The 'Why' & 'What's Next' Behind a Callback

First things first: most women who get called back after a routine screening mammogram do NOT have cancer. In fact, fewer than 1 in 10 women called back for more tests are found to have cancer.

Nonetheless, getting that call can be unnerving. It’s important to remember that diagnosis of cancer cannot be made from a mammogram alone. That means the reason for the call is never to tell you that you have cancer but rather, that more imaging is needed.

Despite all the advances in digital and 3D imaging used in mammograms, the resulting images aren’t always clear. Some common—and unconcerning—reasons for that include:

Dense breast tissue: unrelated to the size of your breast, dense breast tissue just means there is a lot of fibrous and glandular tissue that make it hard to see the entire breast during an image review.

Calcifications: calcium deposits within breast tissue—calcifications—appear as white spots or flecks on a mammogram. Calcifications are common on mammograms, especially with patients age 50 and over.

Cysts: breast cysts are fluid-filled sacs within the breast, which are usually non-cancerous. While they can occur at any age, they develop most often in pre-menopausal women, typically under the age of 50. It’s not uncommon for screenings to reveal one or multiple cysts in a breast.  

It’s important to note that callbacks are common after a first mammogram as there’s no previous mammogram with which to compare to the new imaging. Callbacks are also more common in women who haven’t gone through menopause.

The purpose of a callback is to set you up for additional imaging, most often in the form of a diagnostic. This type of mammogram is performed just like your annual, or screening mammogram, but frequently with more images taken to ensure any areas previously obscured or of concern can be examined more closely.  

In some cases, ultrasound imaging may also be recommended. Particularly helpful for imaging dense breasts, ultrasound can provide more information and detail about small areas of interest within the breast that may be difficult to see on a mammogram.

Patients who undergo a diagnostic mammogram or ultrasound all receive a call from SVHC’s Breast Health Navigator (BHN) within 24-48 hours of their procedure.

In addition to sharing the results, the BHN provides education and resources on issues related to breast health (e.g., breast density, calcifications, etc.).

In some cases, the results of a diagnostic mammogram or ultrasound may be deemed ‘probably benign finding.’ While this may sound alarmingly vague, in 98% of cases, the finding is benign (noncancerous). But to be sure, patients with this finding are typically called back for another mammogram in six months to be certain there aren’t any changes to the questionable finding. The BHN will arrange for this follow-up and guide patients through the process.

If the diagnostic imaging reveals a ‘suspicious abnormality,’ the BHN, working under direction from the radiologist, will set up a biopsy appointment for the patient and explain what to expect at the roughly 20-minute procedure—including consult time with the doctor.

Again, as alarming as a callback for a diagnostic mammogram and/or ultrasound sounds, they are an essential tool for monitoring your breast health and staying ahead of any issues that may arise. Diagnostic imaging is no more invasive or time consuming than annual screening mammograms. But more importantly, they provide a peace of mind that can’t be over appreciated.

Seline Skoug RN, MS, is the breast health nurse navigator at the Breast Health and Imaging Center at Southwestern Vermont Medical Center. To contact, please email: breastRNnavigator@svhealthcare.org.