If you’ve recently been referred for more imaging after a routine screening mammogram, you’re probably feeling like you have more questions than answers. There are several reasons why you may need more testing, such as new symptoms or an inconclusive mammogram.

Your healthcare provider considers several factors when choosing to send you for a breast MRI versus a mammogram. A breast MRI is usually more sensitive than a mammogram and can detect cancer at an earlier stage. However, because MRIs are so sensitive, there’s a risk of false positives.

In this article, we’ll cover the differences between breast MRIs and mammograms, including the benefits of both methods and what to expect.

Why Do I Need Follow-Up Imaging?

Breast cancer screenings are an important aspect of your overall care. Routine breast cancer screenings can detect cancer earlier and cut breast cancer deaths by a third or more.

Sometimes a screening test identifies an area of concern or is inconclusive. This is relatively common, and only a small percentage of those called back for more testing end up being diagnosed with breast cancer. Fewer than 10 percent of people called back after a mammogram are diagnosed with breast cancer.

You may be more likely to be called back for additional imaging if you have any of the following factors:

• Age between 40 and 49
• Dense breasts
• History of breast biopsy
• Family history of breast cancer
• Currently taking hormone therapy
• Breast implants

Your healthcare provider may recommend more breast imaging if you notice any possible signs of breast cancer, such as a lump. You may also require diagnostic imaging if you’ve recently been treated for breast cancer, as a way to monitor your progress.

What To Expect With a Follow-Up Mammogram

Annual screening mammograms are usually recommended once you turn 40. This may be different for people who have a family history of breast cancer or are considered high risk. A screening mammogram takes X-ray images of the breasts using two imaging plates.

When you’re referred for an additional mammogram, it’s referred to as a diagnostic mammogram. This test is more detailed than a screening mammogram.

A screening mammogram uses two X-ray plates to capture 2D images. A diagnostic mammogram may use both 2D and 3D imaging.

A 3D mammogram uses an imaging system that moves in an arc shape over the breast to provide images from more angles (this test is also known as tomosynthesis). This can provide more detailed pictures for the radiologist to review.

Research shows that 3D mammograms are more sensitive than 2D and can improve cancer detection. This may be helpful for people who have been told that they have dense breasts.

During a diagnostic mammogram, a radiologist will be present to read the images in real time. If more imaging is needed, they will tell you at the time.

After your test, the radiologist will be able to share their initial findings with you. If they determine that the concerning area is benign, you’ll likely go back to your regular screening schedule.

If the radiologist wants to watch the area, they may recommend coming back for more frequent mammograms. If they suspect cancer, they will recommend more testing and explain the next steps.

What To Expect During a Breast MRI

An MRI (magnetic resonance imaging) scan uses magnets and radiofrequency waves (not radiation) to produce detailed images of tissues inside the body. People at high risk of breast cancer may benefit from regular breast MRIs.

A 2019 study found that performing a breast MRI every six months was better at detecting invasive breast cancer than yearly mammograms in people with a higher genetic risk of breast cancer.

During a breast MRI, a radiologist examines images taken before and after you receive IV (intravenous) contrast solution. This solution makes any abnormal areas, such as a tumor, more visible on the MRI.

During the MRI, the scanner takes images and then sends them to a computer to produce 3D images. A traditional breast MRI can take about one hour to perform.

In some cases, your healthcare team may recommend a fast MRI or AB-MRI. This test uses the same equipment but takes only 10 minutes.

Research shows that a fast MRI is less sensitive than a traditional one. Talk with your healthcare team to determine which type is right for you.

A breast MRI is an extremely sensitive tool, and it can produce false positives. A false positive occurs when a medical test detects a condition, such as breast cancer, when it isn’t there. For this reason, breast MRIs are often used as a supplemental test, rather than used on their own.

A breast MRI can be useful after an abnormal or inconclusive mammogram or ultrasound.

What Happens Next?

If your mammogram or breast MRI showed an area of concern, your healthcare provider may recommend a breast ultrasound. This test uses sound waves (not radiation) to produce images of breast tissue and can help your healthcare team take a closer look at certain areas. Breast ultrasounds can be helpful for those who have dense breast tissue.

If your healthcare provider is concerned that you could have breast cancer, they will likely ask you to come back for a breast biopsy. During this test, the healthcare provider uses a needle or small cut to remove cells or tissue from the concerning area, then sends them to the lab to be examined under a microscope by a pathologist.

A breast biopsy is the only test that can diagnose breast cancer; imaging tests only raise suspicion.

It can be very stressful to wait for test results when you’re worried about cancer. It’s normal to feel anxious, fearful, angry, or sad. Don’t go through this alone.

Consider reaching out to a family member or trusted friend for support. Never hesitate to call your healthcare team with questions.

Talk With Others Who Understand

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Have you undergone a breast MRI? What was it like? Let others know in the comments below.