So, you’ve gone for a mammogram, as you are aware that having regular screening mammograms is the most effective way to detect breast cancer at an early stage, when it is most likely to be curable. Now, however, you have been called advising you that the radiologist is recommending further assessment. Should you panic?
The short answer is “no,” since the probability is high, about 94 percent, that cancer will not ultimately be found. It only makes sense, however, to opt for the recommended further testing, be it additional x-ray views of the breast or an ultrasound, for reassurance. Experiencing some anxiety until you hear the final results is completely normal, even though the risk of having cancer is just a possibility, rather than a probability at this point.
The recall rate after your very first screening mammogram is approximately five to ten percent, but that percentage drops with subsequent mammograms because the radiologist then has previous images to compare the current ones to. Findings that remain stable over two years are not concerning for cancer, but new findings may be. The Alberta guideline recommends that average-risk individuals should consider having screening mammograms every two years from ages 45 to 74.
What has become obvious over the past several years is the role that breast density plays in what is considered optimal screening for breast cancer. The more dense your breast tissue is, the harder it is to see early, small breast cancers. Younger women tend to have more dense breasts than older women because, as we age, the dense glandular tissue is gradually replaced by less dense, fatty tissue. The radiologist reviewing your mammogram images always assigns a density score. If that score is high, they will usually recommend that when you go for your next screening mammogram, a breast ultrasound be booked at the same appointment. This protocol saves time, reduces anxiety, and increases the accuracy of screening.
Having a mammogram involves having your breasts x-rayed individually while standing, with the breast tissue being compressed between two panels for each view. There is often some discomfort; thankfully, each view only takes a few seconds. A breast ultrasound, on the other hand, is done laying down. Gel is applied to the skin, then the ultrasound device is moved back and forth over the surface of each breast to obtain images. There is rarely any discomfort.
Once your further imaging has been completed, the radiologist will send their report to the health care provider who ordered it. If the radiologist sees something concerning and recommends that a biopsy be performed, they will often talk to you about it before you leave the clinic. They will also ensure that the ordering physician is notified immediately and that the procedure is booked as quickly as possible. These biopsies are done at the radiology clinic, with the radiologist using just a needle; they do not require freezing of the skin and do not require stitches.
For further information on breast cancer including risk factors, how to assess and reduce your own risk, breast density considerations, and signs and symptoms of breast cancer, please visit the Screening for Life website (screeningforlife.ca).
Dr. Kuzyk has been a family physician for over four decades and is loving being grandma to five. She currently works part-time in family practice.
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