The phone rings after your screening mammogram. You need to come back for further testing. Your stomach drops. 

It is important to know that getting a call back for additional imaging after you had a screening mammogram doesn’t necessarily mean you have breast cancer.  It is also important to follow through with what your radiologist suggests doing next.  

Our expert WellSpan radiologist shares some reasons why you might get that call, and what to expect after you receive it. 

The call 

Remember that the point of a screening mammogram is to catch any abnormalities that could be a sign of breast cancer, says Dr. John Nawa, a WellSpan radiologist who has over 30 years of experience in reading mammograms. 

“Often, the call back is because normal breast tissue appears a bit different from a prior exam due to slight difference in positioning or to confirm that a new finding is definitely benign,” Dr. Nawa says.  

That is the reason you are getting the call: to take extra precautionary steps to ensure that there are no concerns. 

Even if you receive a call, the odds are in your favor.  Most women who get a call back (more than 90%) will not have breast cancer, according to the American Cancer Society.  

What might spur the call 

A radiologist will recommend a call back if they see: 

An abnormality or small area of questionable concern in your breast. This could be due to a group of calcium deposits or a mass. 

Increased density in an area of your breast. Radiologists are looking for these areas, which can be challenging when examining the mammograms of women who have naturally dense breasts. Advanced technology such as 3D mammography, available at all WellSpan mammography sites, is particularly helpful in evaluating these patients. 

An area of the breast that looks different than the rest of the breast or looks asymmetric. In general, the distribution of breast tissue in the breasts mirror each other.  This might be a more likely scenario with first-time mammogram patients, since they do not have any past imaging for comparison.  

A distorted area of the breast, a finding often seen from prior surgery. 

An area of interest highlighted by a new software product at WellSpan that uses Artificial Intelligence to help the radiologist identify a potential area of concern. 

 What happens next 

You may receive a recommendation for one or more of the following that will be discussed during your call: 

• A diagnostic mammogram to gather additional images of any area of concern. This might take a little longer than the screening mammogram because it may require more images from different angles and/or more magnified or targeted views. 
• An ultrasound, which uses soundwaves to produce images. This can help your radiologist tell the difference between a non-concerning cyst and a more concerning solid mass.  
• A breast MRI, which uses a high-powered magnet to create images of the breasts and is often used as a screening exam for high-risk patients but can also help clarify your mammogram findings.  
• CEM or Contrast Enhanced Mammography is becoming more useful as another option in place of MRI. This is a mammogram performed following the intravenous administration of contrast (the same contrast used for CT exams).
• A biopsy, which uses a thin needle to extract a small sample of your breast tissue. This will be examined by a pathologist to determine if cancer is present. A biopsy will only be recommended for about 10% of women who receive a call back.  

Typically, once these recommendations are completed, you’ll be given instructions about what to do next before leaving the imaging department. The vast majority of women receive instructions to return to screening mammography in one year to return for a six-month follow-up due to an area of very low concern (not requiring a biopsy).  

Focus on your health 

“Regular health screenings like mammograms can contribute to a long and healthy life.  And the technology is so good that we can detect cancer much earlier, when it is more treatable” Dr. Nawa says. 

In fact, one study showed that women who received screening mammograms on a regular schedule significantly cut their risk of dying from breast cancer compared to women who didn’t. 3D mammograms and our AI tool can increase the likelihood of detecting cancers and can help reduce unnecessary callbacks.  

“If you are called back, don’t panic. Most women will be told to follow up with a normal screening mammogram or a short interval follow-up,” Dr. Nawa says. “We are using every tool available to aid in the early detection of breast cancer. That is our passion and our focus.” 

Annual screenings save lives! Learn more about mammograms and schedule one here.