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Q: I've been called back for extra mammogram pictures: Should I be worried?

A: Readers of this magazine already know that women should have annual mammograms starting at age 40 to check for breast cancer. What if you had your regular mammogram and the mammogram facility now wants you to return for extra pictures? Should you be worried?

Before we get to that, we first need to discuss the purpose of extra views. They help in evaluating calcium deposits ("calcifications") and possible spots or masses on the original mammogram.

Calcifications show up as tiny white specks and can be a sign of cancer. If the calcifications are new or increasing, magnified pictures are often necessary to determine if they have a benign shape and can be left alone or if they need to be biopsied. The most common reason for extra pictures is to investigate possible masses. What makes mammography challenging is that it's a 2-dimensional shadow picture of a 3-dimensional organ, often with confusing overlapping shadows. It's almost like looking at the shadows on a screen of various objects placed in front of a flashlight and trying to pick out a marble. If there are very few other objects (i.e. "fatty" breasts), the marble is easy to spot. But if there are too many other shadows (i.e. "dense" breasts), the marble may be completely hidden or the combination of other shadows can simulate a marble. Special additional views help to clarify these spots or to prove that no mass exists.

Nationally, about 10% of mammograms require additional imaging. About 15% of those patients end up needing a biopsy, three-quarters of which turn out to be benign. Therefore, if you are asked to return for extra mammogram pictures, you have only a 4% chance of having cancer. That's a 96% chance of NOT having cancer.

So, don't worry!

Hopefully, you won't have to wait weeks to get the extra pictures done. Because the possibility of breast cancer causes so much anxiety, there's no reason why you should have to wait a long time for the additional imaging. If the mammogram facility that called you back can't accommodate you in a timely manner, ask your doctor and friends for other options.

Thomas S. Chang, M.D., FACR

Dr. Thomas S. Chang is one of four specialized radiologists at Weinstein Imaging Associates, with offices in Shadyside (412-441-1161), North Hills (412-630-2649), and South Hills (412-440-6999). For more information, visit weinsteinimaging.com.

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