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October's Wellness Topic: Reducing Risk and Living with Cancer
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Amy Lee, NP
Reducing Risk and Living with Cancer

Reviewing the Mammogram
by Amy Lee

I went in for my routine mammogram last year because I'm over 40. The American Cancer Society recommends that low-risk women (no family history, no genetic mutations or certain specific syndromes, and no history of chest radiation) begin getting their yearly mammogram screenings at the age of 40.

The U.S. Preventive Task Force doesn't recommend that women begin screening until age 50, and then just every 2 years — but I decided to begin at 40, even though I'm low risk.

I expected everything to be clear and normal in my x-rays and so was surprised when I got the call to return for further testing. This is why I decided to use this blog to review the topic of mammogram results and their follow-up recommendations.

Mammogram results

Routine mammograms for those women without any symptoms are called screening mammograms. They take very basic x-ray views of the breast and then an expert radiologist looks at these images for any areas of suspicious changes that could be cancer. Each woman's mammograms are then categorized based on the findings:

  • Category 0: Additional imaging needed
  • Category 1: Negative, continue routine screening
  • Category 2: Benign finding, continue routine screening
  • Category 3: Probably benign finding, initial short-term follow up
  • Category 4: Suspicious abnormality, usually requires biopsy
  • Category 5: Highly suggestive of malignancy, requires biopsy or surgical treatment
  • Category 6: Known biopsy-proven malignancy

What's next?

Usually, if the screening mammogram is suspicious, additional imaging will be recommended. That imaging will focus directly on the area that is of concern. Some types of additional imaging:

  • A diagnostic mammogram may be done while the breast is compressed. This is very similar to the screening mammogram except with many more pictures.
  • An ultrasound may also be done to look directly at the area. Here, a technician will apply gooey jelly on the surface of the breast and then will run a probe over the area in question.
  • An MRI (magnetic resonance imaging) can also be used to evaluate suspicious lesions and in high-risk women.
  • Biopsy. If imaging is still suspicious, the area might be recommended for biopsy. During biopsy, a needle will remove tissue from the area, or the tissue may be removed by a surgeon. The tissue can then be evaluated for cancer. If there is cancer, then the woman would be referred for treatment.

Don't panic

Being called in for more breast imaging is not anything to panic over. On the contrary, most follow-up imaging will be reassuring. If you need to have a biopsy, about 80 percent of breast biopsies will not be cancerous. If you do have breast cancer, however, early diagnosis is critical to successful treatment. So make sure to get your mammograms and, if you get called back, go in! My follow up was fine, by the way. And now it's time to do it all over again!

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