Did you know that “what is a mammogram?” is one of the most commonly Googled women’s health queries? While the routine X-ray is par for the course for women over 40, there’s still a lot of confusion surrounding it, including how to prepare for a mammogram, the different types there are, and whether or not it hurts.

Chirag Parghi, MD, a radiologist and the chief medical officer at Solis Mammography, understands the anxiety that comes with undergoing a mammogram. He knows it can be uncomfortable—and comes with the possibility of discovering breast cancer. However, Dr. Parghi posits that these aren’t reason enough to avoid a mammogram.

“One in eight women are at risk of developing breast cancer in their lifetime and the best thing you can do for your health is to undergo a yearly mammogram,” says Dr. Parghi. “The benefit of catching an early cancer massively outweighs the frustrations and the anxiety associated with the pain.” That said, to keep yourself from spiraling down an internet rabbit hole on mammograms, we’re here to give you the full run-down.

What is a mammogram?

A mammogram, or a mammogram screening, is an X-ray examination that can detect early signs of breast cancer.

What are the different types of mammograms?

Currently, there are two types of mammograms available: 2D mammograms (also known as screening mammograms), which take X-ray images of the front and sides of the breasts; and 3D mammograms (commonly referred to as diagnostic mammograms), which capture photos from various angles.

“Many women receive the standard-of-care technique called 2D mammography, where two X-ray images of a person’s breast are taken (one from the top and one from the side),” says Wendie Berg, MD, PhD, Breast Cancer Research Foundation researcher, radiologist, and distinguished professor of radiology at University of Pittsburgh School of Medicine. “The newer technology is 3D digital mammography which uses the same positioning, but the system takes multiple images from different angles in an arc over the breast. These images are computer synthesized to create a nearly three-dimensional reproduction of a person’s breast.”

According to research published in the journal Radiology, 3D mammograms have been proven to produce fewer false positives and be more effective in detecting breast cancer in women ages 65 and older. Another study published in JAMA also posits that they are ideal for women with dense breast tissue or who are at higher risk for developing breast cancer.

“[With 3D breast imaging,] radiologists can incrementally assess breast tissue—one ‘slice’ at a time digitally—thereby deciphering more detail than previously possible,” Dr. Berg explains, noting that 3D mammograms are also known as 3D tomosynthesis and digital breast tomosynthesis. That said, if you have dense breast tissue, Dr. Berg admits that additional measures may be needed to accurately analyze the situation. “Between 25 and 40 percent of cancers go unseen on a mammogram because they are hidden by dense tissue, and about 40 percent of women have dense breasts,” she points out. “Other screening can help find cancers not seen on mammograms. Whole breast ultrasound (WBUS) or magnetic resonance imaging (MRI) are other breast imaging tools that accompany mammography in certain circumstances. WBUS uses sound waves and MRI uses magnets to produce images of the whole breast. Neither use X-rays and both tools can show abnormalities in the breast that are hidden on mammography.”

What is the best method of screening for breast cancer?

While 3D mammograms have their benefits, 2D mammograms remain the standard of care—and in either case, the procedure is usually the same. Regardless, a doctor will be able to tell which is best for you.

“There is no one approach for all women,” Dr. Berg says. “Your best method for screening will be determined together with your doctor. Your breast density and risk factors will influence the recommendations. Other factors should also be considered. For example, if you have claustrophobia, you may find CEM, MBI, or ultrasound easier to tolerate.” 

While on the topic of breast imaging and the risks associated with dense breasts, it’s worth mentioning that in March 2023, the Food and Drug Administration amended the Mammography Quality Standards Act. “Beginning in September 2024, there will be a new national standard requiring your mammogram results letter inform you if your breasts are ‘dense’ or ‘not dense,'” Dr. Berg shares.

Where can I get a mammogram?

Contrary to popular belief, mammograms aren’t solely offered at OB/GYN offices. “Mammograms can be obtained at various healthcare facilities, including hospitals, outpatient clinics, and specialized radiology or imaging centers,” says radiologist Kien Vuu, MD, who is the founder of VuuMD Performance and Longevity and the bestselling author of Thrive State. Don’t just go to the first clinic you find, though. “It’s important to choose a facility that is accredited by relevant healthcare organizations for quality assurance,” Dr. Vuu says.

What to expect at a mammogram

The mammogram process is fairly straightforward, according to Dr. Parghi. From paperwork to procedure, the appointment will often take 30 minutes to an hour, he says. After you fill out paperwork and before the screening, you will be requested to remove your clothing up top and change into a gown.

As for what to expect during a mammogram: “We typically take four pictures of the breast—two of each breast—and each set of images can take anywhere from 30 seconds to a minute,” Dr. Parghi says. When conducting the mammogram, the technologist (aka mammographer) fits the patient’s breasts onto a “bucky” (or breast support table), and then clamps a compression paddle on the breasts.

Dr. Parghi says this part of the process can cause discomfort, though it’s necessary to produce clear images of the breast tissue and reduce radiation exposure. “When we take the images, there is a necessary compression,” he says. “It can feel a little tender, and sometimes, it can pinch, but the end goal is to get a really good picture.”

What to expect after a mammogram

After the mammogram, Dr. Parghi says that you can expect to receive your results within a week, and depending on the results, a patient might undergo additional tests and procedures. “Typically about 10 percent of [results] are read as abnormal,” he says. “When this happens, we either want you to come back for extra pictures, and sometimes an ultrasound, and then there’s a small subsection of patients who’ll need a biopsy.”

It can be scary to get a call back from your doctor about your mammogram reading but Dr. Parghi says that it isn’t always a cause for concern. “Most of the time, a patient gets extra pictures or a biopsy, and it’s nothing,” he says. “You have to understand that breast radiologists are obsessed with catching anything that could be cancerous and we want to catch it as early as possible.”

How to prepare for a mammogram: Dos and don’ts

For additional tips on how to prepare for a mammogram, here are some of Dr. Parghi’s suggestions for your appointment:

1. Do wear comfortable clothing

Dr. Parghi recommends wearing comfortable clothing to your appointment—and conversely, to avoid tight-fitting clothes. “Tight-fitting clothes are less preferred as they can cause more pain immediately after [the mammogram],” he says.

2. Don’t wear perfume or lotion

“We recommend that you avoid wearing any perfume or lotion,” says Dr. Parghi. “It can show up as an artifact on the mammogram.” An artifact can reduce the quality of the images and may appear as or obscure abnormalities. Dr. Parghi even recommends skipping on deodorant the day of your appointment. “If you wear it, they’re going to typically give you a wipe to remove any antiperspirant.”

3. Don’t psych yourself out

As you prepare for a mammogram, “don’t psych yourself out that it will be painful or associated with a lot of anxiety,” says Dr. Parghi. “Whatever your own personal dance is to minimize anxiety, engage in that process before you come into your appointment.”

4. Do make mammograms a priority

“I’ve seen too many women from 40 on, even 35 on, that delayed the mammogram that could have saved their life—and I’ve just seen too much late-stage cancer,” says Dr. Parghi. “Too many women skip mammograms, and it’s a little awkward to talk about, but it can save lives.”

“Too many women skip mammograms, and it’s a little awkward to talk about, but it can save lives.” —Chirag Parghi, MD

Frequently asked questions

What age should a woman get a mammogram?

General guidelines recommend that women start undergoing routine mammograms (yearly or every other year) starting around age 40. According to Dr. Vuu, though, the recommended age and frequency can vary based on your personal history and risk factors. “For women with higher risk factors—such as a family history of breast cancer, certain genetic markers, or previous radiation exposure—the screenings may begin as early as their 30s,” he says. “It’s crucial to consult with your healthcare provider to determine your specific risk profile and create a personalized screening plan.”

How long does a mammogram take?

The mammogram itself will take about 15 to 20 minutes, says Dr. Parghi—and as mentioned, each image captured during the X-ray should take about 30 seconds to a minute.

Who performs a mammogram?

Mammograms are performed by licensed, board-certified technologists. “Radiologists are physicians who then review the mammogram and send a report back to your primary care doctor,” Dr. Berg says.

Is it okay to have a mammogram while on your period?

Being on your period shouldn’t affect your mammogram results, says Dr. Parghi. However, he does mention that women tend to be more sensitive during their cycle. “[Breast tissue] can be very sensitive around different hormonal fluctuations like during period cycles, so that can also contribute to pain,” he says.

Another reason you shouldn’t automatically cancel your mammogram? If you have COVID-19. Instead, reach out to your doctor to determine the best next steps. Depending on your family history and previous results, your doctor may still want you to show up for imaging.

Can you take a pain reliever before a mammogram?

According to Dr. Parghi, it’s perfectly safe to take over-the-counter pain relievers to prepare for a mammogram, and those who are sensitive to pain or anxiety can get prescription medication prior to the appointment. However, he only recommends anxiolytics for a small minority of patients (adding that those who need them shouldn’t be driving to their appointment that day or driving home).

Can you drink caffeine before a mammogram?

You can drink caffeine before a mammogram, says Dr. Parghi, but for some women, particularly those with fibrocystic breast disease, it can increase the pain of the procedure. “Fibrocystic disease is a common condition where these little balls of water, like little water balloons, form in the breast called cysts, and those can be painful,” he says. “If you are in that situation—and it’s a common condition, not cancer—it can cause pain that’s associated with caffeine.”

Do breast implants interfere with mammograms?

Breast implants are dense and, as such, can hide cancers on mammograms, Dr. Berg admits. Because of this, she says that “it’s necessary to perform twice as many images, with more radiation exposure” in order to get the most accurate imaging possible.

Do mammograms replace the need for self-breast exams?

Mammograms are done yearly or every two years. Self-breast exams are meant to be performed monthly. As such, even if you’re on top of your mammogram appointments, don’t let it be an excuse to overlook your at-home screenings.

How much does a mammogram cost?

Like most medical treatments, the cost of a mammogram is subjective. “Under the Affordable Care Act, and the PALS Act, annual ‘screening’ mammograms must be covered in full by insurance for women aged 40 and older,” Dr. Berg says. “If you are under 40 and recommended for screening by your physician, or if you require additional testing because of an abnormality on your screening mammogram or if you have a lump or other symptom, that mammogram is considered a ‘diagnostic’ mammogram and the cost will depend on your insurance.”

How accurate is mammography?

If you’re going to go through the anxiety and discomfort of a mammogram, it’s only natural to expect it to be accurate in its imaging. The hard reality, though, is that mammograms aren’t 100 percent perfect at all times. “While mammography is a crucial tool in breast cancer detection, it is not infallible,” Dr. Vuu reveals. “It has its limitations, including the risk of false negatives and false positives. Sometimes, additional imaging or biopsies are needed to clarify or confirm findings, particularly for women with dense breast tissue.”

The bright side is, if you don’t have dense breasts, Dr. Berg says that mammography is very accurate. “It is less accurate in women with dense breasts—about 10 percent of women screened with mammography will be called back for additional testing, and 95 percent of women called back do not have cancer,” she explains. “New technology like artificial intelligence and contrast-enhanced mammography shows promise in providing more accurate results—reducing false positives, unnecessary procedures (and the resulting stress), and improving detection of cancer.”

Who can I talk to if I have questions about mammograms?

If you still have questions about the mammogram process and the X-ray itself, Dr. Berg says to start a conversation about your breast health with your primary care provider. “If needed, they can connect you with a radiologist to conduct a breast screening,” she says. “You can also check out DenseBreast-info.org as a helpful resource to learn more.”

If you are at high risk for developing breast cancer or have had abnormal results in the past, Dr. Vuu says that going directly to a breast specialist may be the best move. “Always consult with healthcare professionals for advice tailored to your unique medical history and condition,” he encourages.