Abnormal mammogram: what to do next

Q: What does it mean when you get called back after a mammogram?

A callback (recall) after a screening mammogram means the radiologist wants additional images or evaluation of a specific area. It does not mean cancer has been found — about 10% of women are called back after a screening mammogram, and of those, about 80–90% turn out to be normal or benign after additional imaging. Common reasons for callback include overlapping tissue, a spot that needs different angles or magnification, a mass, or calcifications that need closer evaluation.

Q: What is a BI-RADS score?

BI-RADS (Breast Imaging Reporting and Data System) is a standardized scoring system from the American College of Radiology used to categorize mammogram findings. Scores range from 0–6: 0 = incomplete (additional imaging needed), 1 = negative, 2 = benign, 3 = probably benign (short-interval follow-up), 4 = suspicious (biopsy recommended), 5 = highly suggestive of malignancy, 6 = biopsy-proven malignancy.

Q: What is a BI-RADS 3 finding?

A BI-RADS 3 (probably benign) finding has a less than 2% chance of being malignant. It typically means the radiologist sees something that is almost certainly benign but wants to confirm stability over time. The standard recommendation is a short-interval follow-up mammogram in 6 months to confirm the finding has not changed. If stable at 6 months, follow-up continues at 12 and 24 months before returning to annual screening.

For patients who received a callback or abnormal result after screening · 8 min read

Quick answer

An abnormal mammogram result does not mean cancer. About 10% of women are called back after a screening mammogram, and the vast majority — about 80–90% — are found to be normal or benign after additional imaging. The key number is your BI-RADS score. BI-RADS 0 means more imaging is needed; BI-RADS 3 is probably benign; BI-RADS 4–5 means biopsy is recommended.

Receiving a call saying your mammogram results are "abnormal" or that you need additional imaging is alarming — but it is also extremely common. Understanding what your results actually say, and what the follow-up process involves, can help reduce anxiety while you wait for your appointment.

~10%

of women are called back after screening

80–90%

of callbacks are benign or normal

5–10

cancers found per 1,000 screenings

Understanding BI-RADS scores

Every mammogram report uses the BI-RADS (Breast Imaging Reporting and Data System) from the American College of Radiology. This standardized scoring system tells you — and your doctor — how to interpret the findings and what action is recommended.

Score	Category	Meaning	Action
0	Incomplete	Additional imaging needed before assessment	Diagnostic mammogram / ultrasound
1	Negative	Nothing to comment on — normal	Routine annual screening
2	Benign	Definitively benign finding (e.g., cyst, calcified fibroadenoma)	Routine annual screening
3	Probably benign	<2% chance of malignancy — likely benign but needs stability check	Follow-up mammogram in 6 months
4	Suspicious	2–95% chance of malignancy — warrants tissue sampling	Biopsy recommended
5	Highly suspicious	>95% chance of malignancy	Biopsy required
6	Known malignancy	Biopsy-proven cancer — used in treatment planning	Treatment planning

If your report says "additional imaging recommended" or "BI-RADS 0," this means the radiologist needs more information before assigning a final score. This is routine and does not indicate a suspicious finding.

What happens at a diagnostic mammogram

A diagnostic mammogram (as opposed to a screening mammogram) is a more targeted examination. Instead of the standard 4 images taken at a screening, a diagnostic mammogram may include:

Spot compression views — a smaller paddle compresses a specific area to spread out overlapping tissue and get a clearer image
Magnification views — enlarges a specific area to evaluate calcifications in detail
Additional angles — different positioning to evaluate a finding from multiple directions
Targeted ultrasound — often done at the same appointment to characterize a mass as solid or cystic

At a diagnostic mammogram, a radiologist is typically present to read the images in real time and communicate results before you leave.

Common reasons for callback

Calcifications

Tiny calcium deposits in the breast — most are benign. The shape, size, and distribution pattern determine significance. Coarse or "popcorn" calcifications are almost always benign (often from old fibroadenomas). Fine, clustered calcifications in a linear or segmental distribution can be concerning and may prompt biopsy.

The report may describe calcifications as:

Benign-appearing — no action required
Probably benign (BI-RADS 3) — 6-month follow-up
Suspicious (BI-RADS 4) — biopsy recommended

Mass or nodule

A distinct three-dimensional finding in the breast. Characterized by its margins (smooth vs. irregular), density, and behavior on ultrasound (solid vs. cystic). Simple cysts are benign. Solid masses with irregular margins are more concerning.

Asymmetry

An area where the breast tissue on one side looks different from the other. Often caused by overlapping normal tissue (not a true lesion). Additional imaging determines whether it represents real tissue or is a projection artifact.

Architectural distortion

An area where the normal breast tissue pattern appears pulled or distorted. Can indicate a benign scar, radial scar, or a cancer. Usually requires biopsy for definitive diagnosis.

If biopsy is recommended (BI-RADS 4 or 5)

A recommendation for biopsy is understandably frightening, but remember: BI-RADS 4 is assigned across a wide range of suspicion (2–95% malignancy risk). Many BI-RADS 4 biopsies return benign results. The purpose of biopsy is to get a definitive tissue diagnosis.

Most breast biopsies are done with a needle (core needle biopsy or fine needle aspiration) under image guidance — either mammogram guidance (stereotactic biopsy) or ultrasound guidance. They are outpatient procedures done under local anesthesia.

Questions to ask at your diagnostic appointment

What exactly was seen on the screening mammogram that prompted this recall?
What is my BI-RADS score after additional imaging?
Is what you're seeing likely to be benign or concerning?
What is the next step — follow-up imaging or biopsy?
If biopsy: what type, and how long will results take?

Have mammogram or breast imaging? Upload and understand it.

Upload your DICOM mammography or breast MRI files and ask your first question for free.

Upload my scan — it's free to start

DICOM Reader is an educational tool. It does not provide a medical diagnosis and does not replace your radiologist or physician.

Frequently asked questions

What does it mean when you get called back after a mammogram?

A callback means the radiologist wants additional images or evaluation of a specific area. It does not mean cancer has been found — about 10% of women are recalled after screening, and 80–90% are found to be normal or benign after additional imaging. Common reasons include overlapping tissue, a spot needing different angles, or calcifications needing closer evaluation.

What is a BI-RADS score?

BI-RADS is a standardized scoring system for mammogram findings. Scores range from 0–6: 0 = incomplete (additional imaging needed), 1 = negative, 2 = benign, 3 = probably benign (6-month follow-up), 4 = suspicious (biopsy recommended), 5 = highly suggestive of malignancy, 6 = biopsy-proven cancer.

What is a BI-RADS 3 finding?

A BI-RADS 3 finding is "probably benign" with less than 2% chance of malignancy. The standard recommendation is a follow-up mammogram in 6 months to confirm the finding is stable. If stable at 6 months, follow-up continues at 12 and 24 months before returning to annual screening.

Does an abnormal mammogram mean I have cancer?

No. Most abnormal mammogram findings are benign. Of every 1,000 screening mammograms, about 100 women are recalled, and only 5–10 ultimately receive a cancer diagnosis. Common benign findings include cysts, fibroadenomas, and most calcifications. An abnormal result means additional evaluation is needed — not that cancer is present.

Medical disclaimer: This article is for educational purposes only. Always discuss your imaging results with a qualified physician.