Sample Patient Questions

Breast density refers to the proportion of fibroglandular tissue (glands and connective tissue) compared to fatty tissue on a mammogram. Dense breasts have more fibroglandular tissue and are extremely common - roughly 40-50% of women have heterogeneously or extremely dense breasts.

Dense tissue has two important implications. First, it can partially obscure small masses on a mammogram because both dense tissue and tumors appear white on the image. Second, dense breasts carry a modestly elevated independent risk for breast cancer. Many states now require that patients be notified if their breasts are dense, and supplemental screening with ultrasound or MRI may be recommended.

A callback (also called a recall) after a screening mammogram is very common and is usually not cause for alarm. Approximately 10-12% of women are called back after their first mammogram, and roughly 5-10% after subsequent screenings. The large majority of callbacks result in a normal outcome.

A callback means the radiologist saw something that needs a closer look - often an asymmetry, a possible mass, or calcifications that are easier to see with additional views or ultrasound. A BI-RADS 0 is assigned, which means the study is incomplete pending further imaging. This is a diagnostic process, not a diagnosis of cancer.

Calcifications are tiny calcium deposits in breast tissue that show up as bright white specks or clusters on a mammogram. They are extremely common and the majority are completely benign - caused by aging, past injury, or normal cellular activity.

What matters to a radiologist is the size, shape, and distribution of the calcifications. Large, round, smooth calcifications are almost always benign. Small, irregular, or tightly clustered (especially in a line) calcifications may require biopsy because they can occasionally be associated with early breast cancer or a precancerous condition called DCIS. Your radiologist will assign a BI-RADS score based on this assessment.

BI-RADS 4 means a finding looks suspicious enough that a biopsy is usually recommended. It does not mean you definitely have breast cancer. It means imaging cannot confidently call the area benign, so tissue sampling is recommended to get a clear answer. BI-RADS 4 covers a wide range of concern, from low suspicion to higher suspicion.

A breast biopsy is a procedure in which a small sample of tissue is removed from the suspicious area and examined by a pathologist under a microscope. It is the only way to know definitively whether a finding is benign or malignant. Being recommended for biopsy does not mean you have cancer - the majority of biopsied lesions turn out to be benign.

Most breast biopsies today are performed as minimally invasive image-guided procedures using a hollow needle - either ultrasound-guided or stereotactic (X-ray-guided). The procedure is done under local anesthesia, takes about 30-60 minutes, and does not require surgery. A small clip is typically placed at the biopsy site as a marker. Results are usually available within 2-3 business days.