Mammography is one of the best tools for breast cancer screening with its proven track record of reducing death rates through early detection. According to findings presented at the 2023 Radiological Society of North America (RSNA) Scientific Assembly and Annual Meeting, the study group that participated in scheduled mammograms had a survival rate of over 80%, whereas those who did not take part in any screenings had survival rates between 59.1% to 77.6%. The participants who attended all five scheduled mammograms also showed a 72% minimized risk of breast cancer mortality.
Whether born male or female, many of us are at risk of developing breast cancer. Understanding what a mammogram is, how it works, and why it matters can help us make educated choices regarding our health. In this article, New Hope Unlimited answers the following questions:
- What is a mammogram?
- What is digital mammography? Is it different from conventional mammography?
- What is a 3-D mammogram?
- How does 3-D mammography differ from traditional 2-D mammography?
- Is it necessary to compress the breast?
- How accurate is mammography?
- Why should I get a mammogram?
- When should I start getting mammograms?
- How does a mammogram feel?
- Where can I find specific recommendations for screening mammography?
- What is BI-RADS®?
- Where can I get high-quality mammograms?
- Can an uninsured or low-income individual get a free or low-cost mammogram?
- What should women with breast implants know about mammograms?
- What should I do and not do before a mammogram?
- How soon can I get my mammogram results?
- What if my mammogram results are abnormal?
- What if I have breast cancer?
What is a mammogram?
A mammogram produces X-ray images of each breast.
Mammograms help screen for breast cancer in individuals, especially if they exhibit no signs or symptoms of the disease. Known as a screening mammogram, it involves taking two or more X-ray pictures of each breast, allowing for the detection of tumors that a self-breast exam nor a physical examination cannot detect. Screening mammograms can also reveal tiny calcium deposits (microcalcifications) that may indicate breast cancer.
Mammograms can also detect breast cancer following the discovery of a lump or other symptoms indicative of the disease. Experts refer to this type of mammogram as a diagnostic mammogram.
In addition to lumps, possible signs of breast cancer include breast pain, skin thickening, nipple discharge, or changes in breast size or shape, although these symptoms can also signal benign or noncancerous conditions. A diagnostic mammogram can assess changes detected during a screening mammogram or review breast tissue when getting a screening mammogram is challenging, such as with the presence of breast implants.
What is digital mammography? Is it different from conventional mammography?
Digital mammography, or full-field digital mammography (FFDM), is an advanced form of mammography that captures breast images electronically and stores them on a computer. Like conventional film mammography, digital mammography uses X-rays to produce detailed images of the breast. However, digital mammography uses digital detectors instead of film to capture the image. The image can be magnified, enhanced, or manipulated for closer evaluation, unlike with regular mammography.
During a digital mammogram, two plates compress the breasts like in film mammography, and X-rays pass through the breast to capture an image. The main difference is how the technology records, views, and stores the image. Digital mammography has replaced conventional mammography in the United States, but it is only available at facilities with FDA approval to conduct digital mammography.
What is a 3-D mammogram?
Three-dimensional (3-D) mammography, also known as digital breast tomosynthesis (DBT), is an advanced form of digital mammography. In DBT, X-ray machines take multiple images of the breast from different angles, capturing thin “slices” that a computer then reconstructs into a comprehensive 3-D image. This technique is similar to how computed tomography scanners generate detailed images of internal body structures.
DBT uses very low doses of X-rays. But since radiologists often perform it alongside standard two-dimensional (2-D) digital mammography, the total radiation dose can be higher than that of standard mammography alone. Innovations in tomosynthesis now allow DBT to be conducted independently, potentially reducing the radiation dose to levels comparable to standard mammography.
How does 3-D mammography differ from traditional 2-D mammography?
3-D mammography offers several advantages over traditional 2-D mammography:
- Enhanced detection: Capturing multiple slices of the breast from various angles allows DBT to provide a more detailed view. In fact, DBT increases cancer detection by 21% compared to traditional mammography. It improves the detection of small and obscure tumors that 2-D images might miss.
- Reduced recall rates: The detailed imaging can lead to fewer callbacks for additional testing, reducing anxiety and inconvenience for patients.
- Better visualization: DBT benefits younger patients and women with dense breast tissue, as it can distinguish overlapping structures more effectively than 2-D mammography.
Many doctors recommend getting this type of mammogram, if possible. However, not all health insurance plans cover 3D mammograms, and not all accredited units are 3D-capable. Call and ask whether your local hospital and health insurance provider offer and cover 3D mammograms beforehand.
Is it necessary to compress the breast?
Breast compression spreads tissue and reduces thickness for better X-ray images. This process enhances the accuracy of breast cancer screenings by capturing a clear and detailed view of the tissue, which allows doctors to detect abnormalities more easily.
How accurate is mammography?
In general, the sensitivity of mammography is 87%, meaning it correctly identifies 87 out of 100 women who have breast cancer. The imaging technique can be more accurate in men since they do not have dense breasts or common breast changes that interfere with screening.
One downside of mammography’s high sensitivity is the possibility of false positive results. For example, a mammogram can mistake an abnormal finding for cancer, but further testing reveals there is no cancer.
The following refers to women specifically:
- Frequency: The chances of a false positive increase with the number of mammograms a patient undergoes. After one mammogram, the likelihood is from 7 to 12%, depending on age. Younger women, although still at risk of breast cancer, are more susceptible to false positives. Related: Breast Cancer in Young People: Causes, Types, Consequences.
- Factors: Women younger than 50 and those with dense breasts are more prone to false positive results. However, many women under 50 years old have dense breasts, which means these two groups can overlap.
False positives can trigger unnecessary anxiety and stress. This emotional turmoil can persist long after the initial scare. Receiving a false positive result may also require additional follow-up tests, which can be physically, emotionally, and financially taxing.
Second opinions are not always necessary, but there are times when getting one may be critical, especially considering the above disadvantages. A second opinion can provide clarity, reduce needless worry, and determine whether further testing or treatment is necessary.
Why should I get a mammogram?
Simply put—to detect breast cancer before it progresses and lowers your chances for recovery. Mammograms help identify potential issues when symptoms like palpable lumps, indentation of the breast skin or thickening, nipple retraction, discharge, erosive nipple sores, or discomfort in or around the breast area arise. Early detection through mammography saves lives by increasing the likelihood of successful treatment. Regular mammography screenings are of higher importance for individuals at high risk, such as those who have a family history of breast cancer or have a cancer risk gene like BRCA1 and BRCA2.
When should I start getting mammograms?
Women over 40 at average risk should get yearly mammograms to check for breast cancer. The age recommendation may be lower for high-risk individuals.
After consistent annual screenings, women 55 and up can have mammograms every other year, but they can continue yearly mammograms if they want to. Screening should continue as long as the person is healthy and is expected to live for another ten years.
These guidelines do not apply to:
- Anyone with a personal or family history of breast cancer
- Anyone at high risk of malignant breast tumors based on specific genetic markers
- Anyone with a history of exposure to high-dose radiation to the chest
- Anyone with a history of lesions on past biopsies
Men with gynecomastia should also consider getting an annual mammogram, starting at age 50 or ten years before the earliest male breast cancer case in the family.
Is your risk of developing breast cancer high? Find out here and here. Our previous post, Female Versus Male Breast Cancers, also has valuable information that can help with your research.
How does a mammogram feel?
For many women and men, having a mammogram can be uncomfortable, and for some, it can be painful. However, the procedure is quick. It typically lasts a few seconds per breast, and any discomfort or pain is brief. Nonetheless, early detection and accurate diagnosis outweigh any temporary discomfort.
Your breast size, the technician’s skill and technique, and the compression level required are factors that influence how a mammogram would feel. For women, if you’re about to start or are on your period, your breasts may be more sensitive, potentially increasing the pain or discomfort during the procedure. Consider scheduling your test after your period, or when your breasts no longer feel sore or sensitive.
Where can I find specific recommendations for screening mammography?
Numerous breast cancer organizations and professional societies, including the U.S. Preventive Services Task Force (arranged by the Agency for Healthcare Research and Quality, a federal agency) and the American Cancer Society, have established guidelines for mammography screening. They all stress the importance of discussing the benefits and risks of mammography with a healthcare provider, as well as determining the best age to begin breast cancer screening and the recommended frequency.
What is BI-RADS®?
The American College of Radiology has introduced an easier way for radiologists to explain mammogram results. The system, called the Breast Imaging Reporting and Database System or BI-RADS for short, has seven levels (0-6). Each level details a follow-up plan to help radiologists and other doctors manage a patient’s care.
| Level | Assessment | Follow-Up |
| 0 | Require additional imaging test | Additional imaging is necessary to assign the appropriate level |
| 1 | Negative for breast cancer | Continue routine mammograms |
| 2 | Benign (noncancerous) | Continue routine mammograms |
| 3 | Possibly benign | Get a follow-up mammogram after six months |
| 4 | Suspicious abnormality in the breast | May require a biopsy |
| 5 | Highly suggestive of malignancy (cancer) | Requires a biopsy |
| 6 | Biopsy-proven malignancy (cancer) | A biopsy confirms the presence of cancer cells before treatment begins |
The BI-RADS system also includes four categories for reporting breast density, as determined by the radiologist overseeing the mammogram. From least to most dense, these categories provide a comprehensive description of breast tissue composition:
- The breasts are mostly fatty.
- Scattered areas of dense glandular and fibrous connective tissue, also known as fibroglandular density.
- The breasts are heterogeneously dense or contain more areas of fibroglandular density, which can obscure small masses on a mammogram.
- The breasts are extremely dense, which can make it difficult to identify tumors on a mammogram.
In the U.S., many states have laws requiring mammography specialists to inform women if they have dense breasts—heterogeneously or highly dense—and to explain the risks. Dense breast tissue complicates mammogram interpretation and is a risk factor for breast cancer.
Where can I get high-quality mammograms?
High-quality mammograms are available at breast clinics, private radiology practices, hospital radiology departments, mobile units, and doctors’ offices.
The Mammography Quality Standards Act (MQSA) is a federal law ensuring uniform quality standards for mammography facilities nationwide. According to MQSA requirements, all mammography centers must: 1) obtain accreditation from an FDA-approved accreditation body; 2) receive certification from the FDA, or a state agency approved by the FDA, confirming they meet the necessary standards; 3) pass an annual MQSA inspection; and 4) clearly display their certification.
People are encouraged to verify FDA certification with their doctor or the mammography facility staff before scheduling an appointment. They should also check the validity and expiration date of the facility’s MQSA certificate. MQSA also mandates that mammography facilities provide patients with clear and easily understandable reports of their mammogram results.
Can an uninsured or low-income individual get a free or low-cost mammogram?
Some local and national health programs, as well as employers, offer mammograms at no cost or for a reduced fee. One notable example is the Centers for Disease Control and Prevention, which oversees the National Breast and Cervical Cancer Early Detection Program. This initiative makes screening services, such as clinical breast exams and mammograms, accessible to underprivileged individuals across the United States and several U.S. territories. Those interested can find contact information for local programs on the CDC website or by calling 1-800-CDC-INFO (1-800-232-4636).
Hospitals, health departments, women’s centers, and various community organizations are also valuable resources for locating affordable mammography services. They help ensure that financial barriers do not prevent access to life-saving breast cancer screening.
What should women with breast implants know about mammograms?
Women with breast implants, regardless of type and size, should undergo regular mammograms to ensure early detection of breast cancer. Simply notify the mammography facility about having implants when scheduling the appointment. This information allows the technologist and radiologist to prepare and utilize specialized techniques for imaging. For instance, implant displacement views (ID views) involve gently pushing the implant back against the chest wall and pulling the breast tissue forward. This method allows for better visualization by maximizing the amount of breast tissue a mammogram can capture.
What should I do and not do before a mammogram?
Do not use deodorant, creams, or powders on your underarms, chest area, or breast skin before a mammogram. These substances can leave a residue that may appear on the images, potentially concealing small abnormalities or mimicking signs of breast cancer. Attend the appointment with clean, dry skin for optimal imaging quality and to avoid the need for repeat scans. Clean the underarm and breast areas thoroughly on the day of your mammogram if you regularly apply deodorant, antiperspirant, powders, or lotions. The goal is to ensure no residue remains on the skin.
For premenopausal women and those of reproductive age, schedule a mammogram the week after a period, as breasts may be more sensitive and prone to discomfort during menstruation.
On the day of the procedure, wear a two-piece outfit (e.g., a button down shirt paired with jeans) that’s easy to remove from the waist up. Inform the technician or radiologist of any concerns or recent breast changes before starting the test.
How soon can I get my mammogram results?
Mammogram results are typically available within a few days, although the timeline can vary per institution. In many cases, a radiologist reviews the mammogram and forwards the results to the patient’s doctor, who then discusses the findings with the patient.
What if my mammogram results are abnormal?
Don’t worry; an abnormal mammogram is not always malignant. Follow-up mammography after six months, biopsy, and other exams may be necessary before an oncologist confirms whether the abnormality is cancerous. Also, only 8 to 10% of all patients with an abnormal mammogram will require a biopsy, and of those biopsies, 80% are noncancerous.
What if I have breast cancer?
If your doctor finds a malignant tumor, know that you have an army rallying alongside you. New Hope Unlimited is one of such allies, and we are here to provide comprehensive care, guidance, and alternative cancer treatments that consider you as a whole person—body, mind, spirit, and emotions included. Contact us if you have questions about how alternative treatments, including immunotherapy for breast cancer, can help you achieve remission.
