What to Expect at a Mammogram

Maybe you’ve been putting off a mammogram because you're anxious about what it might find. But experts encourage women to reframe having a mammogram as empowering. “You can’t prevent breast cancer, but mammograms help you take some control,” says Dr. Nina S. Vincoff, chief of breast imaging at Northwell Health in New York. “Mammograms find cancers when they are smallest and easiest to treat. Women who have mammograms are less likely to die from breast cancer and less likely to need aggressive treatments like mastectomy and chemotherapy.”

Dr. Laurie Margolies, professor and vice-chair for breast imaging at the Icahn School of Medicine at Mount Sinai, puts it even more succinctly: “Just come!  Don’t be afraid!”

But many women don’t. That’s true even if there are symptoms, Margolies says. Some “pretend nothing is happening and allow a breast mass to grow and grow until it erodes through the skin, and they find themselves bleeding and come to the emergency room,” she says.

The screening isn’t remotely as scary as you think. Ahead, Vincoff and Margolies walk you through what to know about mammograms and what the potentially life-saving exam entails.

What is a mammogram?

Breast cancer is relatively common. In the U.S., one in eight women will develop the disease sometime in her life. A mammogram is an X-ray examination of the breast used to detect breast cancer and other breast diseases.

“Some mammograms are performed on people who are having breast problems such as lumps or nipple discharge,” says Margolies, and others—known as screening mammograms—are performed as part of well care in people who have no known breast problems.

Who should be tested?

Knowing your risk is important. “The American College of Radiology suggests that all women have a risk assessment by age 30,” Margolies says. You can have this done by your physician or use a free online calculator that asks questions about family history, prior breast biopsies, and more.

Women of average risk should have yearly mammograms starting at age 40, says Vincoff. “Those are the guidelines that save the most lives.”

If you have a family history of breast cancer or personal medical history that could put you at increased risk for breast cancer, talk to your doctor about earlier screening. In these high-risk cases, it may be recommended you start mammograms before the age of 40 and/or to supplement mammograms with other tests like ultrasound or MRI, says Vincoff. Mammograms use a very small amount of radiation and are safe during pregnancy and breastfeeding, she adds.

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“It is very important for women to know that young women can get breast cancer even when pregnant, so if something does not seem right, speak up,” Margolies says. “The saddest perhaps are the very young women, often young mothers, who have breast cancer. There are unfortunately too many.”

When should women stop getting this annual test? “There is no absolute age cut-off for mammography” as long as you’re healthy, says Margolies. One of her patients in her late seventies asked if she could stop mammography given her age. “I quietly asked if she thought she was healthy and [would] live for at least five years,” Margolies says. “She replied, ‘Of course.’” Her next mammogram revealed bilateral breast cancer. “The great news is she is alive and well” eight years later, says Margolies. That may not have been the case had she skipped the test.

The bottom line: Continue getting mammograms every year—well into your 80s, even—if you’re in good health.

Men and transgender people have different considerations to keep in mind. Occasionally, men get mammograms either because they feel something abnormal or because they have a gene that puts them at higher risk for breast cancer, says Margolies. For transgender people, follow the “screen what you have” ethos, she says, with the timing of screening depending on multiple factors including how breasts were created and any hormonal treatments. Work with your doctor to figure out a plan.

How should you prepare for a mammogram?

The best preparation for a mammogram is the hardest: “Relax!” Margolies says.

If you are relaxed, she says, it will make the technologist's job easier and your mammogram better. This is because when the pectoralis (or chest wall muscle) is relaxed, the technologist can image more of your breast tissue optimally, making the mammogram image clearer for the radiologist.

Here are some other guidelines to follow before going to your mammogram, according to Margolies and Vincoff:

What should you expect during a mammogram?

You’ll likely spend more time checking in and getting undressed and dressed for the exam than that actual mammogram. The mammogram itself, start to finish, should take less than 10 minutes.

The typical mammogram consists of two X-ray images of each breast: one taken from the top and one taken from the side. To perform a mammogram, one breast is placed on a hard surface, and a plastic compression paddle then holds the breast in place with pressure before automatically lifting up and away from the breast. This is repeated on the other breast. While the mammogram takes a few minutes to perform, the compression that is needed to get the lowest radiation dose and clearest image lasts only a few seconds, says Margolies.

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Will it be painful? It shouldn’t be. While your breast is being held in place and compressed with a clear plastic plate, Vincoff says the exam may be “slightly uncomfortable, but it shouldn’t be painful.”

Are there alternatives to mammograms?

The short and sweet answer is that there is no substitute for a mammogram. 

“It is the only breast cancer screening tool that has been shown to save lives over and over again—in old studies using old equipment. The results are even better now,” says Margolies.

Breast ultrasound and breast MRI are the most common supplementary tests to mammograms. “These are often recommended if one has dense breasts,” says Margolies. “Dense breasts are normal, and about half of women have dense breasts.”

The reason why women with dense breasts sometimes need these additional tests is because dense breast tissue looks white on a mammogram and can hide cancer even on a 3D mammogram. “Ultrasound can find some of these hidden cancers, and breast MRI can find even more,” says Margolies.

What followups may be required?

Research indicates that about 10% of screening mammograms find something that requires additional evaluation. (Advances in technology such as 3D mammography and artificial intelligence are reducing the number of women who get recalled even more.)

Most patients who are recalled have the area of concern cleared up by additional mammogram images with different compression paddles or an ultrasound, says Margolies. Occasionally, you may be asked to obtain additional imaging in six months to ensure nothing is growing or changing, adds Vincoff.

Although it can be scary to learn that you need further testing, Vincoff says that women should know that only about 20 out of 1,000 mammograms find something that needs a needle biopsy. “And only about 5 of every 1,000 mammograms find a cancer,” she says, so try not to assume the worst if they find out they need more testing.

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Unfortunately, following a mammogram and follow-up tests, some women will need a biopsy, and some of those biopsies will result in cancer diagnoses, says Margolies. “That is why it is so very important to follow up if you are asked to return after a screening mammogram.”

You’ve likely heard this many times regarding mammograms, but it bears repeating: mammograms save lives. In fact, since mammogram screening started in the 1980s, the mortality rate from breast cancer has decreased by 40% in the U.S. “That’s partially due to better treatment, but early detection is playing a big role,” says Vincoff. “Mammograms find cancers when they are small and easiest to treat,” she adds, noting that women who have mammograms every year starting at age 40 have a 40% lower risk of dying from breast cancer than women who don’t.

Plus, women who have breast cancer detected on a mammogram—instead of waiting until the cancer becomes big enough to feel—are less likely to need aggressive treatments like mastectomy, chemotherapy, or a complete axillary dissection (removal of all the lymph nodes under the arm.)

A mammogram is only the beginning 

Though mammograms are an essential part of many women’s annual health care appointments, this test is only one part of preventive health for women. As a practicing radiologist, Vincoff says she sees a lot of women who have their mammogram every year but are neglecting other parts of their health. “Heart disease is still the biggest killer of women in the U.S., and it’s important for women to have regular checkups to test for things like high blood pressure and diabetes, to have colonoscopy and to have lung-cancer screening if they are at risk,” she says.