What Does It Mean to Get Called Back After a Screening Mammogram?

Getting called back for additional imaging after a screening mammogram can be alarming, but the first thing to know is that it's not uncommon — especially if it's your first mammogram.

"Mammograms help us find breast cancers when they are tiny, which is why this screening technique is the gold standard," says Dr. Ainel Sewell, a breast radiologist at Houston Methodist.

That said, a tiny breast cancer won't jump out at a radiologist as they read a mammogram. Normal tissue can look like breast cancer, and breast cancer can look like normal tissue.

This is a big reason why it's important to get your screening mammograms at a specialized breast imaging center that employs fellowship-trained, board-certified radiologists that subspecialize in breast imaging only. (Related: 5 Things to Consider When Choosing Where to Get Your Annual Mammogram)

"Rather than a general radiologist that dabbles in multiple disciplines, a breast radiologist focuses solely on mammograms and detecting subtle changes in breast tissue," explains Dr. Sewell. "This level of sub-specialization is critical for early detection."

Still, callbacks happen.

"When we see something unusual, it's not that we think it's definitely breast cancer," reassures Dr. Sewell. "It's that additional imaging is needed to take a more detailed look. The goal is to make sure we don't miss a tiny tumor forming, because that's when breast cancer is easiest to treat."

Why callbacks are common after your first mammogram

Think of your mammogram like you would your fingerprint. "Your breast tissue is that unique and looks completely different from everyone else's," explains Dr. Sewell. "Even in the same family, breast tissue can look vastly different."

Because your first mammogram serves as a baseline of what your "normal" breast tissue looks like, radiologists don't yet know what could be considered "normal" for you. That's why callbacks are more common after a first screening.

4 reasons you may receive a callback

Getting called back after a screening mammogram doesn't necessarily mean something is wrong, but it does mean the radiologist needs a closer look to clarify what they're seeing.

Here are the most common reasons for callbacks:

1. Dense breast tissue

About 50% of women have dense breast tissue, which is completely normal.

The issue, however, is that dense tissue appears white on a mammogram — the same color as potential abnormalities, like tumors. This means that having dense breast tissue can make it harder to detect breast cancer on a mammogram.

"Think of dense breast tissue as snow and breast cancer as a snow bunny," adds Dr. Sewell. "It's very hard to decipher a white bunny in a snowy field"

If your mammogram results indicate you have dense tissue, your radiologist may call you back in for an ultrasound — another imaging tool that can provide an additional look at a specific area or finding. In future screenings, a supplemental ultrasound may be performed in addition to your annual screening mammogram depending on how dense your tissue is and other factors like family history.

2. Asymmetry between breasts

It's not uncommon for one breast to look different from the other. This is especially common during a woman's first mammogram, when there's no previous image to compare to.

"The majority of women do not have symmetrical breasts," says Dr. Sewell. "When we don't have prior images to use a baseline, we may call you back in for more imaging to ensure that an asymmetry we see is your normal anatomy and not something concerning."

3. Distortions or calcifications

Distortions refer to areas where the normal architecture of the breast tissue looks disrupted, almost like a cobweb. These can be caused by prior surgery, trauma or other benign conditions, but they can also be red flags — meaning they require further evaluation.

Calcifications are tiny deposits of calcium in the breast tissue. They're extremely common and usually harmless, but certain patterns, like tight clusters or linear patterns, can be a sign of early in situ breast cancer.

Radiologists look closely at these patterns to decide whether further testing, like a biopsy, may be warranted.

4. Cysts or fibrocystic changes

Cysts are fluid-filled sacs, and they are exceedingly common in the breast — as well as benign. Often, an ultrasound is used to confirm that the area is a cyst and not a solid mass. Most of the time, no treatment is needed. (Related: Breast Cyst Vs. Breast Cancer: How to Decipher the Difference)

"Fibrocystic breast changes, which are especially common in young women and during menopause because of hormone level fluctuations, can cause lumpiness, tenderness or thickened areas in the breast," explains Dr. Sewell.

These changes can look suspicious on a mammogram, especially if there's no prior imaging for comparison.

What happens during a callback appointment?

If something on your screening mammogram needs clarifying, you'll be asked to return for follow-up imaging — either a breast ultrasound, a diagnostic mammogram or both. Dr. Sewell adds that the follow-up imaging needed depends on what was seen on your screening mammogram.

"If I think I'm looking at cysts, I might go straight to an ultrasound. The same goes for very dense breast tissue," Dr. Sewell explains. "Or we might get a diagnostic mammogram done first and then, depending on what we see, perform an ultrasound or not."

(Related: What Are the Different Types of Mammograms?)

After your workup, your breast radiologist will talk to you about the results and next plan of action, if one is needed, at the same appointment.

What to know if you get a callback

"Everyone in our breast care centers — from desk attendants to nurses to mammogram technologist and ultrasound technologists — know how anxiety-provoking it is to be faced with the idea that something could be wrong with you," says Dr. Sewell. "It's why our goal is to schedule you to come back in quickly and help get your questions answered."

If you are called back for additional imaging, the following tips can help you navigate the experience:

• Don't panic: Callbacks are common, and they don't mean something is definitely wrong
• Schedule promptly: Following up quickly can help avoid anxiety around the unknown
• Ask questions: Understanding your imaging results and next steps can help you feel more in control
• Stick with one breast center: Consistency helps build your "fingerprint" over time

"The power of mammography really comes from doing that exam at the same place year, after year, after year," adds Dr. Sewell.

(Listen: What to Know Before Your First (or Twentieth!) Mammogram)