Confidence in mammogram readings

[Yippy121]

How confident can one truly be in the readings of mammograms? My recent experience has made me a bit uneasy regarding this. I had a baseline mammogram in 2000 at age 35. After my first screening since a few weeks ago, I was asked to come back for a spot compression. It seems that an asymmetrical density was overlooked in both the baseline and the next mammogram 4 years later.

The baseline mentioned nothing abnormal at all. The screening a few weeks ago informed "Comparison made to exams dated (2000). Fibroglandular elements in both breasts. A 1.5 cm irregular focal asymmetric density with an indistinct margin in left breast (2:00) in posterior depth. Not readily classifiable as benign or malignant. Further views recommended. If mass is confirmed, ultrasound would be appropriate. Birads 0."

The diagnostic mammo resulted in "Comparison made to (2000) and (2004). Scattered fibroglandular elements in left breast. A 1.5 cm irregular focal asymmetric density in left breast (2:00). Compared to previous films from 2000, this focal asym. density is not significantly changed. This focal asym. density is seen in the additional views. Impression: benign. Birads 2"

When I asked about this, the technician I spoke with became defensive. How could it be looked over initially twice? Can I be confident that the density hasn't actually changed? The radiologist who read the diag. mammogram is not, to my knowledge, a specialist in reading mammograms. I'm just not sure I feel 100% okay about these.

Thanks so much for your service!

[CCF-RN,MSN-rf]

Dear Yippy121: When we are young, mammograms can be difficult to interpret due to dense tissue.  This is probably why the density was not noted in the baseline.  In hindsight, one could go back and see that the irregularity was there at baseline.  The fact that it has not changed adds strength to it's being benign. It is not uncommon for additional views to be taken once something is identified.  The BIRADS scoring system is used to categorize mammographic findings and recommend follow up. The following is the BIRADS scoring system 1-Negative 2-Benign finding 3-Probably benign finding - short interval follow-up 4-Suspicious abnormality - biopsy recommended 5-Highly suspicious of malignancy.  I can understand why you are concerned.  If you are feeling uneasy, take your mammograms and get a second opinion.  If for no other reason than peace of mind.

[surgeon]

In most instances, when cancer is seen on mammogram, it's quite obvious. The problem is that breast tissue also has lots of other shadows, and it's rare that the two breasts are mirror images of each other. So, whereas cancer is usually so different appearing as to be quite easy to see, mammograms have lots of other shadows one can notice. And there is indeed some human variation in the attention paid to these various "assymetric" shadows. The bottom line in your case is that what was evidently considered insignificant was indeed found to be so; I've viewed hundreds of mammograms in which one radiologist referred to a particular shadow differently from another. I guess it's better that they error on the side of calling attention to shadows, which is what happened belatedly in your case. On the other hand, the person who considered your original mammogram ok was, it seems, correct. Is it possible to say with 100% certainty that a given shadow could in no way ever be cancer, nohow? Well, not really. But when images are compared over time, compression views are taken, and the images are read by experienced people, the chance of being wrong is down to the minimum possible with human beings. There are always other options: you could ask for a review of the films by another radiologist, or you could even request a biopsy. But what you describe is a fairly common scenario, one with which I'd be very comfortable at this point.

[Yippy121]

Thank you for your tinmely response - eases my mind a bit. A couple of factors I forgot to add, however, in my previous question - my mother was diagnosed with breast cancer last year at the age of 55, I am overweight, and also have quite large/lumpy breasts (even when not overweight). Should I ever pursue additional readings of mammograms in my situation? Would I be "scoffed" at or basically dismissed if I sought an additional reading in a situation such as this? Thanks again...

[surgeon]

I'd hope you wouldn't be scoffed at. As far as I'm concerned, you have the right to be satisfied. I'd suggest talking to your doctor -- the one that ordered the mammogram. Tell her/him your concerns and see if she/he would be the one to request an additional reading.