Mammograms: 8 Things Doctors Want You to Know

Whether you’re thinking about getting your first mammogram or have been getting routine screening for years, you may have heard conflicting reports about the different types of mammograms and when and how often to be screened. Mammogram screening—an X-ray of the breast—can, in most cases, detect breast cancer in women who have no apparent symptoms. Doctors also order mammograms to investigate suspicious results on a screening test or signs of breast cancer. To help debunk the myths and confirm the facts about mammograms—including why mammography can be painful—leading breast imaging specialists provide their insight.

The purpose of a mammogram is to find cancer as early as possible before it develops into a lump in the breast or causes other symptoms. “Unfortunately, we don’t yet have a cure for breast cancer,” says Nina Watson, MD, assistant professor of Radiology and Imaging Sciences at Emory University School of Medicine. “That is why it’s important to detect it when it’s as small as possible and easier to treat.”

According to Melissa Durand, MD, assistant professor in Radiology and Biomedical Imaging at Yale University School of Medicine, women should get their first mammogram at age 40. For average risk patients, the American College of Radiology and the Society of Breast Imaging also recommend age 40 and continuing every year. The American Cancer Society (ACS) recommends patients start by at least age 45, with a personal choice of starting at age 40. For women who have a close family member diagnosed with breast cancer, the recommendation may be to start earlier, adds Watson. “It’s important that women discuss their family history, past medical conditions, and surgeries/treatments with their doctor to see when it is best for them to start having an annual mammogram.”

Since breast cancer is easier to treat the earlier it’s found, it’s best to get a screening mammogram every year. It gives patients the best chance at finding a tumor when it is most likely to be curable, says Durand. That’s because mammography can find evidence of breast cancer when the tumor is at the smallest and earliest stage. “Annual mammograms allow your doctor to pick up subtle changes from year to year, so going regularly is important,” she notes. And if you change facilities, make sure to bring your prior images to your new facility.”

According to Susan Harvey, MD, Director of Breast Imaging at Johns Hopkins Medicine, many women feel they only need mammography if they perceive they are at risk for breast cancer. “Family history of breast cancer, for example, plays a role only in a minority of breast cancers,” she notes. “So even if you don’t have a family history of breast cancer, you should still undergo screening for malignancy because only a small percentage of breast cancers are related to family history and genetics.”

During your mammogram, your breast will be placed on a special platform and squeezed (or compressed) with a clear plastic paddle. The squeezing, or compression of the breast is why mammograms can be painful. Compression may not be comfortable, but it’s important for several reasons, says Watson. “It helps to spread out the breast tissue, to better help breast cancer be seen if it is present, and it helps reduce motion, which could make the pictures unreadable. It also allows for a lower X-ray dose to be used to create the mammogram images."

In today’s world, the best quality mammogram is a screening mammogram with digital breast tomosynthesis (DBT), also known as a 3D mammogram. “Not only have studies shown that 3D mammograms decrease the rate of false alarms and the need for follow-up exams, they have been shown to help detect more invasive cancers,” says Durand. In a large study of almost half a million patients, doctors using 3D mammography increased their invasive cancer detection rate by 41% compared to regular 2D mammography, while decreasing false alarms by 15%.

There are many concerns women have about mammograms, such as pain, radiation, or receiving a breast cancer diagnosis, according to Harvey. “I encourage women to reach out and learn more about mammography from their Ob/Gyn, breast imagers, and radiologists at specialty clinics, as well as friends and family, so they can overcome the fear enough to get the screening they need,” she notes. Talk with providers who are well informed about breast cancer screening, and ask questions about the risks and benefits as they relate to your individual health and needs.

Many women understandably worry that if they receive a recall after a mammogram, it must mean they have breast cancer. But Harvey offers some reassuring statistics. “In the U.S., we recall around 10% of women,” she notes. “While that’s very stressful without question, the majority of those women turn out to be just fine and do not have breast cancer.”