That waiting period can be really hard for patients.
Mayra C. Beauchamp Bruno, MDAn abnormal cancer screening can spark your worst fears. The screening results don’t necessarily mean you have cancer, but anticipating further testing and worrying about the unknown can feel stressful.
“That waiting period can be really hard for patients,” says Dermatologist Mayra C. Beauchamp Bruno, MD, of Dartmouth Hitchcock Clinics Manchester.
Here’s what you need to know.
Don’t assume the worst
Getting called back for additional testing usually results in a positive outcome, experts say. If your initial screening revealed a mole, calcification or nodule, it means your doctor needs more information. For example, about 10% of mammograms lead to additional ultrasound imaging, but only 0.5% of those result in a cancer diagnosis.
“Getting a call from your doctor for a follow-up can be highly stressful, but we want you to feel calm and not worry too much,” says Linda T. Vahdat, MD, a breast oncologist and the section chief of Medical Oncology at Dartmouth Cancer Center.
What additional testing means
Breast cancer screening
“Abnormal mammogram findings typically include what’s called an ‘architectural distortion’ and ‘microcalcifications,’ but those are often not cancerous,” Vahdat explains.
On a mammogram, an architectural distortion can be an irregular shape or pattern of breast tissue, while microcalcifications appear as white spots or flecks. According to the American Cancer Society, additional testing may be required because:
- The initial mammogram images weren’t clear or didn't show some of your breast tissue.
- A radiologist sees something suspicious, such as calcifications or a mass.
- The radiologist sees an area that appears different from other parts of the breast.
Dense breast tissue can also obscure abnormal findings like distortion or calcifications, reducing the accuracy of mammograms. If your mammogram screening is abnormal, you may get another imaging test, such as an ultrasound of the breast to examine the area of concern.
“You should schedule follow-up imaging as soon as possible to reduce anxiety and avoid prolonged uncertainty,” Vahdat says.
Lung cancer screening
Screening for lung cancer is important if you have a history of tobacco use.
“The challenge is, that unlike breast or colon cancer, where 75-80% of eligible patients are screened, only about 6% of eligible people get screened for lung cancer,” says Pulmonologist David J. Feller-Kopman, MD, of Dartmouth Hitchcock Medical Center (DHMC). “Lung cancer screening saves lives, and results in a 20-33% reduction in mortality.”
Screening for lung cancer is recommended for adults between ages 50 to 80 with a 20-pack-year smoking history (one pack a day for 20 years), who currently smoke or have quit smoking within the last 15 years. A test known as a low-dose CT (LDCT) scan is used to screen for lung cancer. About 24% of screened patients have abnormal findings—or nodules—but 96% of those are not cancerous. You might also be called back for additional testing if the scan revealed a spot or a shadow in the lung tissue.
“When it comes to your lungs, you’re exposed to the environment with every breath you take,” Feller-Kopman says. “There are all kinds of fungi and spores you can breathe in, and as a result, we see a lot of nodules that are not cancerous.”
Most nodules are less than three centimeters—or about 1.2 inches—in diameter. Anything larger is typically called a mass, which has a higher likelihood of being cancerous, he says. But most patients screened—about 75%—will not have a nodule or abnormal finding.
“For the remaining 25% who do, that’s when we must decide, do we just watch it with another CT scan to make sure it's not growing, or do we need a biopsy?” he says.
Next steps may include additional CT scans, a minimally invasive biopsy or scheduling surgery, depending on your risk level and your doctor’s recommendation.
“That window between an abnormal result and active treatment can be a tough emotional space,” Feller-Kopman says. “Our job is to get patients the answers—and the care—as quickly and clearly as possible, and we have a wonderful team to help guide our patients through this journey.”
Skin cancer screening
Experts recommend you have your skin checked by a dermatologist every two to three years. But if you've had any type of skin cancer, certain health conditions or a family history of melanoma, your dermatologist should check your skin annually. If your dermatologist finds a suspicious mole, a nodule or swollen lymph nodes, they will typically take a biopsy immediately for testing. Lab results can take about a week.
“We do biopsies because we want to be absolutely sure,” Beauchamp Bruno says.
Once the results return from the lab, no additional tests are needed. But if skin cancer—basal cell, squamous cell or melanoma—is found, your dermatologist will discuss surgery or treatment options.
“I try to be upfront during the visit, so the result isn’t a complete shock,” Beauchamp Bruno says. “It helps patients mentally prepare and reduces the anxiety of the unknown while they wait.”
Why screening matters
A recent National Institutes of Health study found that between 1975 and 2020, nearly six million deaths from common cancers were averted through prevention, screening and improved treatments. Prevention and screening helped avoid about 80% of those deaths.
“Be a good self-advocate,” Vahdat says. “Knowing your risk of cancer, getting screened and asking questions can save your life.”
Remember that abnormal cancer screenings don’t mean cancer, and in all likelihood, the odds are in your favor.