Lenore Fusciello Baker won’t quickly forget that day in 2020 when she opened what she thought would be a routine letter from her radiology facility telling her that a recent screening mammogram had been fine. Instead, it said the test had found an “abnormality” and told her to return for more imaging. It was 10 days before she could get an appointment — 10 long days of anxiety when she could think of little else.

“I totally freaked out. I was sure I had breast cancer,” says Baker, 56, a yoga and Pilates teacher. “Will I need chemo? Surgery? Who will teach my classes? I put my life on hold and wouldn’t make any plans beyond the date of that appointment. It really took me over.”

Tense with fear, she brought her husband along for support. “I couldn’t sit there alone and have them tell me I have cancer,” she says. Happily, the abnormality turned out to be a benign cyst. “The relief was enormous,” she says.

Mammogram callbacks are common — about 10 out of every 100 women are told they need more imaging after an initial screening, according to the American College of Radiology — but can be scary, especially if you have to wait for an appointment. The vast majority of the callbacks, however, turn out to be false alarms, according to the American Cancer Society. Fewer than 1 in 10 women who return for more imaging have cancer.

Women should never ignore a callback, which usually involves more extensive pictures, known as a diagnostic mammogram, and sometimes will require a sonogram and biopsy, experts say. Early detection of breast cancer usually means less-invasive treatment and high survival, more than 90% five years out, experts say.

“Callbacks happen frequently and with good reason, because we want to be sure,” says Karen E. Knudsen, chief executive officer of the American Cancer Society. “Most of the time, nothing is wrong. But if you get a callback, make the appointment.”

Still, for some women, the time between a callback and additional tests can be terrifying. “The stress is profound. I have been there,” Knudsen says of her own callback in January 2023. Hers required a biopsy, which found she did not have breast cancer, she says, but “I do understand firsthand the stress. You don’t think this will happen to you. I didn’t stay calm. I had to wait, which was nerve-racking. They did the biopsy right away, but it was another week before I got the results. Even knowing the odds, I found it very stressful.”

Many readings can prompt a callback, including a suspected mass; calcifications, which are calcium deposits that show up as tiny white specks like grains of salt; and dense breast tissue, which makes it difficult to see various parts of the breast. Another finding, known as “asymmetry,” means one part of the breast looks different from the corresponding area in the other breast. One cause of asymmetry is overlapping tissue, which results when the breast is compressed during imaging, experts say. It looks suspicious but is harmless.

The percentage of callbacks tends to be higher for a first mammogram and declines with age, according to the cancer society. There are several reasons for this. Younger women, typically in their 40s, have no prior mammograms for comparison purposes, so the radiologist can’t see changes over time. Older women, on the other hand, have a history.

Also, as women age, their glandular tissue — the tissue that makes milk — steadily turns to fat, which makes a mammogram easier to read. Finally, younger women tend to have denser breast tissue than older women.

“Our bodies change over time,” so women should have a baseline first-time mammogram and establish a history of yearly images “so you can see the changes,” says Elisa Port, professor of surgery at the Icahn School of Medicine at Mount Sinai and chief of breast surgery for the Mount Sinai Health System. “Things change for different reasons, so it’s important to know what is normal for you.”

There is some debate among experts as to when to start getting mammograms and how often.

The cancer society says it’s optional for women between 40 and 44 to have one annually; for those 45 to 54, yearly mammograms are recommended. A woman is at average risk if she doesn’t have a personal history of breast cancer, a family history of the disease, or any of the genetic mutations linked to an increased risk of breast cancer, according to the cancer society. (Chest radiation therapy before the age of 30, can also increase the risk.) After 54, it’s up to the woman to decide whether to have mammograms annually or every other year.

The U.S. Preventive Services Task Force recommends biennial screenings for women between 40 and 74 at average risk for breast cancer. It’s best to consult with your doctor about your individual risk factors to determine timing.

As for the callback, Port says some women psychologically “want the resolution and are willing to drop everything and come in, and should have that option,” if it’s possible, she says, while others, with busy lives and other commitments, are comfortable waiting a week or two.

At Mount Sinai, “we are very motivated to get women back in and move things along,” Port says. “I think a woman should be able to come in within three or four business days, if that’s what she wants. But it’s not a medical emergency. Nothing will be growing or changing in a week or two,” she adds. “You haven’t blown anything by waiting.”

How can someone decrease the chances of getting a callback? Experts have some tips for that — and recommendations for how to reduce any anxiety before and after a mammogram.

• Before your screening mammogram, ask the radiology center about its equipment. The use of three-dimensional mammography — which combines multiple X-ray images of the breast — decreases the callback rate, according to Laurie Margolies, vice chair for breast imaging for the Mount Sinai Health System and professor of diagnostic, molecular and interventional radiology. Ask also whether the center uses AI, which “acts like a second opinion,” Margolies says. “It’s not perfect, but it’s helpful.”

• Make sure the facility has your prior mammograms for comparison purposes. If this is your first visit to a new facility, ask your previous one to load your earlier mammograms onto a CD so you can bring it with you.

• Get screened regularly, depending on your risk, to establish a history.

• If you are really anxious about the possibility of a callback, ask if your mammogram can be read while you wait. “Some practices will do that,” Margolies says. If that isn’t an option and if the radiology center has a patient portal, it should have the report as soon as the physician signs off on it.

• If you do get a callback, ask how quickly you can be seen. Some facilities make it a priority to schedule callbacks as soon as possible.

• Try not to panic, which doctors acknowledge can be easier said than done. “I had one older lady having a biopsy who thought she was going to die,” Margolies recalls. “She started giving away her dishes. I thought it would be benign, and it was.” If you do get regular mammograms and cancer is found, “your chances of beating it are phenomenal,” she adds. Most women who die of breast cancer neglect to have these screenings or ignore callbacks, she says. “Get the screen. You don’t want to wait until it’s the size of a tennis ball and bleeding.”

• Remind yourself that callbacks are not uncommon and the likelihood of finding cancer in such cases is remote. Even if you need a biopsy, it doesn’t mean you have cancer. And if you do, it’s likely that screening will mean it has been picked up early and with a high survival rate.

• If you are anxious, the American Cancer Society has a phone line (800-227-2345) and a live chat line, available at the bottom of its homepage.

• Finally, know that it is normal to feel anxious. “Take a deep breath,” Margolies says. “There’s a very good chance it will be benign. But if it’s not, it will most likely be an early breast cancer with a high cure rate and minimally invasive treatment. If you get a callback, don’t panic. Go back. Take care of business.”