What to Expect with an Abnormal Mammogram

Dr. Steve M. Thomas
OakBend Medical Center in Richmond

If you have received an abnormal mammogram, what happens? You can expect some follow-up testing, maybe a spot compression view, which is a type of mammogram where they focus on the area of the breast that they thought looked abnormal, trying to rule out if this is just an area of overlapping tissue on the original mammogram that makes it look abnormal, and when they focus on that area, sometimes they can rule out a suspicious abnormality. Another test is an ultrasound, and usually one or both of those tests are the follow-up. That will then help the doctor determine if that is something to follow or if you need a needle biopsy.

A needle biopsy involves a sampling of tissues.  There is a fine needle aspiration or biopsy, where you actually just collect some of the cells from the breast, and that’s called cytology. A pathologist looks at the cells and makes a diagnosis.  But more accurate than that and what we use frequently, is a core biopsy. This is a little bit larger needle that actually samples the tissues and not just the cells, and it can give you a better idea of what we are dealing with. Those can be just guided by feel but more frequently with ultrasound guidance to make sure the needle is where it should be.

If there is a diagnosis of breast cancer, the first step is to get an oncologist involved and do a workup that will hopefully show that the tumor has not spread and is localized in the breast tissue. Depending on the sign of the primary tumor, whether it has spread, the characteristics of the primary tumor, how aggressive it is or is it sensitive to certain factors will determine the next step, and sometimes the next step is starting with chemotherapy.

If surgery is involved and a mastectomy is performed, a plastic surgeon will get involved with the surgery if the patient wants reconstructive surgery.  This can be done at the same time without having surgery later.

You are also evaluating the lymph nodes when there is breast cancer. In the past, the only options was to remove all of the lymph nodes, but now, the usual routine is to perform a sentinel biopsy where sampling consists of just a few of the nodes. If those are negative, then it has been shown that the remainder of the nodes should be negative as well, meaning less surgery and less weakness.

One of the best things you can do for yourself is to perform a monthly self-exam. Once you reach 40, for the next 20-30 years, you should get annual mammograms. Remember, ignoring these steps does not work out well if something does happen. The sooner you find an issue, the sooner it can be eliminated.

For more information, visit www.oakbendmedicalgroup.com.