AARP Hearing Center
Naomi Elliott
It’s the phone call — if not message in your patient portal — nobody wants: Your mammogram showed an area of concern that needs further evaluation. Schedule an appointment for additional imaging.
Your heart skips a dozen beats. A tidal wave of panic washes over you. Your mind leaps to the worst-case scenarios ahead. But here’s what a so-called “abnormal mammogram” fails to make immediately clear: It’s common, and more often than not, the area of concern is found to be noncancerous. In fact, fewer than 1 in 10 women called back for additional tests are diagnosed with breast cancer.
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Follow-up scans usually end up clarifying something the first image couldn’t fully show, such as dense breast tissue, an overlapping shadow on the X-ray, scarring from prior breast procedures, or a benign (noncancerous) cyst — something that’s especially common with age and hormonal changes.
“There are many benign things that can happen in the breast over the course of a woman’s lifetime,” says Dr. Rachel Freedman, a medical oncologist in the breast oncology center at Dana-Farber Cancer Institute in Boston. “When radiologists review mammograms, they are looking for abnormalities that can include masses, something called distortion (when the breast tissue has an irregular pattern) and certain types of calcifications. Radiologists are trained to tell the difference between what is normal and what is abnormal.”
Even though the overwhelming majority of callbacks result in noncancerous findings, it’s still important to determine what’s causing the suspicious areas on your mammogram.
Who’s likely to receive an abnormal mammogram?
An abnormal mammogram — also called a false-positive — is more common among younger women, women with dense breasts, those who’ve had previous breast biopsies and women with a family history of breast cancer. But anyone can receive a false-positive.
Indeed, the more times you’re screened, the greater your lifetime chance of experiencing at least one false-positive. A study published in 2022 in JAMA Network Open suggests that more than half of women in the U.S. who are screened annually for 10 years will experience a false-positive result; many of them will have a biopsy as part of their follow-up testing.
For some women, that process of ruling out cancer can take up to two years. Not surprisingly, that can take a toll.
“Most patients have image-guided biopsies with local anesthesia and often say that the anxiety was far worse than the biopsy itself,” says Dr. Laurie Margolies, vice chair for breast imaging at Mount Sinai Health Service in New York City.
In a large study, published in 2024 in Annals of Internal Medicine, researchers looked at 3.5 million mammograms from about 1 million women and found that those who received false-positive results were significantly less likely to return for routine screening.
What to expect if your mammogram shows something abnormal
“If a screening mammogram raises a question, the next step is usually a diagnostic evaluation, which may include additional mammogram images and/or a breast ultrasound,” says Dr. Stephen J. Seiler, medical director of breast imaging at UT Southwestern University Hospitals and Clinics in Texas.
Most of the time, these follow-up tests show normal or benign findings, he says. “Sometimes the radiologist may recommend short-term, follow-up imaging in about six months to make sure the area remains stable. These findings rarely turn out to be cancer.”
If something appears more suspicious, a biopsy may be recommended to determine exactly what it is, Seiler adds.
Follow-up tests include:
Diagnostic mammogram. This is usually the first step after an abnormal screening mammogram. Unlike a routine screening mammogram, which takes standard images, a diagnostic mammogram “will magnify a certain area in the breast or take more focused pictures” of the suspicious area, Freedman says. These extra images allow the radiologist to zoom in and determine whether the finding is benign, like overlapping tissue, or needs further evaluation.
Breast ultrasound. An ultrasound, which uses sound waves rather than radiation to create images of breast tissue, is commonly used to determine whether an unusual spot on a mammogram is a breast mass or calcification, Seiler says.
“A mass can be either a fluid-filled cyst or a solid lump,” he explains. “Calcifications are tiny calcium deposits that appear as small white dots on a mammogram. They can occur for many normal reasons in breast tissue.” Most are harmless, Seiler adds, “but certain patterns may require closer evaluation because they can sometimes be an early sign of breast cancer.”
Ultrasound is often performed during the same follow-up visit as a diagnostic mammogram. You’ll most likely get the results during the visit.
Breast MRI. If neither of the above provides answers, a breast MRI — which uses powerful magnets instead of radiation to create highly detailed images — may be recommended. Unlike a mammogram or a breast ultrasound, a breast MRI uses a contrast dye that’s injected into your vein (through an IV line) before the pictures are taken. This helps make any abnormal areas in your breasts easier to see.
Breast biopsy. If imaging shows “a mass or calcifications that the radiologist feels has a 2 percent or greater chance of being cancer, these findings are almost always recommended to be biopsied,” Margolies says.
During a breast biopsy, which is usually done on an outpatient basis, a small sample of breast tissue is removed and examined under a microscope to determine whether it contains cancer cells. Most biopsies ultimately show benign conditions rather than cancer.
“Each test has advantages and limitations,” Seiler says. “Discussing these options with a primary care physician or breast imaging specialist can help determine the best screening plan for that individual.”
Fewer callbacks
Although callbacks are common, advances in technology are making them less so. For one thing, older film mammography has largely been replaced by digital mammography and 3D mammography (or digital breast tomosynthesis), which produces a layered, three-dimensional views of the breast.
“3D mammography allows radiologists to examine the breast layer by layer, which helps detect more cancers, especially invasive cancers, and reduce callbacks for additional testing,” Seiler says, echoing the results of a study published in 2024 in the journal Radiology. “This improves the overall accuracy of screening.”
Artificial intelligence (AI) plays a role, too.
“AI for mammography is a major advance,” Margolies says. “It can find some subtle cancers that a radiologist might not have seen. And AI for breast ultrasound can provide decision support and allow [the radiologist] to safely follow some benign-looking masses rather than biopsy them.”
When an abnormal mammogram leads to a cancer diagnosis
The good news is that catching breast cancer early on opens up the possibility for more treatment options and better outcomes. According to the American Cancer Society, the five-year survival rate for women who are diagnosed before cancer spreads beyond the breast is about 99 percent.
“Breast cancer treatments are constantly evolving and becoming easier to tolerate,” Margolies says. “Advances have led surgeons to do smaller operations, oncologists to use easier-to-tolerate medications, and led many patients to be safely given shorter courses of radiation therapy.”
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