Few things create more anxiety than getting a message that your mammogram requires “additional imaging.” I know this from personal experience. The word abnormal can sound alarming, but most callbacks are not cancer. In fact, they are a routine part of making sure every image is clear and complete. Understanding what happens next can make the process far less stressful. So, let’s walk through the process.
What Does a “Callback” Really Mean?
A callback simply means the radiologist needs more information. This is especially common in the following circumstances:- After a first mammogram, when there are no prior images for comparison
- In women with dense breasts, where normal tissue can look similar to small shadows
- When a spot on the image is unclear or partially hidden
- When a woman has gained or lost a significant amount of weight, or anything else just looks different from the last imaging
A callback is not a diagnosis. It is simply a request for clarity.
So, What Happens Next?
Let’s go through the steps.
Step 1: Diagnostic mammogram
The first step is usually a diagnostic mammogram, which takes additional, more focused views of the area in question. The technologist may use different angles and/or magnification to get a sharper picture. Many times, once the area is seen more clearly, the radiologist can tell that everything looks normal after all.
Step 2: Targeted breast ultrasound
If the mammogram still shows something that needs evaluation, the next step is a targeted ultrasound. Ultrasound is excellent at distinguishing solid tissue from fluid-filled cysts, and it often explains findings that looked uncertain on the mammogram.
Step 3: Short-term follow-up (if needed)
Sometimes the radiologist sees something that is almost certainly benign but wants to confirm stability. In these cases, you may be asked to return in 3 to 6 months for a repeat mammogram or ultrasound. This is called a BI-RADS 3 (“probably benign”) finding.
Step 4: When a biopsy is recommended
If an area still looks suspicious, a biopsy may be advised. Modern breast biopsies are outpatient procedures done with local anesthesia. Depending on the location, they may be:
- Ultrasound-guided biopsy
- Stereotactic biopsy (using mammogram guidance)
- MRI-guided biopsy
Understanding the results
Most biopsies do not result in a cancer diagnosis. Biopsy results typically fall into three categories:
- Benign – This is the most common result. No cancer is found. It could be a benign fibrous tumor or other benign condition.
- Probably benign, requiring short-term follow-up – The pathology is not absolutely conclusive but there is no true evidence of cancer in the biopsy tissue. Depending on the results, your doctor will recommend repeat imaging in 3 months, or possibly a different type of biopsy to get a better tissue sample.
- Suspicious or malignant – In this case, your doctor will develop a plan to include further testing and treatment options.
What’s the Bottom Line?
A callback is not a cause for panic. It is a careful, stepwise process designed to ensure accuracy and early detection. It does not mean you have cancer. In fact, you are much more likely to have a benign reason for the callback. But completing follow-up testing is important; one of the most important things you can do for your breast health. Finding breast cancer early leads to better treatment options, saves lives, and can save your breasts.
If you have any questions about breast cancer, please log into your account and send us your question. We are here to help.
Dr. Anita Bennett MD – Health Tip Content Editor