I’ve suffered from health anxiety for as long as I can remember. As a child, I used to draw pictures of life-threatening rashes in a therapist’s office. When I dropped a coffee mug twice in one week, I was convinced an ALS, or amyotrophic lateral sclerosis, diagnosis was imminent. It’s never just a sore throat, never just a headache — in my mind, it's something terminal.
So, even though I didn’t have any tangible lumps or bumps when I walked into my first mammogram last month, I was convinced there was something ominous brewing underneath the surface.
As the technician positioned my breast on the machine, she instructed me to hold my breath while the X-rays were taken.
I told her that wouldn’t be a problem. I was pretty sure I hadn’t taken in any air since I walked into the room.
In between each set of pictures, I read the technician’s face for signs of concern. I asked questions I knew she wasn’t allowed to answer: “Am I OK?” and “Do you see a tumor?”
“I hope you don’t get called back, but if you do, try not to panic,” she said.
The call came five days later. I panicked.
About one in 10 women who have a screening mammogram will be called back for additional imaging, according to Dr. Laura S. Dominici, a breast surgical oncologist at Dana-Farber/Brigham and Women’s Cancer Center in Boston. But fewer than one in 10 women called back are found to have cancer.
“Many times, when the image gets into the hands of the radiologist, they may feel they didn’t get a good enough look at a certain part of the breast or some of the breast tissue wasn’t flattened out to read the mammogram properly,” Dominici told TODAY. There are also findings such as benign cysts and lymph nodes that just need a second look.
The callback rate is higher for women like me having their first mammogram, Dominici explained.
“When someone has had prior mammograms, we can look back and say, ‘Oh, that’s been there for 10 years and it hasn’t changed. We don’t need to biopsy those sorts of things,” Dominici said. “But when you come in for your baseline and we see a lump, we can’t tell if you've had that lump forever or if it just showed up a week ago. We don’t have anything for comparison.”
Women with dense breasts — that means more glandular tissue than fat tissue — have a higher rate of callbacks. Though it’s a normal finding, dense breast tissue appears as a solid white area on a mammogram, which can make it difficult to see through. However, with the relatively new technology of 3D mammography, fewer patients are called back, Dominici noted.
As for me, I found myself driving back to Atrius Health in Dedham, Massachusetts, for calcifications in my left breast. These small calcium deposits are very common, according to my radiologist Dr. Elizabeth Cua.
“Calcifications may indicate there is something going on in a small region of the breast. They’re just a red flag to say, ‘Look over here.' They aren't cancer," Cua explained. “We look at them and we say, ‘Are they new?' We look at the shape and how they are distributed. The more clustered they are, the more concerned we are.”
Though my calcifications are “not worrisome,” Cua recommended a repeat mammogram — known as a diagnostic mammogram — in six months.
“Many times, we’ll see a finding on an exam and it bumps up our level of concern slightly, but not enough for us to say, ‘Let’s order a biopsy,'" Cua said. "After six months, if something worrisome is going on, we might see it move in that direction. But, six months isn’t such a long period of time that we lose an opportunity to do something about it.”
I am feeling surprisingly calm. One thing I found helpful was being prepared with questions when I met with Cua after my second mammogram. Radiologists understand that medical terminology can be scary and overwhelming.
"Catch your breath and take a moment to collect your thoughts," Cua told TODAY. "We want you to ask questions."