What do I do if I have an abnormal mammogram?

Keep breathing
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Sometimes the films just don't come out right and they need to repeat them.

The three most common "things" that radiologists see in mammograms that they want "worked-up" are:

  1. a new nodule
  2. an asymmetric density — (the breast tissue doesn't look the same in each breast)
  3. a new cluster of calcifications (little white specks)

The first 2 should have an additional spot compression film to see if it is real and an ultrasound to see if the area is fluid or solid and have a better look at its shape. Nodules that are irregular or spiculated (like a star) are more worrisome.

Calcifications should have special magnification views done of them which can help determine if they are normal or worrisome. Most calcifications are normal and associated with aging — not from taking too much calcium.

If someone tells you to wait 6 months and recheck it it is usually because they think it is benign. However, if you don't want to wait 6 months you have the right to ask for a second opinion.

If someone tells you you need to have something biopsied you should feel you have gotten your questions answered as to why, and that the mammogram has been worked up sufficiently. Someone should also examine your breasts and correlate them with the mammogram to be sure that nothing is palpable. Remember the point of getting a mammogram is to find lesions early and too small to feel.

Most breast centers today have equipment to biopsy mammographic findings with a needle and thus spare a woman a trip to the operating room. This is called a stereotactic biopsy or a mammotone-core biopsy. This type of biopsy has been shown to be as accurate as a surgical biopsy and much less invasive. I recommend you try to find a center which does these biopsies and does them frequently — our breast center does 2 to 4 stereotactic biopsies a day. 

Another way to biopsy is with ultrasound guidance — this is sometimes a bit easier because your breast does not have to be compressed. Most mammographic problems, except calcifications, can be identified on ultrasound. Most breast centers have accredited mammography and ultrasound units and specialized breast-imaging radiologists.

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