Everything You Need to Know About Mammograms

Female breast cancer is a common type of cancer, accounting for 15% of all cancer diagnoses. Breast cancer is far less common in men.

The American Cancer Society estimates that over 310,000 new cases of breast cancer will be diagnosed in women in 2024. 

Although the disease cannot be prevented, getting a mammogram is an effective way to ensure early detection of breast cancer in women. In light of Breast Cancer Awareness Month, we rounded up everything you should know about mammography.

Overview of Mammograms

What is a Mammogram?

A mammogram is an X-ray picture of the breast that is done to detect changes in the breast tissue. Mammograms can show changes caused by breast cancer before a lump can be felt or other changes like nipple or skin changes develop. 

During a mammogram, the breast is exposed to a low dose of radiation, which is used to create an image of the breast. A radiologist evaluates the mammogram image on an X-ray film or a computer screen (this is called a digital mammogram), looking for suspicious findings such as tiny calcifications that can be a sign of breast cancer.

Is a Mammogram Only For Breast Cancer?

Mammograms are primarily used for breast cancer screening, diagnosis, and monitoring. However, a mammogram can also be an important tool for detecting other breast diseases, such as benign cysts and tumors. 

Overview of Breast Imaging 

According to the National Breast Cancer Foundation and the American College of Radiology, there are two main types of mammograms: screening mammograms and diagnostic mammograms. 

Screening Mammogram

A screening mammogram is used to look for signs of breast cancer in women who don’t have any symptoms of breast cancer. X-rays of each breast are typically taken from two angles.

Diagnostic Mammogram

A diagnostic mammogram is used to examine a woman’s breast if she has: 

• Symptoms, such as a lump felt on a breast exam.

• Changes documented on a screening mammogram. 

• A confirmed diagnosis of breast cancer (to monitor response to treatment).

• For follow-up of women previously treated for breast cancer.

Digital Breast Tomosynthesis (DBT) or 3D Mammograms

Digital breast tomosynthesis (DBT) is a type of advanced mammogram that is also called three-dimensional (3D) mammography. It is very accurate in detecting breast cancer, especially in dense breasts. 

This imaging test uses two-dimensional images to create a 3D image of the breast. In contrast, a standard mammogram provides 2D images. At present, a 2D mammogram is the standard test for breast cancer screening. However, given its effectiveness, in the future, digital breast tomosynthesis (DBT) may replace 2D mammography as the gold standard in breast imaging.

Screening Guidelines: What Age Should A Woman Get A Mammogram?

The United States Preventive Services Task Force recommends that “all women who are at average risk of breast cancer get screening mammography every other year, starting at age 40 and continuing through age 74, to reduce the risk of dying from this disease.” 

Women at a high risk of breast cancer should start screening mammograms earlier in life. Risk factors for breast cancer include:

• A lifetime risk of breast cancer of 20% to 25% or higher, as calculated by risk assessment tools (these tools are mainly based on a family history of breast cancer). For example, if your mother developed breast cancer at age 40, your healthcare provider may recommend starting screening mammograms 5-10 years earlier, when you are 30 or 35 years old.

• Known BRCA1 or BRCA2 gene mutations found on genetic testing.

• First-degree relative (parent, sibling, or child) with a BRCA1 or BRCA2 gene mutation in women who have not undergone genetic testing themselves.

• Radiation therapy to the chest before age 30.

• Personal or family history of Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome.

Women who are at high risk for breast cancer for the above-listed reasons may also need to get a breast MRI (magnetic resonance imaging) in addition to a mammogram, usually starting at age 30.

Additional Screening and Diagnostic Tests

Breast Ultrasound vs Breast Mammogram

Breast ultrasounds and breast mammograms are both imaging studies that can help to detect abnormalities in breast tissue, but they are different in many ways: 

• Radiation exposure: A breast mammogram uses a low dose of radiation to create an image of the breast. A breast ultrasound uses sound waves and does not expose you to radiation. 

• Best for: Mammograms are considered the gold standard for breast cancer screening, especially in women over 35. Ultrasounds are often used for women under 35, or in addition to mammograms in women of all ages. 

• What they detect: Mammograms are better at detecting early signs of breast cancer, like microcalcifications. Breast ultrasounds are better at determining if a breast cyst is solid or fluid-filled. 

• How they're used: Mammograms are used to screen for breast cancer before symptoms develop or to look for abnormalities if a patient develops new symptoms. A breast ultrasound may be used for supplemental screening, to help diagnose breast abnormalities found during a physical exam, or to characterize potential abnormalities seen on a mammogram. 

• Other considerations: Mammograms are performed standing up, and the breast is compressed between plates on the X-ray machine during the procedure. A breast ultrasound is performed lying down with a handheld device called a transducer. No special preparation is needed for either procedure, but it's best to get a mammogram in the week after menstruation. 

Breast Biopsy

Your health care provider might recommend a breast biopsy if they feel a lump or see nipple changes or skin changes in your breast on physical examination and if your mammogram, breast ultrasound, or breast MRI reveals suspicious findings. A breast biopsy procedure involves obtaining a small sample of breast tissue for examination in the laboratory to look for signs of breast cancer. 

Preparing for a Mammogram

Do's and Don'ts Before a Mammogram

No special preparation is needed before a mammogram. However, the CDC recommends that you avoid having a mammogram the week before or during your menstrual period because breast tenderness at these times in the menstrual cycle can make the imaging test uncomfortable. 

Also, avoid wearing deodorant, perfume, or talcum powder on the day of your mammogram, as these products can affect the quality of the X-ray images.

What to Expect During a Mammogram

You will have the mammogram in the Radiology Department of a hospital or medical clinic. You will need to undress from the waist up. The technician will place each breast between two plates of an X-ray machine. These plates will compress (flatten) your breast for a few seconds to get a clear image. The test itself is painless, but some women find breast compression uncomfortable.

The entire mammogram test should take about 10 to 15 minutes to complete, but it can take longer if additional angles are needed. For women with breast implants, the procedure can take up to 30 minutes to obtain clear images.

Is a Mammogram Painful? 

Mammograms can be uncomfortable or even painful for some people because the breast needs to be compressed to get a good image. But the discomfort is typically brief. 

How painful you find a mammogram will depend on various factors, such as your breast size, breast density, where you are in your menstrual cycle, the amount of breast compression required, and the skill of the technologist. 

You can reduce mammogram-related discomfort by relaxing as much as possible when the technologist positions you for the X-ray.

Benefits and Risks of Mammograms

Early Detection of Breast Cancer

Mammograms are a type of low-dose X-ray of the breast that can detect breast cancer before symptoms appear. Early detection of breast cancer through mammograms has many benefits, including:

• Improved survival rates: Women who get regular mammograms have a lower risk of dying from breast cancer compared to those who don't get screening mammography.

• More effective treatment: Breast cancers that are detected early are more likely to be treated successfully with chemotherapy and radiation and may not require aggressive treatments like mastectomy (surgical removal of the breast).

The American Cancer Society reports that breast cancer death rates have dropped by 43% between 1989 and 2020, which translates to more than 460,000 fewer breast cancer deaths in this time period. This progress is largely attributed to earlier detection of breast cancer through screening, increased awareness, and advances in breast cancer treatments.

Potential Harms and Limitations

Mammograms are not perfect, and they can miss some cancers. This is called a false negative result. Sometimes, mammographic findings return a false positive result. Meaning, the mammogram looks suspicious for breast cancer when cancer is not actually present. The suspicious mammographic findings lead to more diagnostic work-up, such as additional imaging or a breast biopsy, but no breast cancer is ultimately found.

Understanding Mammogram Results

Mammogram results are reported using the Breast Imaging Reporting and Data System (BI-RADS) as follows:

Receiving a breast cancer diagnosis, or any cancer diagnosis, can be overwhelming. The medical terminology and treatment concepts can be complex and confusing. If you or a loved one is facing this, remember that your care team is there to support you, so don't hesitate to ask questions and seek clarity. 

Your doctor will explain the test results and treatment plan in a way that is clear and understandable, empowering you to make informed decisions about your health.  

When Will I Receive My Mammogram Results?

Depending on the facility where you have your mammogram, you should receive the results within two weeks. A radiologist will read the results and report them to you and your healthcare provider. You should contact your provider if you haven’t received your results after 30 days.

Access to Mammogram Screening

How to Find Mammogram Facilities?

Your primary care provider can refer you for a screening mammogram. All mammography facilities in the United States are required to meet standards set by a federal law called the Mammography Quality Standards Act (MQSA). You can check if a facility is MQSA certified by looking for the MQSA certificate, which is usually prominently displayed. 

You can also talk to your healthcare professional about getting breast imaging at a specialized facility that offers 3D mammography, which can produce higher-quality images and is more accurate than standard mammography. 

Costs and Insurance Coverage

The Affordable Care Act mandates that screenings for women's preventive health care be covered without any cost-sharing. This means screening mammograms should be 100% covered by your insurance plan without a copay if you are age 40 or older. Some plans may not cover 3-D mammograms or may charge higher copays for them.

Without insurance, out-of-pocket costs for a mammogram can range between $250 to $550, depending on where you live and the type of mammogram. Three-dimensional (3D) mammograms typically cost more than standard 2D mammograms.

Options for Low-Cost or Free Mammograms

If you don’t have health insurance, you may be able to get free or low-cost mammograms through various organizations. Check your state and local health programs. The CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast cancer screening and diagnostic services to uninsured or underinsured women from low-income groups.

Many mammogram facilities offer patient financial assistance programs and special deals on screening mammograms to help you save money.

Special Considerations

Mammograms for Women with Breast Implants

Women with breast implants should get regular screening mammograms based on their age and breast cancer risk unless they had a bilateral mastectomy (surgical removal of both breasts) before placement of the breast implants. 

It is best to inform the mammogram facility that you have implants before your appointment. You may need to get your mammogram at a facility where the technologists have experience doing mammograms on breasts with implants. Very rarely, getting a mammogram can cause an implant rupture. 

Both saline implants and silicone implants can make it harder to view the breast tissue. Women with breast implants, therefore, need additional views (pictures) taken of their breasts. 

Advanced Screening Technologies

Advanced mammography screening technologies include digital mammography and digital breast tomosynthesis (DBT), also known as 3D mammography. These have been described above.

Follow-Up for Abnormal Results

If you have an abnormal mammogram, your healthcare provider will likely order further testing. This may include a diagnostic mammogram with additional views, a breast ultrasound, a breast MRI, or a breast biopsy. An abnormal result on a screening mammogram needs to be investigated further, but it does not necessarily mean you have breast cancer. For example, a breast ultrasound might reveal the suspicious area is a cyst. In this case, no further testing will be needed, and you can return to your regular schedule of breast cancer screening with mammograms every other year and clinical breast exams.