The message says the imaging center called and would like you to come back for a few more pictures. You read it twice. Then you sit down on the edge of the bed with your coat still on, and the rest of the afternoon goes somewhere you cannot follow.

If that is roughly where you are right now, take a breath and read the next paragraph slowly, because it is the single most important fact about the situation you are in.

Most women who get called back do not have cancer

Being called back after a screening mammogram is common, and the large majority of those callbacks end with a clean result and a note to come back next year. It is not a soft reassurance handed out to keep you calm. It is simply what usually happens.

Here is the reason, and understanding it helps more than any pep talk. A screening mammogram is designed to be sensitive. Its job is to flag anything that is not clearly normal, and to do that with a set of standard images taken quickly on a healthy woman with no symptoms. A screening exam is a wide net, and a wide net catches things that turn out not to be fish.

The radiologist reading your images is not saying they found cancer. They are saying there is something on these pictures that they are not willing to call normal without looking harder. That is the correct instinct, and it is the whole point of doing the screening at all. A radiologist who never called anyone back would be missing things.

The fear you are feeling is real and reasonable. Nobody reads a callback notice calmly. But the fear and the odds are pointing in very different directions, and the odds are the part based on evidence.

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Why the call happens

Callbacks come from a short list of ordinary situations. Knowing which one applies to you can take some of the air out of the worry.

• Overlapping tissue. Breast tissue is layered, and on a standard image those layers stack into a flat picture. Normal structures sitting on top of one another can form a shape that looks like a mass but vanishes the moment you look from a different angle.
• No prior images to compare. If this is your first mammogram, everything on it is new information. A small finding that has plainly been sitting there unchanged for six years is reassuring. The same finding with nothing behind it is simply unknown, so it gets a second look.
• An area that needs more detail. Sometimes a spot is at the edge of the image, or partially obscured, or just not captured as sharply as the radiologist would like. More pictures, better angles.
• Calcifications. These are tiny flecks of calcium, very common, and usually meaningless. Their pattern is what matters, and pattern is hard to judge on a screening view, so magnified images get ordered.
• Something genuinely changed. Comparing this year to last year shows a difference worth explaining. Most differences have benign explanations, including cysts, which are fluid filled and extremely common.

One more thing worth naming. The callback usually comes from a technologist or a scheduler, not from the radiologist, and that person cannot interpret your images or tell you what was seen. It can feel like you are being stonewalled. You are not. They are following the rule that image interpretation belongs to the physician, and they are not hiding bad news from you.

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What the diagnostic visit actually involves

The appointment you are being asked to come to is called a diagnostic mammogram, and it is a different animal from the screening exam you had. It is targeted. Instead of a standard set of pictures of everything, the technologist works on the specific area in question.

Expect additional mammogram views. These may be spot compression views, where a small paddle presses on one area to spread that tissue apart, or magnification views that enlarge a region so calcifications can be examined in detail. This is where overlapping tissue tends to fall apart and reveal itself as nothing. Detailed imaging using our 3D and digital mammography technology often resolves the question right there.

There is a good chance you will also have a breast ultrasound. Ultrasound uses sound waves rather than X-rays, and it is very good at one job in particular that mammography cannot do well. It tells the difference between a solid mass and a fluid filled cyst. On a mammogram those two can look alike. On ultrasound they do not, because a simple cyst has a characteristic appearance that is recognizable in seconds. A large number of callbacks end exactly this way, with a cyst identified, no treatment needed, and you on your way.

The ultrasound itself is painless. Warm gel, a handheld probe, a technologist moving it over the area while watching a screen. No radiation, no needles, nothing to prepare for.

The biggest practical difference from your screening visit is the waiting. At a diagnostic appointment, the radiologist is generally reviewing your images while you are still in the building, and in many cases can speak with you before you leave. You came in for an answer, and the visit is built to give you one.

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How to get ready

A few things you can control, and controlling something helps.

Schedule it quickly. The waiting is the worst part, and every day you postpone is another day of carrying this around. Same day and next day appointments are often available at our Western New York offices, so ask.

Track down your prior mammograms. If any of your earlier imaging was done somewhere else, tell us when you call so those images and reports can be requested ahead of time. Comparison images are genuinely valuable, and they occasionally settle the whole question on their own.

Skip deodorant, antiperspirant, powder, and lotion that morning. Those leave tiny specks on the images that can look like calcifications. Wear a two piece outfit so you only undress from the waist up.

Bring someone if you want to. You are allowed. A friend in the waiting room is not a sign you are overreacting, and on the drive home through a gray Buffalo afternoon you may be glad they are there.

Write your questions down. Under stress people forget what they meant to ask and remember it in the parking lot. A short list on your phone fixes that.

To get your diagnostic appointment on the books, call our Breast Care Center at 716-836-4646 or use our scheduling information page. Say that you were called back after a screening mammogram, and mention where your previous images were taken so we can pull them before you arrive.

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What happens after

Most often, the extra imaging shows normal tissue and you go back to your routine screening schedule. Sometimes the radiologist finds something clearly benign, like a simple cyst, and the answer is the same. Sometimes they recommend a short interval follow up, usually a repeat look in several months, which is a way of watching something that appears benign but is worth confirming over time. That recommendation is not a coded warning.

In a smaller number of cases, a biopsy is recommended to sample the tissue and get a definite answer. That word lands hard, so it is worth knowing that most biopsies come back benign, and that a breast biopsy here is typically done with ultrasound guidance through a small needle with numbing medication, in an outpatient visit rather than an operating room.

Whatever comes next, remember what your imaging team does and does not do. We produce the pictures and the radiologist's interpretation, and that information goes to your physician, who works with you on what it means for your care. Our job is to make sure the picture is clear enough that the decision is a good one.

If you were called back and you are staring at the phone, call Great Lakes Medical Imaging at 716-836-4646 or reach out through our contact page, and we will get you scheduled for your follow up imaging quickly, explain each step before it happens, and get you to an answer instead of another week of wondering.