The other day while driving out in our fair city on a familiar path, I did a double take. The path I knew had changed with a new building half built where an empty field once stood. The double take and second more detailed look was instantaneous – and helped answer the questions (how did that happen? What is it?) initiated by the change in the familiar. And it got me to thinking about how often second looks happen in my day to day mammography practice.
Second looks are a common occurrence in breast imaging. This can come in many forms- a second look by a computer as another final check for subtle signs of breast cancer, a second look by a colleague to discuss a subtle point or a second look with additional imaging to sort out an area of concern.
In the field of breast imaging, looking for change, analyzing various shades of grey and white is the norm. Science guides us, yes, but there is still an art to interpretation. For those of us who make this our job, we recognize that a second look is not only commonplace but also a beneficial thing. That second glance through the images may find what we dismissed the first go-around.
One of the so-called harms of screening mammography identified by the United States Preventive Services Task Force is anxiety and stress from additional work-up that may be necessary after a screening study. So, I thought it may be of benefit to review the use of second looks and additional imaging in screening breast studies.
First off, know that a request for additional views or needing further work-up does not mean the worst. The changes that can signal the presence of breast cancer are subtle and can mimic normal tissue in many ways. We use additional views to help sort out normal from abnormal and to assess areas that look different from year to year.
Extra views does not equal certain breast cancer!
If we look at the numbers roughly, out of 1000 women getting a screening mammogram:
- 900 (or slightly more with 3D mammography) will be normal (see you next year!)
- 100 will need further work-up
- Of those 100, most will need either additional mammographic views, ultrasound or less frequently MRI
- 20 of those women will receive a recommendation for a breast biopsy
- Only 5 or so women will ultimately be found to have breast cancer (¾ of the biopsies will be benign or non-cancerous findings)
So, if we tell you you need additional diagnostic work-up, take a deep breath. Realize a second look in most cases answers the question and only rarely will mean having to undergo a biopsy. At our practice, if additional work-up views or breast ultrasound are required, those diagnostic studies can be completed immediately following your screening test. We think this lessens anxiety (no waiting around for results or having to take additional time for another appointment). One of the ways our practice centers on what’s best for you, our patients!
Second looks – a common theme, and not one to dread. We hope this explanation lessens anxiety. Fear of screening should not be a barrier!