Diagnostic Mammography at UPMC

Diagnostic mammograms are done when there are problems such as lump, nipple discharge, change in skin color/texture, or change in size or shape of breast. This may also be done if you are asked to return after your first exam for additional evaluation

Try not to panic. It's pretty common to get called back for more tests after a screening mammogram.

It doesn't mean you have breast cancer. Fewer than one in 10 women called back for more tests end up having breast cancer. It could be what's called a false positive.

A suspicious finding may be just dense breast tissue, a cyst, or even a benign tumor. Other times, the image isn't clear, and a clearer image is needed.

Or, if this is your first mammogram, your doctor has no prior results to compare it to. They simply may want to look at an area more closely.

If your doctor has concerns about your screening mammogram results, they'll schedule another appointment – often within a few days. They'll want you to get new images or have other tests.

Waiting for the tests and the results can be emotionally and physically draining.

One thing you can do at this point is to learn about the process ahead and take charge of your health. That can make you feel better and more empowered.

Find an imaging location near you

What Tests Will I Need at My Follow-Up Mammogram Appointment?

Your doctor will likely give you another mammogram called a diagnostic mammogram.

It's much like your screening mammogram, but they'll take more pictures of the area of concern.

Breast ultrasound

Ultrasound uses sound waves to create a computer image of your breast tissue.

It lets your doctor look more closely at the area of concern.

What Your Imaging Test Results Might Mean

Soon after — sometimes even during your visit — you'll get the results.

Your doctor will tell you one of three things:

It's nothing to worry about, and you can return to your regular mammogram schedule.
It's probably nothing to worry about, but you should have your next mammogram sooner as recommended. They'll often want you to have the test in 3 or 6 months to ensure it doesn't change over time.
A biopsy is needed to further evaluate your breast health.

You'll get the written results during your appointment.

What are false positives?

A false-positive mammogram looks abnormal even though no cancer is present. The more mammograms you have, the more likely you'll have a false positive result that needs follow-up tests.

Keep in mind:

The chance of having a false positive result after one mammogram ranges from 7 to 12 percent, depending on your age. It's more likely in younger women since most women under 50 have dense breasts.
Women who have past mammogram results to compare reduce their odds of a false-positive finding by about 50 percent.
After 10 yearly mammograms, the chance of having a false positive is about 50 to 60 percent.
False positives are also more common in women who've had breast biopsies, have breast cancer in the family, or are taking estrogen.
One way to help avoid a false-positive is to make sure your doctor has the results of any past mammograms. They can compare them with your new mammograms.
For instance, a mass or defect that hasn't changed for years may be benign and not need further tests.
What tests could I need at my follow-up diagnostic mammogram appointment?
Your doctor may do one or more tests to rule out breast cancer.

What if I need a breast biopsy?

Even if you need a breast biopsy, it doesn't mean you have cancer. Most biopsy results are not cancer, but it's the only way to find out for sure.

There are a few different types of biopsies. These vary in how your doctor performs them and how much tissue they remove.

Your doctor will decide which biopsy is best for you.

Types of breast biopsies

Fine needle aspiration (FNA). The surgeon inserts a very thin needle into the area of the breast mass and withdraws tissue for testing. FNA is quick, and discomfort lasts only a few minutes.
Core needle biopsy. Your doctor may use this approach if they need a larger breast tissue sample. They'll use a local anesthetic and a bigger needle to get the tissue.
Image-guided biopsy. If your doctor can't feel the suspicious spot, they may use imaging tools (such as an ultrasound). These tools will help them guide the needle to the proper place.
Surgical breast biopsy. If other biopsy approaches don't provide a clear-cut diagnosis, your doctor may do a surgical biopsy. They'll remove part or all of the suspect tissue for further testing.

After the biopsy, your doctor will send the tissue or fluid to a lab.

A doctor trained in lab techniques will look at the samples under a microscope. Then, they'll decide whether or not cancer cells are present.

Your doctor should have the results within a week and will go over them with you.

Tips to help put you at ease while you wait

Waiting for appointments and the results of tests is distressing.

You may have strong emotions during this time, including disbelief, anxiety, fear, anger, and sadness.

Some things to remember:

It's normal to have these feelings.
Most breast changes are not cancer and are not life-threatening.
Talking with a loved one or a counselor about your feelings may help. It may help to talk with other women who have been through this process.
The American Cancer Society has a 24/7 support line to answer your questions and simply talk. Call them at 1-800-227-2345.
Learning about the tests and writing down questions to bring to your appointments can help you feel calmer and more in control.
Remember, your feelings are completely normal.
Even when the news is good, and you don't have cancer, you may still feel anxious. Some women feel the mental strain of a false-positive result six to 12 months later.

Getting your biopsy results

When getting the test results, bringing a friend or family member to your appointment is a good idea. They can provide comfort and support, listen to what your doctor is saying, and take notes.

If the results are negative or benign, the biopsy did not find cancer.

Be sure to ask your doctor if you need more follow-up tests. Also, find out if you can stick to your yearly mammogram or if they want you to have one sooner.

If the mass is malignant or cancerous, the lab tech will include the following details in your test results:

Breast cancer type and if it has spread outside the milk ducts or lobules of the breast where it started.
Grade of the tumor. This describes how the cancer cells look different from healthy cells and if they're slow or fast-growing.
If proteins (estrogen, progesterone, HER2) are present in the cancer cells. These results can help your doctor learn about your risk of cancer coming back. They also guide your doctor in planning the best treatments.

What If It's Cancer?

Yes, breast cancer is scary but beatable.

Keep in mind:

If you've had routine screening mammograms and done self-exams, chances are you caught the breast cancer early when it's easier to treat. New tools, like 3D mammography, are also finding cancers even earlier.
Per an American Cancer Society report published every two years, breast cancer deaths have declined by 40 percent between 1989 and 2017. That's about 375,900 fewer victims of the disease.
These great outcomes result from newer treatments, which are better than ever. Breast cancer care is different for every person. Today, we tailor treatments to meet each person's unique needs. They're also less toxic and more effective than ever.
New drugs are broadening treatment options. For instance, there are drugs for women with HER2-positive tumors, a protein that spurs cancer cells to grow and spread quickly.

You're Not Alone

The prospect of cancer and its treatment is scary. But there are many people ready to help you.

Once you find a breast cancer doctor and treatment center, you'll be the center of a team of:

Doctors and nurses.
Dietitians.
Social workers.
Support staff.

We'll work with you and your loved ones to provide the best possible cancer care.

There are also many outside resources to help you.

The American Cancer Society's treatment and survivorship site has a wide range of tools and resources for you, caregivers, and family members.

Breast cancer is a challenge, but you'll have a lot of help to beat it.