How To Catch Breast Cancer Early: Stanford Doctors Explain Mammography Options
False-Positive Mammogram Results
Many women who get a mammogram will be asked to come back for further testing. But in most of these cases, there is no breast cancer.
By Debra-Lynn B Hook
Medically Reviewed by Lindsey Marcellin, MD, MPH
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No woman wants to hear that her routine mammogram results look suspicious for breast cancer and that further testing is needed. But for as many as 1 out of 10 women who will have a routine mammogram in the United States this year, that’s exactly what will happen.
The majority of these women will not have cancer, but rather will have experienced what is known in the medical world as a false-positive mammogram for breast cancer, resulting in anxiety and worry about whether breast cancer is present, not to mention additional tests and, sometimes, surgery. False positive refers to any mammogram that results in a woman getting a call-back for further testing, which ultimately turns out not to be breast cancer. In some cases, this is simply a request to come in for more mammographic pictures because the initial pictures weren’t clear enough.
“Mammography does fail women,” says breast imaging specialist Alice Rim, MD, vice chairwoman of the Imaging Institute and section head of breast imaging in the department of diagnostic radiology at the Cleveland Clinic in Ohio. “What we try to do is warn women — ‘This is a screening test. This is part of the process, and it's not a perfect process. It’s not a perfect test.”
A mammogram is considered a screening test because it can only point to abnormalities on the X-ray film that might be cancer. If something looks suspicious, then additional diagnostic tests will be done.
Further complicating the process is the complexity of reading a mammogram. Each woman’s breast looks different on a mammogram. A shadow on one woman’s breast may, upon further testing, end up being just that, while on another woman’s breast, a true mass is revealed, requiring further testing, such as a biopsy.
Why a False-Positive Mammogram Occurs
Situations that put a woman at greater risk for a false-positive mammogram include:
- Dense breast tissue.Dense breast tissue is most often seen in younger, pre-menopausal women; in pregnant or nursing women; and in post-menopausal women undergoing hormone therapy. The radiologist may not be able to see through the dense tissue on the typical two mammographic views per breast and may ask you to come back for additional mammogram views.
- Calcification.This is a tiny deposit of calcium within the breast tissue that looks like a small white spot on the X-ray film. A calcification can be an early indicator of a type of breast cancer known as DCIS, or ductal carcinoma in situ. Or it can be a benign calcium deposit that amounts to nothing more than a fibrocystic change in your breast, aging arteries, inflammation, or evidence of past injuries to the breast. Your doctor may ask for additional mammogram views to see if your calcification is benign, meaning its edges are round and smooth. If the edges are lacy and branched out, or if the calcification is a new finding after several years of uneventful mammograms, your doctor may want to do a needle biopsy, which involves inserting a needle to remove tissue or fluid for analysis. In some cases, particularly if the calcification is close to the chest wall, a surgical biopsy may be necessary, requiring the surgeon to make an incision in the breast and remove the abnormal area.
- Cysts or other masses.Cysts are benign, usually fluid-filled sacs, whereas a true breast cancer tumor is solid. The difference is not apparent on first glimpse. If your doctor sees any kind of mass on your mammogram results, you may be called back in for additional views; your breasts will be pressed down and viewed to see if the mass goes away, which means it was simply dense tissue. If your doctor still sees a mass, you may be asked to have an ultrasound exam, which can discern the difference between a fluid-filled sac and a solid tumor. Even then, an ultrasound may not be conclusive because not all solid masses are tumors. It may be a fibroadenoma, which is a benign (non-cancerous) tumor. But if your doctor sees a solid mass on your ultrasound, you may be scheduled for a biopsy. Sometimes a mass may be part solid and part fluid, and your doctor may want to repeat your mammogram in a few months to see if it’s changed.
Decreasing the False-Positive Odds
There will always be a certain percentage of false positives among women getting mammograms. But you can take steps to reduce your personal risk of false-positives by making sure your radiologist has all your past mammography films to use as a baseline for comparison with your current mammogram. You should also get your mammograms at a qualified practice where breast imaging is a specialty or at least a large part of the practice. And remember that if you are one of the women called back for further testing, the odds are still in your favor that you will get a clean bill of health.
Video: Mammography & Breast Cancer Screening Guidelines | Q&A
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