Mammography — X-ray imaging of the breast — is the primary screening tool for breast cancer, the most common cancer in American women. Annual mammography reduces breast cancer mortality by detecting cancers at earlier, more treatable stages. Despite its proven benefit, many women delay or avoid mammography due to discomfort concerns, anxiety about results, or lack of clear guidance on when to start. This guide explains the mammography screening process and what to expect.
Types of Mammography
Standard digital mammography captures two-dimensional images. 3D mammography (digital breast tomosynthesis) acquires multiple thin image slices through the breast from different angles, reconstructed into a three-dimensional view that improves cancer detection and reduces false positives — particularly in women with dense breast tissue. Most breast imaging centers now use 3D mammography as the standard of care.
The Procedure
Each breast is compressed between two plates while X-ray images are taken — typically two views per breast (craniocaudal and mediolateral oblique). Compression is uncomfortable for most women, particularly around menstruation when breasts are more tender — scheduling mammograms 1–2 weeks after the end of your period reduces discomfort. The entire procedure takes approximately 15–30 minutes.
Understanding Your Results
Mammography results use the BI-RADS classification: 0 (incomplete — additional imaging needed), 1 (negative), 2 (benign finding), 3 (probably benign — short-interval follow-up), 4 (suspicious — biopsy recommended), 5 (highly suspicious for malignancy — biopsy strongly recommended), 6 (known malignancy). A “callback” for additional views does not mean cancer — approximately 10% of initial mammograms require callback, and fewer than 5% of callbacks reveal cancer.
Conclusion
Mammography is the most effective tool we have for detecting breast cancer early — when it is smallest, most localized, and most curable. Commit to the recommended screening schedule, bring prior mammography films to new radiology centers for comparison, and know your breast density (which affects mammography sensitivity and may indicate need for supplemental screening).
FAQs – Mammography
Q1. At what age should I start mammograms?
A: Guidelines differ: the American Cancer Society recommends annual mammograms starting at 45 (optional 40–44); the USPSTF recommends every 2 years starting at 40. Women at high risk (BRCA mutation, strong family history) should start annual mammography plus MRI at 30. Discuss your personal risk with your clinician.
Q2. Does mammography use radiation?
A: Yes, though at a very low dose — approximately 0.4 mSv per bilateral mammogram (about 7 weeks of background radiation). The benefit of early cancer detection vastly outweighs the tiny radiation risk from annual mammography.
Q3. What is dense breast tissue and why does it matter?
A: Dense breast tissue (more glandular and fibrous tissue than fatty tissue) appears white on mammography — the same appearance as cancer. Dense tissue reduces mammogram sensitivity and slightly increases breast cancer risk. Supplemental ultrasound or MRI screening may be recommended for women with extremely dense tissue.
Q4. Can I have a mammogram if I have breast implants?
A: Yes. Special additional views (implant-displaced views) are taken to examine breast tissue not covered by the implant. Notify the imaging center about your implants when scheduling so appropriate views are planned.
Q5. Should I wear deodorant on mammogram day?
A: Avoid applying deodorant, antiperspirant, powder, or lotion to the underarms or breast area on mammogram day. These products can appear as specks on mammography images that may be confused with calcifications, potentially requiring additional views.
