Getting a Mammogram: What to Expect

If you’re planning to get a mammogram done, congratulations—you’re taking advantage of one of the safest and most accurate screenings available in the U.S. The procedure is credited with decreasing breast cancer mortality in the U.S. by almost 40 percent since 1990. 

Mammograms are quick, universally available, and may detect cancer early, when treatment and a cure are often possible. That’s why most doctors advocate strongly for them. In fact, when it comes to mammograms, the only controversy isn’t about the test itself, but rather about the timing of the screening. 

“There’s significant debate about mammograms right now,” says gynecologic oncologist Kristin Zorn, M.D., associate director for clinical research, Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences. “But I want to make sure women don’t interpret that as meaning the tests are of no value. They are still incredibly important.”

When should I get my first mammogram?

A mammogram is simply a breast X-ray image used for screening and diagnosis. The initial or “baseline” pictures serve as a reference point for future comparisons. Guidelines previously suggested that the first testing should occur at age 40, but the U.S.Preventive Service Task Force (an independent group advising on preventive testing) recently hiked the recommended first-time imaging age to 50 for average-risk women. Many other professional societies still recommend starting at 40. 

Regardless of that debate, ask your doctor if you need screening at 40 or earlier, especially if:

• Your first-degree relative (a parent, sibling, or child) had breast cancer. 
• Your second-degree relative (aunt, uncle, or grandparent) had breast cancer. 
• You have a clear genetic risk, especially the BRCA1, BRCA2, or other mutations. In this case, screening ideally should start at age 25.

But, according to Dr. Zorn, even women who don’t fall into a higher-risk group could benefit from earlier testing.

“Since one in eight American women eventually develop breast cancer, it’s important that even women without a family history get a baseline mammogram at 40 to help quantify factors such as dense breasts,” says Dr. Zorn.

Whether this is your first mammogram or your 20th, here’s what you should know.  

Before you schedule a visit:

• Confirm that your testing facility is certified by the Food and Drug Administration and has significant mammography experience.
• If you’re premenopausal, plan your appointment around your menstrual cycle. You may experience less discomfort and tenderness if you’re screened the week after your period.
• Try to schedule a test early in the day. You can’t use deodorant, powder, lotion, or ointment around the chest area beforehand, so you may want to start your day with the screening and bring deodorant or skin cream along to apply afterward.
• If this isn’t your first mammogram but you’re going to a new facility, arrange to have your prior mammograms sent in advance. You can also request and bring a CD of the images. Having your previous results gives the radiologist a basis for comparison.
• Understand the screening options. “Old-fashioned” conventional mammograms used regular X-ray film. Today, there are other options: 2-D digital mammography stores its findings on a digital chip. 3-D combines multiple images together for reconstructions that visualize the entire breast. In a 2016 study, 2-D digital and 3-D detected more potential problems, but they also returned more “false positives”; that is, they found potential problems where none existed. Of the two options, 3-D mammograms tend to have less false positives, but providers are still working to perfect the results.

“There’s a very large study underway right to determine how 2-D and 3-D compare,” says Dr. Zorn. Until those results are tallied, she makes clear “any mammogram is better than none.”

On the day of your visit

• Dress accordingly. Since you’ll need to undress from the waist up, plan to wear a top with pants or a skirt. You’ll also have to remove any necklaces.
• Inform the technician. Let your provider know if you’ve seen recent changes to either of your breasts, are at a high genetic risk of breast cancer, or if you’re breastfeeding, may be pregnant, have breast implants, or have skin abnormalities.
• Skip the deodorant and lotion. Skin creams, lotions, deodorant, or any other product on or near the chest area can interfere with the X-ray pictures, so you’ll be asked to avoid them before your exam.

“The small amount of aluminum in antiperspirants can make it hard to distinguish between breast calcifications that may be problematic and metallic particles in the deodorant,” warns Dr. Zorn. Creams and lotions can cause the same problem, as well as make the breasts slippery during the compression that a mammogram requires.

“Moles, growths, or scars can complicate reading the mammogram, so you’ll want to point them out for the technician to mark,” says Dr. Zorn. Otherwise, they could be labeled as suspicious.

The screening itself

• The picture. The procedure takes less than half an hour. Each breast is compressed onto a plate to even out the thickness and allow for better visualization. The pressure also prevents motion that could blur the image. You’ll be asked to hold your breath and remain motionless while the image is processed. Most full tests involve several pictures taken from above and from the sides of both breasts.
• The wait. You’ll be asked to wait while the technician confirms that the pictures are clear. Occasionally, dense breast tissue “folds” on itself and creates an inexact image, requiring an additional picture. It’s not a cause for alarm.

After the exam

• Getting the results. By law, all patients must receive written exam results within 30 days. Most patients hear from their doctor far earlier. If not, call and ask for the findings. Increasingly, they’re being shared almost immediately. “Some high-volume centers offer same-day test results, so you can go home knowing what was found,” says Dr. Zorn. That’s a big plus for those who suffer from post-test anxiety.
• Ask questions. If you have any concerns, raise them with your doctor. Also, make sure you’re informed about the basic characteristics of your breasts. There are four categories of mammographic density (breast-tissue thickness), and the FDA recently changed its rules to ensure that patients know the distinct risks of each of the classifications.
• If your results are unusual. Don’t panic if the results are inconclusive or you’re asked for a follow-up visit. About 10 percent of tests reveal something unusual, but real problems are blessedly rare. In most cases, the issue is related to the quality of the pictures themselves. And even when something is detected, it is far more likely to be a harmless cyst, dense breast tissue, or a benign calcium deposit than anything serious.

Once you have the likely all-clear, remember to track your breast health on your own. Conduct regular self-exams, pay attention to any changes, and inform your doctor if something concerns you. Keep in mind: The sooner breast cancer is detected, the sooner it can be properly treated.