Mammograms for Breast Cancer Screening

If a mammogram is performed early enough, it can find breast cancer in the earliest stages of the disease — sometimes even before symptoms appear — and therefore, when the cancer may be the easiest to treat.

Mammography is an X-ray picture of the breast that’s used to detect breast cancer.

Mammograms are used in two ways: as a screening test or as a diagnostic test.

• Screening mammogram: If you’re getting a routine mammogram, or don’t have any symptoms of breast cancer, it’s called a screening mammogram. Screening mammograms are performed in the hopes of catching the disease in the earliest (and most treatable) stages, before it has spread to other areas of the body.
• Diagnostic mammogram: If you’re experiencing possible symptoms of breast cancer — such as breast pain or nipple discharge — or if a screening mammogram has revealed an abnormality in the breast tissue, a doctor may suggest you have a diagnostic mammogram.

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Additionally, mammograms can be captured in two ways: by using film mammography or digital mammography.

• Film mammogram: This is a conventional form of mammography whereby X-ray images are captured and stored on a photographic film plate.
• Digital mammogram: This is a newer form of mammography whereby the detectors in digital mammograms convert the X-rays passing through them into electronic signals, which are then displayed on a monitor or stored as files on a computer. In the United States, digital mammograms are replacing photographic film plate mammograms.

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During 2D mammography, two images of a breast are typically taken — one from above and one from the side. During 3D mammography, multiple images from different angles are taken, since the X-ray machine moves in a small arc around the breast.

A screening mammogram is used to examine a person who isn’t showing symptoms of breast cancer. In contrast, a diagnostic mammogram is used to examine a suspicious area on the breast, for example, to help a doctor diagnosis breast cancer.

Leading health organizations have provided their own mammogram screening guidelines for breast cancer based on a person’s risk of the disease.

USPSTF Screening Recommendations

American Cancer Society (ACS) Breast Cancer Screening Guidelines

The ACS recommends that:

• Women who are at average risk of breast cancer between ages 45 and 54 should get a mammogram screening every year; starting at age 55, they can choose to get it every year or switch to every two years.
• Women with a high risk of breast cancer — meaning, they have a family history of breast cancer, have had chest radiation therapy before the age of 30, or who have mutations in their BRCA1 or BRCA2 genes — should get a mammogram along with an MRI every year, starting at age 30.

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The American College of Obstetricians and Gynecologists (ACOG) Screening Guidelines

National Comprehensive Cancer Network (NCCN) Mammogram Screening Guidelines

The National Comprehensive Cancer Network (NCCN) strongly recommends annual breast cancer screenings with 3D mammograms. Here is the summary of their guideline.

• Those with an average risk of breast cancer should start mammogram screening at age 40.

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• Those with an increased risk may start annual screening mammograms as early as age 30.
• Annual screening mammograms for people with a family history of breast cancer should start 10 years before the youngest family member was diagnosed.
• Individuals who have undergone thoracic radiation therapy (RT) between the ages of 10 and 30 should have a 3D screening mammogram every year, eight years after RT (but not before the age of 25).
• Individuals with dense breast tissue should be offered supplemental screening using other diagnostic techniques, such as magnetic resonance imaging (MRI) and molecular breast imaging (MBI).

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Next, the technologist operating the machine will ask you to stand in front of the machine and place your breast on a plastic platform on the machine. An upper plate will then be lowered to compress the breast for 10 to 15 seconds. This flattens the breast tissue, which allows for a clearer X-ray image. For 3D mammograms, the machine will move in a circular arc from side to side and from the top, taking pictures of your breast while it is compressed.

Two views of each breast are usually enough for screening mammograms, but more images may be required for people with larger breasts or breast implants as well as for those doing a diagnostic mammogram.

Use these tips to ease discomfort during a mammogram.

• Schedule your test for the week after your menstrual period, when your breasts are the least likely to be sore.
• Use a facility you trust and request a technologist you like and can easily communicate with.
• Before the compression, try doing relaxation techniques, such as deep-breathing exercises.
• If you feel pain, let your technologist know right away. There may be some room to adjust the compression plates to your comfort.
• Ice the painful area to reduce soreness.
• Consider taking over-the-counter pain relief medications like acetaminophen or ibuprofen about 30 minutes before the test.

The significant advantage of a mammogram is that it raises suspicion about cancer. A tissue biopsy — which involves taking a sample of tissue from the suspicious area and testing it for cancer in the lab — will have to be carried out to tell for sure whether you have breast cancer or not.

Depending on the facility, you might get your result right after the mammogram or about one to two weeks after. The next step will depend on the result.

• If the result reads incomplete, it may mean the images were not clear enough or they revealed a suspicious area. In that case, you may need to do more tests.
• If the finding suggests a benign tumor is present, your provider may suggest repeating the imaging test in 6 to 12 months.
• If a result is highly suggestive of cancer, your provider may order a biopsy.

Always discuss your results with your doctor and ask questions.

The Takeaway

A mammogram is an X-ray image of the breast that’s used to detect breast cancer. Mammograms have the potential to find breast cancer in the earliest (and most treatable) stages of the disease, even before symptoms such as a lump or breast pain appear. Many leading cancer organizations recommend getting a mammogram every year or other year starting at the age of 40 or 45.