UNDERSTANDING THE TERM “NORMAL LIMITS”
If your letter states that your results were “within normal limits,” it means that your mammogram images were found to be within the expected range for breast tissue that currently does not show signs of breast cancer.
However, even with findings in normal limits, your letter may also include recommended next steps based on additional factors that could affect your breast health. The following sections include details about these next steps and why you may need them.
Your Results: Normal or Abnormal Findings and Next Steps
Your SmartMamm was interpreted by a radiologist. This physician, who has expertise in breast imaging, was also assisted by MammoScreen™—an AI tool that helps make even the smallest abnormalities easier to find.
At the most basic level, your results tell you whether your SmartMamm:
-
- Had findings within normal limits, with no additional steps needed until your next SmartMamm, scheduled based on your age, breast density, or other risk factors.
- Showed abnormalities that are probably not cancer but may need follow-up imaging sooner (in 6 or 12 months, for example).
- Had results that require additional imaging, such as a diagnostic SmartMamm, Smart Breast MRI™, or breast ultrasound, to more closely examine abnormalities seen in a SmartMamm.
- Had results that require a biopsy to physically examine suspicious tissue.
- Had results that your referring physician will need to review with you to discuss next steps in diagnosis or treatment.
If your SmartMamm report recommends next steps, reviewing them promptly with your doctor and completing them at the recommended time is important to your health.
Even though your SmartMamm may show no sign of cancer, you may need additional exams based on:
-
- Your calculated lifetime risk of breast cancer
- The density of your breast tissue
- Other aspects of your medical history
- Or other factors
Understanding Breast Density
Your SmartMamm results will inform you whether you have dense breasts. Breast density refers to how much of the inside of your breasts is made up of fatty tissue vs. fibroglandular tissue.
The term fibroglandular is a mouthful, but it refers to the kind of tissue that makes up the milk-producing glands, as well as connective tissue.
-
- Non-dense breasts have mostly fatty tissue (Category A) or scattered areas of fibroglandular tissue (Category B).
- Dense breasts have either roughly equal amounts of fibroglandular tissue (Category C, called heterogeneously dense) or nearly all fibroglandular tissue (Category D, called extremely dense).
mostly fatty
(about 10% of women)
scattered areas of dense fibroglanduar tissue
(about 40% of women)
roughly equal amounts of fatty & fibroglandular tissue
(called “heterogeneously dense,” about 40% of women)
nearly all of the tissue is fibroglandular
(called “extremely dense,” about 10% of women)
It is important to understand that dense breast tissue can make abnormalities harder to detect on a mammogram. It also generally increases breast cancer risk. As a result, an exam in addition to your SmartMamm, such as Smart Breast MRI or breast ultrasound, is recommended if you have dense breasts.
Understanding Risk Level
Every SmartMamm includes, at no additional cost, a calculation of your lifetime risk of breast cancer. The calculation is based on a formula called The Claus Model.
You can learn more about your risk by using our interactive Breast Cancer Risk Calculator.
average risk
high risk
The radiologist analyzing your SmartMamm assigns a score level that represents the patient’s percentage likelihood of developing breast cancer.
Even with normal SmartMamm findings, or with or without dense breasts, you may need more exams if you have risk factors such as:
-
- Past personal history of breast cancer
- History of breast cancer in certain close relatives
- A known genetic mutation that increases breast cancer risk
Other Factors
Your SmartMamm report may also recommend additional breast imaging in other situations, including but not limited to:
Atypia – Cells in the breast that are “not entirely normal.” While these cells may never become cancerous, they may need more frequent monitoring, which will be recommended in your SmartMamm report.
Silicone implants, which can leak, possibly causing side effects such as deformation or scar tissue in the breast. If you have silicone implants, your SmartMamm report may recommend Smart Breast MRI monitoring at times based on when you received your implants.
Additional imaging needed. Your letter may say that you need to return for another exam, such as a Smart Breast MRI or breast ultrasound, or for additional SmartMamm angles. These “call-backs” can occur for various reasons, such inconclusive findings or an area of the breast that was difficult to clearly view in your SmartMamm images.
Taking the Next Steps
If your letter and/or your SmartMamm report recommends additional imaging with Smart Breast MRI or breast ultrasound, for dense breasts or other reasons, completing your next steps at the recommended time is important.
For example, additional screenings with breast MRI or breast ultrasound should be considered to supplement the annual mammogram for both categories of dense breasts—C and D. Princeton Radiology offers both Diagnostic Smart Breast MRI and Screening Smart Breast MRI. Most insurance plans cover Diagnostic Smart Breast MRI for women at increased risk of developing breast cancer, such as those with:
-
- A Claus risk score higher than 20 (indicating lifetime breast cancer risk more than 20%).
- Category D dense breasts.
- An inherited condition such as BRCA1 or BRCA2 genetic mutations.
- A pre-existing history of breast cancer.
Ultrasounds may also be considered as an option for additional testing. However, breast MRIs can be more sensitive than ultrasounds for detecting breast cancer and small changes in breast tissue.
Princeton Radiology offers the following options to tailor your next steps to your specific needs.
Diagnostic Smart Breast MRI
Diagnostic Breast Ultrasound
Consider as a follow-up to SmartMamm if you have
- High Claus score greater than 20
- Category D dense breasts
- History of breast cancer before age 50
- History of breast cancer at any age with category C or D breast density
- A mammogram finding that needs clearer visualization
A physician’s order is required. Typically covered by most insurances.* Exam time: approx. 30 min.
May be considered as a follow-up if you have
- Suspicious or inconclusive Screening SmartMamm, Screening Breast Ultrasound, or Screening Smart Breast MRI findings
- Suspicious findings on a physical exam, or other breast-related concerns
- Symptoms present (lump or nipple discharge)
Screening Breast MRI
Screening Breast Ultrasound
May be considered if you are concerned about having dense breasts or a family history of breast cancer and do not meet the insurance coverage requirements.
A physician’s order is required
Cost: $375
Exam time: approx. 10 min.
A physician’s order is required. Typically covered by most insurances.* Exam time: approx. 30 min.
May be considered in addition to the annual SmartMamm for concerned patients with dense breasts or certain other risk factors.
May be considered for patients without symptoms.
*Insurance coverage varies from plan to plan. For Diagnostic Smart Breast MRI, category C breast density may not be covered.
SOURCE: State Law Map. DenseBreast-Info.org (2024, May 2).
Schedule Your Next Steps Now
If your SmartMamm report recommends next steps, scheduling them promptly within the recommended timeframes may maximize the benefit to your health.
- If you have already reviewed your findings with your referring physician and have the required physician order, you can schedule online, or call 609.921.8211 for our New Jersey offices or 267.386.2620 for our Newtown, PA office.
Otherwise, contact your referring physician to discuss your next steps.
