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Called Back for More Mammography Imaging: As Stressful as Women Claim?

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Called Back for More Mammography Imaging
Called Back for More Mammography Imaging

There’s a lot of media coverage swirling around right now about whether women suffer long-term psychological damage when they are told that they have an abnormality on their mammogram and need to have additional imaging done.

Really? Hmmm. I truly question that getting a call-back from the breast center can do “damage” to a woman’s psyche. However, if the imaging staff communicates this frightening news to the patient in a clumsy or insensitive way, then the patient could very well experience some psychological fallout.

Fifty Freaked-out Emails a Day

I receive more than 50 emails a day from women saying that they just got a letter in the mail calling them back for more imaging studies, because of a vague finding on a screening mammogram.

These women are, quite frankly, freaked out. Most of them are trying to analyze every single word in their letters—only to learn from me that such letters are purposefully written with vague language because the staff at the mammogram center don’t yet have enough information to provide anything more specific.

The patients want to know just exactly what the phrase “probably benign” means—a 75-percent chance? a 95-percent chance?—but these letters aren’t going to say, because no one knows what is going on inside the breast yet.

What We Do Know

About 80 percent of the time, a call-back on a screening mammogram turns out to have a benign outcome.

But patients can then become hung up on this encouraging statistic, too, wanting a guarantee that no cancer exists anywhere in either of their breasts. Well, the only way to “guarantee” this is to do bilateral mastectomies and have a pathologist verify that the tissue is cancer-free—which is not recommended, obviously.

I notice too that the media are using the term “false positive” incorrectly when they describe mammogram results, and I take offense at this misuse of the term. To me, a false positive means that the patient was first told that she had cancer, only to find out later through additional imaging or diagnostics that she doesn’t have it. Simply being called back for more imaging studies does not imply a false positive result.

So if you are someone who has experienced a call-back requesting more imaging studies—and most women have, over their lifetime of mammograms—I hope you are not worrying and fretting about this every day, as the media has implied that women are.

How to Solve this Problem

The real key to solving this problem, however, is better communication. At Hopkins, we don’t do call-backs because our radiologists read the screening mammogram while you are still right here—and if additional imaging is needed, it is done right on the spot, with the radiologist explaining what is seen and what it means. Even if a biopsy should be needed, it happens right then, with a volunteer (who is a survivor) holding your hand if you feel anxious. Pathology results come back the next day.

One woman said to me recently, “I like coming [to the Johns Hopkins Breast Center] because of the thoroughness and no call-backs. If they have any doubts, they take a few more pictures and I know the results before I go home. Even when I have had additional imaging studies done, even including an ultrasound, it gives me peace of mind that I am okay, or at least my breasts are.”

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