A routine mammogram is meant to answer one question: does everything look normal? Sometimes the answer isn't clear, and that's when additional tests are recommended. An abnormal mammogram doesn't confirm breast cancer, but it does mean doctors need more information before making a diagnosis.
Why the mammogram came back abnormal
Mammograms can catch changes in breast tissue long before anyone could feel them by hand. Sometimes an image just isn't clear enough for the radiologist to be sure what they're looking at. Other times there's a spot that looks a bit different from the surrounding tissue.
There's a range of reasons this happens. Dense breast tissue is a big one; it can make mammograms harder to read in general. Cysts are common too, along with benign lumps like fibroadenomas. Small calcium deposits, called microcalcifications, show up sometimes as well. And occasionally it really is just that the images weren't sharp enough the first time around.
Most of these end up being nothing to worry about. But you won't know that without more testing.
What is likely to happen next
Treatment is determined by what is seen in the initial scan. It can begin with a diagnostic mammogram, which is a more targeted exam that focuses on the region of concern from several additional angles. Thereafter, a breast ultrasound is common as well. It aids in distinguishing between a fluid-filled cyst and something solid and is particularly effective for women who have dense breast tissue.
Once those two don't provide a clear picture or if you have a higher than average risk due to a family history of breast cancer or a known gene mutation, a breast MRI may be next. If the imaging hasn't given him the answer he's hoping for, he will typically undergo a biopsy to get a definitive answer to the question. A small piece of tissue is removed and tested in a lab. This is the one test that will tell you definitively if cancer is present, and all other tests are just trying to rule it out.
BI-RADS score
You might notice a BI-RADS category on your report. It's shorthand radiologists use to sum up what they found and what should happen next. A 0 means more imaging is needed before they can say anything. A 1 or 2 means things look normal, or whatever they found is clearly benign. A 3 usually means it's probably fine, but they'll want another mammogram in about six months just to check nothing's changed. A 4 or 5 means it needs a closer look, which usually means a biopsy. If you're unsure what your number means, just ask. Your doctor can walk you through it.
What you should do
If you've been called back for more testing, go. Do not skip or delay. If you have had mammograms elsewhere in the past, tell your health care team; it helps a great deal because it tells whether it is new or if it has been there for years without changing. Ask questions. As many as you need. It can help make the whole thing feel a lot less overwhelming to understand what's going on and why. An abnormal mammogram is just the beginning of a closer examination, not a diagnosis.
Most of the time, it's a minor thing: a cyst, dense tissue, some other harmless change. Doctors determine what is really happening and if treatment is necessary by further imaging or by a biopsy. Early detection often provides more options and better outcomes if it is indeed cancer. While waiting, there's only one thing to do – go for the follow-up tests. That's what gets you real answers.