick up an actual cancer.

Q: What does a radiologist do when he or she finds an abnormality on a mammogram?

First of all, the patient must be notified of the abnormality. Secondly, the radiologist reports the abnormality to the referring physician, usually by fax. They do it either in batches, or one at a time. If the person reading the film has a serious concern about the breast tissue – or if it appears to have the characteristics of a malignancy, the radiologist will personally call the referring physician right away.

Q: What advice would you give to a woman who receives a letter in the mail indicating that she’s had an abnormal finding on her mammogram?

Please try not to be concerned yet. Wait for the doctor to fully evaluate the mammogram and do further testing before you make any assumptions about the diagnosis. Although it’s almost impossible not to feel anxious, you must understand that the vast majority of “abnormal findings” on a mammogram are NOT cancer.

Listen to the full interview here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.


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13 Responses to “Abnormal Mammograms Often Terrify Women Unneccesarily”

  1. Anonymous says:

    I’m sorry to disagree with your assessment, but I must encourage women to be concerned, and to find out exactly what’s being seen on their mammogram.

     I had an “abnormal” mammogram for two years, and was requested to come back at six month intervals.  I never saw a radiologist — only received a form letter.  My primary care doctor indicated that if I was worried about these “abnormal” mammograms, I should get genetic testing.  (She was receiving the actual reports.) The fourth mammgram was rated as fibrocystic disease, and I was instructed to return to normal screenings.  At the next “normal” screening, I was diagnosed with bilateral breast cancer (cancer in both breasts).  The lesion originally seen as “abnormal” had tripled in size.  No biopsy or aspiration was ever recommended.  Certainly, many abnormal findings are not cancerous.  However, whenever there is any question, a biospy (or needle aspiration) should be recommended.  Otherwise, as in my case, the possiblity for early deduction of breast cancer, and the related improvements in treatment options and survial, are lost.

  2. bwatson says:

    I AM A 45 YEAR OLD FEMALE. I DID A MAMOGRAM LAST JANUARY 2007, AND MY RESULTS  SHOWED THAT I HAD A CYST THAT WAS 1CM IN SIZE. I ASKED THE DOCTOR TO REMOVE IT BUT I WAS TOLD THAT THE CYST WON’T GROW. NOW A YEAR LATER, MY CYCST GREW FROM 1CM TO 3CM. NOW I HAVE DUCTAL CARINOMA IN SITU (DCIS) CANCER. I HAVE TO HAVE A BILATERAL MASTECTOMY. SO WHEN THOSE LETTERS TO COME TO YOU, YOU HAVE TO BE CONCERNED, I WISH I HAD. I WOULD HAVE PROBABLY CAUGHT THE CANCER EARLY.

  3. Anonymous says:

    After being diagnosed with calcium deposits in one breast, I was advised by the radiologist to get a biopsy. After consultation with a surgeon, he agreed and a needle biopsy was schduled.  I requested anasthesia for the biopsy. It was turned down, the reasons given were that I had to be awake and the procedure would be fast and about as painful as a bee sting.  They all lied. The procedure was extremely painful and barbaric. I was literaly pinned to a table on my stomach with my breast passed through a hole. The procedure, which I sensed to consist of 4 or 5 needles directly into my breast,  took more then one hour and was the most painful experience of my life.  Since I did not provide any assistance during the procedure, why was I not anesthisized and why was I lied to on the pain and duration the test would require.  

  4. jenbini says:

    I just had a mammogram this past tuesday 1 day after my 36th birthday.  Wednesday I get a call from some radiology clinic saying there is an abnormality and I need to come in as soon as possible for further tests.  I go next Wednesday and am scared to death.  The clinic that called me is not who did my mammogram, and my Dr. hasn’t called me yet.  DO I have reason to be concerned.

  5. ValJonesMD says:

    Dear Jenbini,

    I can certainly appreciate your feeling anxious about this – but please keep in mind that “abnormalities” on mammograms are VERY common and include everything from “shadows” to an “incomplete visualization of the breast tissue” to normal dense breast tissue, to small cysts. As a young woman the odds are certainly on your side that this will amount to nothing serious. However, you should certainly follow up with the radiologists as they requested. Stay positive and don’t worry yet… Good luck!

  6. PAMELA ALBERTSON says:

    I had my yearly mammo a couple of weeks ago and was called back. I went back on 7/18 for repeat, and then u/s. I am so scared. I have been referred to a breast surgeon for bx. I go tomorrow for consultation. The findings showed:

    Imag Rpt: DIAGNOSTIC LEFT MAMMOGRAM & DIRECTED LEFT BREAST ULTRASOUND

    Pamela Albertson 061430 07/18/2011

    HISTORY: Add-views for new calcs.

    REQUESTING PHYSICIAN/PROVIDER: H. Paige Fisher, M.D. (Arlington)

    FINDINGS: This study is CAD assisted. Left mammogram demonstrates a moderately dense stroma. At 12 o’clock in the left breast, a 4 mm cluster of polymorphic microcalcifications is seen with an associated soft tissue density of 15 mm. No nipple inversion nor abnormal axillary lymph node is seen.

    False-negative rate for mammography is about 15%, and a negative mammogram report should not deter further evaluation of a clinically-suspicious area.

    DIRECTED LEFT BREAST ULTRASOUND

    FINDINGS: Real-time imaging reveals at 1-2 o’clock an 8 mm nodular density with one area of shadowing, which may correlate with the mammographic finding. Surgical consult is recommended.

    ASSESSMENT: Suspicious for malignancy (BI-RADS 4C)

    RECOMMENDATIONS: Surgical consult is recommended.

    Results discussed with the patient and given to Dr. Fisher at 3:30 p.m. on 07/18/2011.

    MT/lwb 7/18/2011 3:44:09 PM

    SECOND SIGNATURE NOTE TO: H. Paige Fisher, M.D.

    Signed by Marcia Thompson MD on 07/18/2011 at 4:09 PM

    Signed by H Paige Fisher MD on 07/18/2011 at 4:29 PM
    ________________________________________________________________________
    refer to Dr. Habal for left breast calcifications

    LAST YEAR – APRIL 2010 SHOWED:
    PRIOR STUDY COMPARISON: 07/05/2006 and 06/01/2005, bilateral screening mammograms. Digital screening mammogram dated 04/13/2009.

    Scattered fibroglandular densities are seen in the breasts. Stable small nodular density in the left subareolar region and focal asymmetric density in the inner left breast. No evidence of skin thickening or retraction. Small benign-appearing calcification in the left breast.

    ASSESSMENT: Benign finding (BI-RADS 2)

    RECOMMENDATIONS: Routine yearly screening mammogram.

  7. Deborah Lonergan says:

    If my breast imaging facility had a 40% recall rate I would RUN (I said RUN) to another facility. The national average is around 10-12% and that often includes the need to obtain previous images not just clinical recalls. If a facility is running that high of a percent they either have inexperienced physicans, poor imagers or a very high risk clientele. At our facility all patients receive a verbal explanation of the interpretation process and we provide a written copy of the same. We call our patients before they would receive this type of information in a letter and most patients are scheduled for their recall imaging exam in 24-48 hours of interpretation.

  8. Mizz Concerned says:

    How come women don’t meet personally with a face to face consult with the radiologist? After all, it’s the radiologist who is making the frontline decision, i.e. Birad scores, recommendations to biopsy which is invasive, and in my case, neither the surgeon nor my own physician have had either the ability, time or inclination to sit down with me and actually review the mammogram and ultrasound films even though I got them from medical records. I feel there’s a lot of buck passing going on here while the radiologist hides behind a door somewhere. That b.s. needs to stop, and I intend to stop it.

  9. Helen Huff says:

    Too Deborah Lenegran… Amennnn!!! N too Mizz Concerned.. Amen n go gettem! Where is this state wise I mean? I am having problems here too long story when have time put it up. But sad part is my mom had bilateral breast cancer when she was in late twenties n she survived it thank God. But died this last march of other causes. N my sister had one breast taken off at age 42 n has survived it so far. So mine being abnormal more than once I am terrified. N Dr here not worth crap. But one thong I can say is too the ones with cancer don’t give up the fight. I have seen n known many survivors. Good luck n God Bless all!!

  10. KAY says:

    I’ve been getting breast ultrasound for 15years because I don’t do mammograms…I’ve had fibriods and this time although one of the fibroids had disappeared at 10:30….I now have a small suspicious tissue at 10 oclock…..So now they want me to do a mammo and then a biopsy….I cannot believe they want me to do a Mammo….What would a Mammo prove….it’s the ultrasound that shows the best results…If anything an MRI is the way to go next….

    I’m 72 and not wanting to do anything..because I believe it’s just a calcium accumulation…and I would like to wait 6 months and take another breast ultrasound to see if there are any changes….and then make the decision to see a Breast Surgeon to discuss this further……

    Need some feedback from someone……thanks,
    …..

  11. Jill says:

    I appreciated finding this particular blog. I too received the “letter” and am going in for a diagnostic mammogram in one week. I had brain cancer treatment five years ago, so my fear was some sort of metastacy. I was told brain rumors do not metasticize from the brain down, but can from the body up…..I started fearing all of the “what if” scenarios. Now that I have read this blog, I can remain calm until next week and sleep more soundly.
    Thank you

  12. Jeff says:

    My wife had her first mammogram this week and guess what, yep that’s right; the radiologist reading was that the exam was abnormal and further exams were required. Being an RN, my wife was able to speak directly with the radiologist who is saying that it is probably nothing. I have to be honest,,,,,I am freaking out. I am an RN as well and over time have become numb to certain things in life. I have seen the best in people and have seen the worst in people. I am so scared.. My wife has had two mammograms and an ultrasound and will have the needle biopsy within one week. All of this in less than one week. I am very scared…

  13. Sunshine says:

    Hi guys
    I too have had “normal mammo” for the past 7 years. Always normal… Last year they saw a cyst on my left breast .. Birads 3 6 months follow up. Guess what? After 6 months my cyst is still there and after doing CAD radiologist told me that I have extremely dense breasts.. 75% or more and looking for cancer thru mammo a for me is useless like looking for snow bear in a snow storm. Abnormal mammo. Went to see breast surgeon on my own , contact dr Nancy Capello ( areyoudense.org) she motivated me to seek second opinion.. She asked for bilateral Mri… 3 areas of enhancement (2 left 1 right)pay mri out of my pocket (my insurance did not pick up even having strong family history of bc 1 aunt and 2 sisters and extremely dense breasts) did ultrassound… 3 lesions found! Radiologist contacted my doctor… Having 2 ultrassound guided biopsy tomorrow and 1 on Thursday. I am a nerve wreck right now and yes ladies please check your density with your radilogist because if I find out that I have cancer I swear that I will be very disappointed at my radiology facility and my obgyn that ignored me when I told them about my density
    Good luck to you all

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