Diagnostic Mammography at UPMC in Central Pa.

You did the right thing and got a mammogram. But the doctor has found something suspicious and you’ve got to come back for more testing.

The important thing is to not panic. Getting called after a screening mammogram to get additional testing is fairly common. It doesn’t mean you have breast cancer. Fewer than one in 10 women called back for more tests are found to have cancer. It could be what’s called a false positive.

Next, your doctor will schedule another appointment as soon as possible – usually within few days – to take new pictures or perform other tests.

Waiting for the tests and the results is especially difficult emotionally and physically. The best thing you can do at this point is understand the process ahead and take charge of your health care. That will make you feel better and more empowered.

What Are False Positives?

A false-positive mammogram looks abnormal even though no cancer is actually present. The more mammograms a woman has, the more likely it is she will have a false positive result that requires 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.
• False positive result are more likely among younger women and women with dense breasts. (Most women younger than 50 have dense breasts.)
• Women who have past mammograms available for comparison 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-positive results are also more common in women who have had breast biopsies, have breast cancer in the family, or are taking estrogen.

A suspicious finding may be just dense breast tissue, a cyst, or even a tumor that isn’t cancerous. Other times, the image just isn’t clear and needs to be retaken. Or, if this is your first mammogram, your doctor may want to look at an area more closely simply because there is no previous mammogram to compare it with.

What Happens at the Follow-up Appointment?

When you go back to the doctor, he or she will give you additional tests.

Mammogram. Your doctor will likely give you another mammogram called a diagnostic mammogram. This is much like the screening mammogram you had earlier, but they will take more pictures of the area of concern. The technician, for example, may magnify a specific area to get a more detailed picture.

It’s important to make sure your doctor has the results of any mammograms you had in the past. These can be compared with your new mammograms. An abnormality, such as a mass, that hasn't changed for a number of years may be benign.

Ultrasound. Your doctor may also perform an ultrasound. The ultrasound uses sound waves to create a computer image of your breast tissue. This is used to look more closely at the area of concern.

MRI. Some women will have an magnetic resonance imaging (MRI) test, especially if a mammogram and ultrasound do not provide a good view of the abnormality. An MRI uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body.

Getting the Results

Shortly afterward, sometimes during your visit, you will get the results. Your doctor will tell you one of three things:

• It turned out to be nothing to worry about and you can return to your regular mammogram schedule.
• It is probably nothing to worry about, but you should have your next mammogram sooner than normal – usually in 6 months – to make sure it doesn’t change over time.
• It could be cancer and a biopsy is needed to know for sure.

You will also get a letter with a summary of the findings.

What If I Need a Biopsy?

Even if you need a breast biopsy, it still doesn’t mean you have cancer. Most biopsy results are not cancer, but a biopsy is the only way to find out for sure. During the procedure, a small amount of tissue is removed and looked at under a microscope.

There are several different types of biopsies. These vary in both the way that they are performed and the amount of tissue that is removed. Your doctor will decide which biopsy is most appropriate.

The types of breast biopsy include:

• Fine needle aspiration (FNA). The surgeon inserts a very thin needle into the area of the breast where the mass is located. Tissue is withdrawn from the affected area for testing. This approach is quick and discomfort lasts only a few minutes.
• Core needle biopsy. This approach may be used if a larger tissue sample is needed, using a local anesthetic and a larger needle.
• Image-guided biopsy. If the suspicious area can’t be felt, the doctor may use diagnostic imaging tools (such as an ultrasound) to guide the needle to the appropriate place.
• Surgical biopsy. If other biopsy approaches don’t provide a definitive diagnosis, a surgical biopsy may be performed.

After the biopsy, the small amount of tissue or fluid removed is sent to a lab where a specialist, called a pathologist, will look at it. The pathologist will determine whether or not cancer cells are present. The results are usually available within a week and your doctor will go over them with you.

The Waiting

Waiting for appointments and the results of tests is a frightening time. You may experience strong emotions including disbelief, anxiety, fear, anger, and sadness during this time.

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 support line which is available 24/7 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 no cancer is found, some women still feel the mental strain of a false-positive result six to 12 months later.

Getting the Results

When getting the test results, it’s a good idea to bring a friend or family member with you to your appointments for comfort and also so they can listen to what the physician is saying and take notes.

If the results are negative or benign, that means no cancer was found. Be sure to ask the doctor whether you need any additional follow-up, and when you should have your next screening mammogram.

If the mass is malignant (or cancerous), the pathologist will characterize it by type, abnormality (grade) and whether or not it has spread outside the milk ducts or lobules of the breast where it started. The pathologist will also test the tissue for receptors such as hormone receptors (estrogen and progesterone receptors) and HER2 neu status.

What If It’s Cancer?

The important thing to remember is that you are not alone. When cancer is found, you will be the center of a team of doctors, nurses, family members and support staff who will work together to provide you the best possible care.

Keep in mind:

• If you’ve had mammograms per your doctor’s instructions, and you’ve performed regular self-exams, chances are you caught the breast cancer early when it is easier to treat. New tools, like 3D mammography, are also finding cancers even earlier.
• According to report published every two years by the American Cancer Society, breast cancer deaths have declined by 39 percent between 1989 and 2015. That's about 322,600 fewer victims of the disease.
• These great outcomes are the result of newer treatments, which are better than they’ve ever been. Breast cancer care is different for every person. Treatments today are more personalized, less toxic, and more effective than ever.
• New drugs are broadening treatment options. For example, there are drugs for women with tumors that test positive for HER2, a protein that spurs cancer cells to grow and proliferate.
• And new treatments are available every month.

Finding the Right Doctor and Facility

If cancer is found, you will need to find a breast cancer specialist and a breast cancer treatment facility for your care. Your doctor may offer recommendations based on their experience. You may also want to talk to friends, check with your insurer, or get information from your local hospitals.

Once you have a few names, here are some things to consider:

• Do they have experience treating your condition?
• Is the doctor board-certified in breast cancer treatment?
• Is the doctor part of a treatment team?
• Is the cancer center accredited by professional groups like the American College of Surgeons or the Joint Commission on Accreditation of Healthcare Organizations?
• Are they part of your insurance plan?
• Are they are conveniently located?
• Do they participate in clinical trials of the latest treatments?

For additional guidance, check out the National Cancer Institute (NCI), a branch of the federal government. They have designated a select group of more than 60 medical institutions in over 30 states as cancer centers.

Programs like the UPMC Hillman Cancer Center have earned the highest rating as a National Cancer Institute-designated "comprehensive cancer center." These offer the latest in medications, new techniques, state-of-the-art equipment, and access to clinical trials. Their doctors stay current in the newest methods in treating cancer.

To find a nearby cancer center online, go to https://www.cancer.gov/research/nci-role/cancer-centers/find.

You Are Not Alone

The prospect of cancer and its treatment is a scary. But there are many people ready to help you. Once you identify a breast cancer doctor and treatment center, they will provide a full team to help care for you including doctor, care navigators, nurses, dietitians and social workers.

In addition, most communities have resources to help you. And the American Cancer Society has a wide range of local and online resources to help you.

Breast cancer is a challenge, but you will have a lot of help to overcome it.