An abnormal mammogram does not automatically mean breast cancer, but it does mean doctors may need to take a closer look.
Dr. Anitha Srinivasan, Deputy Chief Medical Officer at NYC Health + Hospitals/Metropolitan, told the Bronx Times that mammograms allow doctors to look for abnormal growths within the breast tissue or ducts. She recommends annual screening beginning at age 40, in part because each new mammogram can be compared with previous images.
“I always tell my patients that a mammogram is not a static, one-time test,” Srinivasan said. “Think of it like a mirror: just as your face changes year over year, your breast tissue changes too.”
Those comparisons can help doctors identify new changes in the breast or determine whether something seen on an earlier mammogram has remained the same.
For women with dense breast tissue, additional imaging may be needed. Dense tissue can make it more difficult to see a mass or an area of calcification clearly, so a breast ultrasound, also known as a sonogram, may be recommended.
Mammogram findings are evaluated using BI-RADS, or the Breast Imaging Reporting and Data System, she said.
A BI-RADS 1 means the mammogram is normal, while BI-RADS 5 means the finding is highly suggestive of malignancy. BI-RADS 6 is used when cancer has already been confirmed. A BI-RADS 0 means the imaging is incomplete and more testing is needed before doctors can make a determination.
If an abnormal area still needs to be investigated, the BI-RADS result and the patient’s medical history help determine whether a biopsy is necessary.
Today, that procedure is far less invasive than many patients may expect.
A breast biopsy can be performed in the mammography suite under local anesthesia. A tissue sample is removed through a tiny incision using a needle only slightly larger than one used for a standard injection. The procedure can be used for very small masses and areas of calcification that cannot be felt by hand.
Once the sample is taken, a tiny inert marker, generally one to three millimeters in size, may be left at the site. The marker allows doctors reviewing future mammograms to know that the area has already been investigated.
“This is a massive advancement from the past,” Srinivasan said.
Breast biopsies once more commonly required surgery, larger incisions and stitches. The tissue can now be sent directly to a pathology lab, with results typically returning within four to 10 days.
A biopsy recommendation also does not mean cancer has been found. Nearly 75% of biopsies can turn out to be benign, according to Srinivasan.
If cancer is detected, a multidisciplinary team may include a medical oncologist, radiation oncologist and primary care provider. Together with the patient, the team determines the next course of treatment, which may include chemotherapy, surgery or a combination of treatments.
A biopsy can also reveal a high risk lesion that is not cancer but may change how often a patient should be screened in the future.
For patients worried about taking the next step, Srinivasan urged them not to let fear prevent them from getting answers.
“Please do not let fear keep you from a biopsy,” she said. “Finding out exactly what lies within an abnormal image gives you peace of mind, and the ability to treat a cancer early. Early detection saves lives.”
