Ep. 10: Mammogram callbacks: Should you be worried?

Sanford Health radiologist Chris Johansen, MD, eases anxiety about breast cancer imaging

Dr. Chris Johansen smiles while wearing scrubs and sitting next to a microphone.

Episode Transcript

Ariana Mount (Host): Hello, and welcome to One in Eight, a podcast series brought to you by the experts at Sanford Health. I’m Ariana Mount with Sanford Health News. One in Eight is a podcast geared toward increasing breast cancer awareness as one in eight women will be diagnosed in their lifetime.

Today we’re discussing mammography and the topic of callbacks. What does it mean? And what should someone know when this happens? To explain these important questions is Dr. Chris Johansen, a radiologist specializing in breast conditions and breast cancer. Dr. Johansen is part of the physician team at Edith Sanford Breast Center. Dr. Johansen, welcome and thank you for being with us.

Dr. Chris Johansen: Thank you so much for having me today.

Ariana Mount (Host): So first things first, what is a diagnostic mammogram?

Dr. Chris Johansen: Well, we do diagnostic mammograms for lots of reasons. The most common is when someone has a screening mammogram that isn’t completely normal. Now that doesn’t mean that person has cancer, but it does mean that we need some more information to make a determination. Other reasons for a diagnostic mammogram include a physical finding such as a lump, nipple discharge, perhaps pain or anything that concerns your clinician. Other very specialized situations can also end up in a diagnostic mammogram like a history of cancer or an abnormal study say six to 12 months ago that needed another mammogram performed to figure out if there was anything important going on.

Ariana Mount (Host): If I get a diagnostic mammogram, should I immediately be worried?

Dr. Chris Johansen: Absolutely not. You know, diagnostic mammograms, again, are performed for many different reasons. And one really important thing to remember is that needing a diagnostic mammogram, including in the setting of a screening mammogram that was interpreted as BI-RAD 0, which is what got you to a diagnostic mammogram. It does not mean that you have cancer. It just means we need more information, and we need to take some more pictures and maybe even do a different kind of test called an ultrasound to get that information.

Ariana Mount (Host): How many people get these callbacks for a diagnostic mammogram?

Dr. Chris Johansen: In general, the rate of callbacks on a screening mammogram varies from around 3 or 4%, up to about 10%, with many of the factors that influence precisely the callback rate being based on the demographics of the population. The most important one that the person can control is getting an annual mammogram. If you get mammograms less than once a year, your chance of being called back for a diagnostic evaluation goes up. If you’re getting a regular screening mammogram, your chance of getting a diagnostic callback goes down.

Ariana Mount (Host): I want back up a little bit. You kind of just touched on it, but these callbacks come from a normal screening mammogram, is that correct?

Dr. Chris Johansen: They come from a screening mammogram or a typical screening scenario. If the screening mammogram is interpreted by the physician to not be completely normal, again, not meaning that you have cancer, that’s why we would ask someone to return for further imaging.

Ariana Mount (Host): So when should women start scheduling those routine mammograms?

Dr. Chris Johansen: For the majority of women, age 40 is the perfect age to start screening mammograms. There are exceptions. If you have a first-degree relative who had breast cancer at an early age or if you have some genetic syndromes – in situations like that, you can talk with your family provider, family practice provider, and see if you fit into those categories. But for the vast majority of women, age 40.

Ariana Mount (Host): And how often should women be getting them?

Dr. Chris Johansen: The best timeframe to get a mammogram is once a year. That’s also what tends to be reimbursed by insurance. So most women can get a screening mammogram with no copay once a year. That’s also a good period of time to look for cancer because it’s long enough for there to be meaningful change if the person has an abnormality, but it’s not so long that you start missing opportunities to act on any findings.

Ariana Mount (Host): And you guys screen men as well for breast cancer. Is that right?

Dr. Chris Johansen: We actually don’t screen men, but we do diagnostic workups on men. The rate of breast cancer in men is about 1% of what women’s rate of breast cancer is because men have breast tissue, but only about 1% of the amount of breast tissue that women have on average. So if you have a symptom as a man, you’ll talk to your doctor and it’s very likely they’ll send you for a diagnostic evaluation. But if you’re asymptomatic, other than very rare exceptions, we won’t do a screening mammogram.

Ariana Mount (Host): For someone who’s never had a mammogram, can you explain what the process is or what they can expect when they come in?

Dr. Chris Johansen: Sure. For a screening mammogram, you would come to a mammography office, like the Edith Sanford Breast Center. You would check in with some of our folks out at the front desk and shortly thereafter, they would call you back. And a technologist would perform four images, two of each breast.

The images are painless. They do involve light compression on the breast, and they need to be very carefully positioned, so as to see all the breast tissue and cover the entire area that we want to evaluate. You’ll want to not wear deodorant that day. Many deodorants actually have metal in them, and we can see that on the mammogram and that causes an artifact, which can be in some cases, confused with cancer. So we would ask people not to use deodorant. The actual test itself takes only a few minutes, and for a screening mammogram at the end of the test, you’re free to go. We’ll contact you either with a letter or through your My Chart app to let you know what the results are.

For a diagnostic mammogram, the process takes a little longer because you’ll get the results the same day. You’ll check in, and a technologist will take your pictures. Once that’s done, they’ll be immediately reviewed by one of the fellowship-trained breast imagers at Edith Sanford or at your breast center. And at that point, a determination will be made either that everything is normal or that we need to do an ultrasound. Pending the results of the ultrasound, you’ll talk with the doctor, and either be scheduled to have a biopsy or be told that everything is fine and return to annual screening mammography.

Ariana Mount (Host): That annual screening. Why is it so important?

Dr. Chris Johansen: Breast cancer is the most common cancer that women get. Particularly if women don’t smoke, overwhelmingly breast cancer is the most common cancer. Breast cancer is also highly treatable when it’s caught early. Small breast cancers, early breast cancers, like those detected on a screening mammogram, as opposed to a cancer that’s grown large enough to actually be palpable or felt by a patient or clinician has a cure rate, very close to a hundred percent. And that’s without using chemotherapy.

Most women that are treated for very small or early breast cancers will never even spend a night in the hospital. The only way to fall into that category, if you have a breast cancer is to have it detected with a screening mammogram. Unfortunately, larger or later-stage cancers, those rules don’t apply. Oftentimes we’ll have to use chemotherapy, you may be hospitalized, surgeries tend to be more invasive and the whole process is more unpleasant and more expensive.

Ariana Mount (Host): So when we talk about just how important those annual screenings are, is there anything women should be doing in between those annual screenings? I hear “self exam” a lot.

Dr. Chris Johansen: Right. You know, if you’re getting an annual screening mammogram, you’re already getting enormous benefit. Some people will do self-breast exams on a regular basis, even as commonly as once a month, although there is some research that shows if you’re getting a screening mammogram done in an accredited center, they’re finding cancer so early, that the chances of you having a cancer that develops to the level where it’s palpable between a screening mammogram is incredibly small. There’s no problem with doing self-examination, but if you’re getting an annual mammogram, it probably adds little if any benefit. You’ll also likely have a breast exam when you see your regular clinical provider once a year.

Ariana Mount (Host): Another term we hear a lot is breast awareness. Can you explain the difference between that and a self-exam?

Dr. Chris Johansen: You know, breast health is actually, it’s complicated. There’s more to it than simply feeling for lumps. People can have things like discharge, they can have pain or other symptoms, and there’s a lot to breast health that doesn’t specifically pertain to cancer. Some people can have breast pain and it can be really severe. And there are things that they can work on with their clinician to make sure that if they have pain, it doesn’t keep them from living the life they want to live or doing the things they want to do.

So really for breast awareness, even though we, of course, focus on breast cancer because it’s horrible, and we want to make sure that that’s always at the forefront of our minds, there’s a lot of other aspects to breast health that can be important for women in improving their day-to-day living.

Ariana Mount (Host): For a lot of women, it may be time for them to get a mammogram whether they just turned 40 and it’s their first one, or they’re over 40 and their last was more than a year ago, or if they’ve just simply never been screened. For someone who fits in one of those categories, who is putting off getting screened, what’s your advice to them? Or why is it important that they go ahead and schedule it?

Dr. Chris Johansen: For lots of people there’s apprehension about going in to get any medical test. You don’t know if it’s going to be painful. The results can be anxiety producing. The thing I would tell them is you’ll have a great experience really, which is hard to think about that. Most people don’t think about their mammogram as a great experience, but especially here, our technologists are amazing. They’ve all been through screening. They all know exactly what the experience is like. And they’ll go out of their way to make sure that everything is explained thoroughly.

At the end of it, you’ll be really happy that you did it. It’s like many things in life that are good for your health. You just have to take that plunge and go ahead. And in this case, call and schedule the appointment. And once you do it, you’ll feel really good and happy that you did.

Ariana Mount (Host): So for those listening who are ready to schedule a mammogram, where do they start?

Dr. Chris Johansen: So the first and most important thing to think about is, do I meet the criteria for a mammogram? You want to be female, over the age of 40 and not have had a mammogram within the last 12 months. If you fall into those criteria, call your regular doctor, they’ll be an invaluable source of information and guiding you to a quality center that will do a good exam and let you know about the results in a timely fashion. They’ll also be a center that can help you if you do need any more imaging to complete that imaging locally and in a timely fashion.

After you talk with your clinician, they’ll likely direct you to a center like the Edith Sanford Breast Center, where you can call and schedule an appointment. Oftentimes screening mammograms only take a few minutes. So it’s very likely that you’ll be scheduled soon and can come in for your appointment.

Ariana Mount (Host): Is there anything else you would like people to know about mammogram callbacks, diagnostic mammograms?

Dr. Chris Johansen: The most important thing I can say about being called back from a screening mammogram is even though your first instinct may be to feel anxiety or even to panic a little, know that most likely you don’t have anything wrong, you don’t have cancer, but we want to make sure. In the unlikely event that you do need any further workup or even a biopsy, or even if you’re found to have cancer, if it’s found on a screening mammogram, it’s likely to be a very early cancer and you’re in a great spot. You’re very, very likely to be treated and cured and again, never spend the night in the hospital or have to undergo chemotherapy. Screening-found breast cancers are typically treated highly, effectively and efficiently. So you’re in a good spot.

Ariana Mount (Host): Dr. Chris Johansen, very valuable information. Thank you for your time today.

Dr. Chris Johansen: Thank you so much for having me. I really appreciate it.

Ariana Mount (Host): One in Eight is a podcast series and one of several from Sanford Health covering a variety of topics and featuring Sanford Health experts. Find Sanford Health podcasts on Apple, Spotify and news.sanfordhealth.org. For Sanford Health News, I’m Ariana Mount, and thanks for listening.

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