From the Guidelines
If you had an abnormal mammogram in the past, you will likely need a diagnostic mammogram for your follow-up screening rather than a standard screening mammogram. Diagnostic mammograms are more detailed examinations that focus specifically on areas of concern identified in previous imaging, as recommended by the NCCN clinical practice guidelines in oncology 1. They typically include additional specialized views and may be accompanied by an ultrasound for a more comprehensive evaluation. The radiologist is usually present during the examination to direct the technologist to capture specific images of suspicious areas. This approach allows for immediate assessment of any concerning findings and helps determine if changes have occurred since your previous abnormal result.
Key Considerations
- The need for diagnostic mammography after an abnormal finding depends on the specific recommendation from your radiologist and healthcare provider, who will consider the nature of the previous abnormality, your risk factors, and clinical history 1.
- For BI-RADS category 3 (probably benign), diagnostic mammograms are recommended at 6 months, then every 6 to 12 months for 1 to 2 years as appropriate, with a return to routine screening intervals if the lesion remains stable or resolves mammographically 1.
- Diagnostic mammograms are essential for proper monitoring of previously identified breast abnormalities and help ensure that any potential issues are detected and addressed promptly, which is crucial for reducing morbidity, mortality, and improving quality of life 1.
Recommendations
- A diagnostic mammogram should be performed if a questionable area remains that is not clearly benign after comparing previous mammograms, with or without ultrasonography 1.
- The NCCN guidelines recommend tissue diagnosis using core needle biopsy or needle localization excisional biopsy with specimen radiograph for BI-RADS categories 4 and 5 (suspicious or highly suggestive of malignancy) 1.
From the Research
Diagnostic Mammogram Requirements
- A diagnostic mammogram may be required if the previous mammogram was abnormal, as timely follow-up of abnormalities is essential for early detection and treatment of breast cancer 2.
- The need for a diagnostic mammogram depends on the results of the previous mammogram and the recommended follow-up plan, which may include additional views, ultrasound, biopsy, or surgical referral 3.
Follow-up After Abnormal Mammograms
- Studies have shown that inadequate follow-up of abnormal mammograms is a significant problem, with 18.1% of women not receiving adequate follow-up within three months of the recommended due date 2.
- Factors associated with inadequate follow-up include lower estimated household income, no history of previous mammogram, and lack of a specific follow-up recommendation in the mammogram report 2, 4.
- The use of a fail-safe system, such as a paper-based system, can help ensure timely follow-up of abnormal mammograms, but clinician adherence and staff transitions can be challenges 5.
Timing of Follow-up
- The timing of follow-up after an abnormal mammogram can vary, with some studies showing that 23% of women with abnormal screening mammograms receive follow-up within 7 days, while 69% of women with abnormal diagnostic mammograms receive follow-up within 7 days 6.
- Characteristics associated with timely follow-up include family history of breast cancer, symptoms at the time of mammogram, and extremely dense breasts for screening mammograms, and symptoms at the time of mammogram and obesity for diagnostic mammograms 6.
Clinical Algorithms for Abnormal Mammograms
- The use of clinical algorithms can help reduce the incidence of unnecessary surgical procedures and improve the management of abnormal mammograms 3.
- Algorithm-based care can help ensure that women with abnormal mammograms receive appropriate follow-up and treatment, and can help reduce delays in diagnosis and treatment 3.