What is a Mammogram? Purpose, Procedure & Results

A mammogram is an X-ray examination of your breasts that helps doctors detect breast cancer and other breast conditions early. This specialized imaging test can spot changes in breast tissue that might not be felt during a physical exam, making it one of the most important tools for maintaining breast health.

Think of a mammogram as a safety check for your breasts. Just like you might get your car inspected regularly to catch problems before they become serious, mammograms help catch breast changes when they're most treatable.

What is a mammogram?

A mammogram uses low-dose X-rays to create detailed pictures of the inside of your breasts. During the test, a technologist positions your breast between two plastic plates that compress the tissue to spread it out evenly.

This compression might feel uncomfortable for a moment, but it's necessary to get clear images of all the breast tissue. The entire process usually takes about 20 minutes, though the actual compression only lasts a few seconds for each image.

There are two main types of mammograms you might encounter. A screening mammogram checks for breast cancer in women who have no symptoms, while a diagnostic mammogram investigates specific concerns like lumps or breast pain.

Why is a mammogram done?

Mammograms are primarily done to screen for breast cancer before you or your doctor can feel any lumps. Early detection through mammography can find cancers when they're small and haven't spread to lymph nodes.

Your doctor might also recommend a mammogram if you notice changes in your breasts. These changes could include lumps, breast pain, nipple discharge, or skin changes like dimpling or puckering.

Most medical organizations recommend that women begin regular mammogram screening between ages 40 and 50, depending on their risk factors. Women with higher risk factors, such as a family history of breast cancer or genetic mutations like BRCA1 or BRCA2, might need to start screening earlier.

What is the procedure for a mammogram?

The mammogram procedure is straightforward and typically takes place in a hospital or imaging center. You'll be asked to undress from the waist up and put on a hospital gown that opens in the front.

Here's what happens during your mammogram appointment:

1. The technologist will position you standing in front of the mammography machine
2. Your breast will be placed on a clear plastic plate
3. Another plate comes down from above and compresses your breast to spread the tissue
4. You'll be asked to hold your breath for a few seconds while the X-ray is taken
5. The process is repeated from different angles, usually two views per breast
6. The entire procedure typically takes 10-15 minutes

The compression can be uncomfortable, but it's brief and necessary for clear images. Some women find it helpful to schedule their mammogram for the week after their period when breasts are less tender.

How to prepare for your mammogram?

Preparing for your mammogram is simple and can help ensure the best possible images. The most important thing is to avoid using deodorant, antiperspirant, powder, or lotion on your breasts or underarms on the day of your exam.

These products can show up as white spots on the mammogram images, which might be mistaken for abnormalities. If you forget and use these products, don't worry – the facility will have wipes available to clean them off.

Consider these additional preparation tips to make your experience more comfortable:

• Wear a two-piece outfit so you only need to remove your top
• Schedule your mammogram for the week after your period when breasts are less tender
• Avoid caffeine before your appointment, as it can make breast tenderness worse
• Bring a list of any medications you're taking
• Inform the technologist if you have breast implants or have had breast surgery

If you're pregnant or think you might be pregnant, let your doctor know before scheduling your mammogram. While mammograms are generally safe, your doctor might recommend waiting or using alternative imaging methods.

How to read your mammogram results?

Mammogram results are typically reported using a system called BI-RADS, which stands for Breast Imaging Reporting and Data System. This standardized system helps doctors communicate findings clearly and determine what follow-up care you might need.

Your results will be categorized on a scale from 0 to 6, with each number indicating a specific finding:

1. BI-RADS 0: Additional imaging needed – this doesn't mean something is wrong, just that more pictures are needed
2. BI-RADS 1: Normal mammogram – no signs of cancer or other significant findings
3. BI-RADS 2: Benign findings – non-cancerous changes that don't require follow-up
4. BI-RADS 3: Probably benign – a small chance of cancer, short-term follow-up recommended
5. BI-RADS 4: Suspicious abnormality – biopsy should be considered
6. BI-RADS 5: Highly suggestive of cancer – biopsy strongly recommended
7. BI-RADS 6: Known cancer – used for mammograms done after cancer diagnosis

Most mammogram results fall into categories 1 or 2, meaning normal or benign findings. If your results show category 3 or higher, your doctor will discuss the next steps with you, which might include additional imaging or a biopsy.

What are the risk factors for abnormal mammogram results?

Several factors can increase your likelihood of having changes show up on your mammogram, though it's important to remember that most breast changes are not cancerous. Understanding these risk factors can help you and your doctor make informed decisions about your breast health.

Age is the most significant risk factor for breast cancer and abnormal mammogram findings. As you get older, your risk increases, with most breast cancers occurring in women over 50.

Here are the main risk factors that might affect your mammogram results:

• Family history of breast or ovarian cancer, especially in close relatives
• Personal history of breast cancer or certain benign breast conditions
• Genetic mutations like BRCA1, BRCA2, or other hereditary cancer syndromes
• Dense breast tissue, which can make mammograms harder to read
• Previous chest radiation treatment, especially at a young age
• Long-term hormone replacement therapy use
• Never having children or having your first child after age 30
• Starting menstruation early (before age 12) or late menopause (after age 55)

Having one or more risk factors doesn't mean you'll develop breast cancer. Many women with risk factors never develop the disease, while others with no known risk factors do.

What are the possible complications of mammograms?

Mammograms are generally very safe procedures with minimal risks. The radiation exposure from a mammogram is quite low – about the same amount you'd receive from background radiation over seven weeks of normal daily life.

The most common "complication" is discomfort during the compression phase of the exam. This discomfort is temporary and necessary for getting clear images of your breast tissue.

Here are the rare complications and considerations to be aware of:

• Temporary breast tenderness or bruising from compression
• False-positive results that may cause anxiety and lead to unnecessary follow-up tests
• False-negative results that might miss some cancers, particularly in women with dense breast tissue
• Radiation exposure, though the risk is extremely small
• Callback for additional imaging, which happens in about 10% of screening mammograms

The benefits of mammography far outweigh these minimal risks for most women. If you have concerns about any aspect of mammography, discuss them with your healthcare provider.

When should I see a doctor about mammogram results?

Your mammogram results will be sent to your doctor, who will contact you with the findings. Most facilities are required to send you a summary of your results within 30 days, though many provide results much sooner.

You should contact your doctor if you don't hear about your results within two weeks of your mammogram. Don't assume that no news is good news – it's important to follow up on all medical tests.

Here are specific situations when you should reach out to your healthcare provider:

• You haven't received your results within two weeks
• You have questions about your results that weren't clearly explained
• Your results show you need additional imaging or follow-up
• You notice new breast changes after your mammogram
• You're due for your next screening mammogram

Remember that being called back for additional images is common and doesn't necessarily mean you have cancer. Your doctor is there to guide you through the process and answer any questions you might have.