Dear Alice,

What exactly happens during a mammogram, and does it hurt?

Dear Reader,

Mammograms are a type of low-dose X-ray that helps detect breast cancer at its earliest and most treatable stage. The test allows for clinicians to screen for breast lumps that may be too small to be felt during a manual exam. Many individuals with breast tissue start getting yearly mammograms when they turn 40, although experts have differing opinions for when to begin screening. The American Cancer Society (ACS) recommends that individuals assigned female at birth age 45 and older get mammograms every year until age 54, whereas those age 55 and older may choose to continue their yearly appointments, or start getting them every other year. On the other hand, the United States Preventive Services Task Force recommends that people assigned female at birth start at begin getting mammograms every other year from the ages of 50 to 74. They recommend that those who are 40 to 49 may find it to be helpful to start the screening earlier based on their own personal risk. All that being said, despite the variations in when to start for those with average risk, if someone has a family history of breast cancer or genes known to increase the risk of breast cancer (such as the BRCA gene), it’s recommended that they discuss the possibility of starting mammography at an earlier age with their health care provider.

Now to get into more specifics: mammography is used for two purposes. The first is for screening in order to identify any possible breast abnormalities, and the second is to diagnose any breast changes that have already been noticed. The first time someone gets a mammogram, it's usually used to get a baseline reading of what a person’s breast tissue typically looks like. This first image will be compared to later mammograms to help detect any changes. Mammogram images then help providers determine if further diagnostic testing or treatment is needed.

Before booking a mammogram, it’s good to look for a certified facility. The good news is that the United States Food and Drug Administration (FDA) provides a list of certified facilities across the country. If cost or lack of health insurance coverage is an issue, check out the Center for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) website to determine if you’re eligible for free or low-cost mammograms and to search for such screenings in your area. For those with a regular period, when scheduling the test, consider planning it for the week or two after your period, as these are times when the breasts are less likely to be bloated or tender. This will not only help reduce discomfort during the procedure but also help with the picture quality.

On the day of screening, it’s recommended to avoid wearing deodorant, powders, lotions, or creams under the arms, as particles from these substances may show up on mammogram images. If there have been any recent breast changes, medical history that may impact the risk of breast cancer, and if breastfeeding or possibly pregnant, it’s best to let the technician know before starting the procedure. For folks who are new to a mammogram facility, it’s also recommended to provide the facility with any past mammogram records so that they can compare this year’s results with past images and information. 

When arriving for a mammogram, clothing from the waist up needs to be removed, and the facility will provide some sort of wrap to wear. The mammogram technician will place one breast on a platform of the X-ray machine. During the test, the breast will be compressed between the platform and a clear plastic cover. They may ask for minimal movement and held breath during the X-ray. This compression helps spread the breast tissue out so the X-rays can get a clear picture. However, this does often cause discomfort, and individuals with sensitive breasts may want to take an over-the-counter pain reliever before their appointment. After both breasts have been compressed and X-rayed, the technician will check the clarity of the X-rays, and do retakes if necessary. It’s worth noting that additional X-rays don’t necessarily mean that there was something abnormal — it may just be that there was movement at the moment the X-ray was taken. Once that’s done, the mammogram is over! The entire procedure typically takes about a half hour.

After the procedure, federal law requires that all mammography facilities contact people with their results within 30 days. If the facility or ordering health care provider hasn't provided results within that time, it could be helpful to follow up. Depending on the results, individuals may be asked to undergo additional screening or follow-up diagnostic mammograms to further investigate an abnormality that was found on the first mammogram. Most of these abnormal findings are benign and may indicate the presence of calcium deposits, cysts, or spots of dense tissue.

Although it’s recommended to start mammography in their forties, individuals assigned female at birth are encouraged to conduct breast self-exams (BSE). Even though current research doesn’t indicate that BSEs help with early detection of breast cancer when individuals are also getting regular screenings, performing BSEs may prompt someone to become more familiar with their breasts and thus better identify any future changes. If you notice breast changes or have additional questions about breast cancer screenings, you may consider making an appointment with your health care provider to discuss your concerns.

Alice!

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