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Mammography

  

 

 

Mammography
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Breast Calcifications 
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Questions to Ask Your Doctor: Mammography
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Mammography
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Mammography (ma-MAH-gruh-fee) is a screening tool that uses X-rays to create images of the breast. These images, called mammograms (MAM-o-grams), are used to find early signs of breast cancer such as a dense mass or clusters of calcium (microcalcifications).  

Mammography is the best screening tool for breast cancer used today. It can find cancers at an early stage, when they are small (too small to be felt) and the chances of survival are highest.   

Learn about mammography recommendations for women at average risk of breast cancer.

Learn about mammography recommendations for women at higher risk of breast cancer.  

Where to get a mammogram

Mammograms can be done in:

  • Radiology and imaging centers
  • Mammography clinics
  • Hospital radiology departments
  • Mobile vans
  • Some physicians’ offices

What to expect

Before your mammogram, you will undress from the waist up, so it is a good idea to wear a shirt you can remove easily. Avoid using deodorants, antiperspirants, perfumes, powders or lotions on the breast and underarm areas on the day of the exam. Ingredients in these products can show up on a mammogram and make it harder to interpret.  

Getting a screening mammogram takes about 15 minutes. During the procedure, each breast is pressed between two plates and an X-ray image is made. Two views of each breast are taken, one with the X-ray beam aimed from top to bottom and the other from side to side.  

Sometimes, the pressure can be uncomfortable, but it only lasts a few seconds. Tell the technologist if you feel any discomfort. Taking acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) about an hour before the exam may help. If you have concerns, talk to your health care provider about other ways to help ease discomfort (or anxiety) during a mammogram. And, before the exam, let your technologist know your concerns.  

Film mammography versus digital mammography

X-ray images of the breast can be captured on film or stored directly onto a computer (digital). Film and digital mammography are similar in their ability to detect breast cancer [1-3]. Most centers now use digital mammography.  

Because digital images are viewed on a computer, they can be lightened or darkened, and certain sections can be enlarged and looked at more closely. This ability to control the images on a computer makes digital mammography more accurate than film mammography for some women. And, because the images are stored on a computer, they can be shared more easily with another radiologist for review.  

Compared to film mammography, digital mammography appears to be better at detecting breast cancer in women who [3]:

  • Are premenopausal or peri-menopausal  
  • Are under age 50
  • Have dense breast tissue

For women who do not fall in one of the above groups, digital and film mammography are similar in their ability to find breast cancer early.

 52829-3.gif  For a summary of research studies on digital mammography versus film mammography for breast cancer screening, visit the Breast Cancer Research section.

Computer-assisted detection (CAD)

A radiologist trained to read mammograms will examine your images for signs of breast cancer. Computer-assisted detection (CAD) software was developed to help radiologists find suspicious areas on a digital mammogram (or film converted to a digital image). CAD software analyzes the images and highlights potential areas of concern that should be looked at more closely. It is commonly used in the U.S.  

Some studies suggest CAD may improve breast cancer detection [4-5]. However, the largest study to date showed CAD did not improve the detection of invasive breast cancers [6]. The authors also found CAD led to an increase in false-positive results [6]. Thus, the benefit of CAD needs more study.  

Learn more about false-positive results on screening tests.

Findings on a mammogram

Mammogram images appear in shades of black, gray and white, depending on the density of the tissue (see images below). Very dense tissue, like bone, shows up as white on an X-ray. Fat looks dark gray on an X-ray. Breast cancer and some benign (not cancer) breast conditions are denser than fat and appear a lighter shade of gray or white on an X-ray image.  

Dense breast tissue

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Breast Density
Fact Sheet

Dense breast tissue can look white or light gray on a mammogram. This can make mammograms harder to interpret in younger women, who tend to have denser breasts. After menopause, breast density decreases, making the mammograms of postmenopausal women easier to read.  

These mammography images show varying breast density. They show breasts with more fat and less breast tissue to breasts with less fat and more breast tissue.
 Breast density images without text 
Fatty breast                                     Some breast density                    More breast density                    Dense breast

Some younger women may have lower breast density after an oophorectomy (removal of the ovaries) or hysterectomy (removal of the uterus). And, women who use menopausal hormone therapy (MHT) often have higher breast density until they stop using MHT. 

For women with dense breast tissue, digital mammography is more accurate than film mammography [3].  

Ultrasound and breast MRI (in combination with mammography) are being studied to learn whether they improve detection in women with dense breasts compared to mammography alone.

Learn more about ultrasound and breast MRI.

Learn about breast density and breast cancer risk.

Benign (not cancer) breast conditions

   Benign Breast Conditions
Fact Sheet

Some common benign breast conditions (such as cysts and fibroadenomas) may show up on mammograms as round or oval patches with distinct borders.   

Learn more about benign breast conditions  

Calcifications and microcalcifications

Calcifications are bits of calcium that can show up on mammograms as small, bright white spots. Most calcifications are benign (not cancer). However, certain patterns of calcifications are suspicious and need more testing. Tight clusters or lines of tiny calcifications (microcalcifications) can be a sign of breast cancer.  

Calcifications are common and appear on about half of all mammograms of women ages 50 and older (and on about one in 10 mammograms of younger women) [7]. They may be related to older age, past injury to the breast or inflammation (swelling) of the breast tissue (from an infection, for example) [7]. For breast cancer survivors, calcifications can also be related to past breast surgery and radiation therapy.

Non-invasive breast cancer - ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer (learn more). On a mammogram, DCIS usually looks like a cluster of microcalcifications. It can be hard to know from a mammogram image whether the cluster is DCIS or invasive breast cancer.  

Learn about follow-up after an abnormal mammogram.

Learn more about DCIS.   

Invasive breast cancer

Invasive breast cancer cells appear as a light patch on a mammogram. They do not stay within the clear borders, but instead invade the surrounding tissue. The outer edges of the cells that have spread into the surrounding breast tissue look fuzzy or spiky (called spiculated).  

Learn about follow-up after an abnormal mammogram.  

Recall rates

If a finding is abnormal, or the mammography image was not clear enough to interpret the results, you will be called back for a follow-up visit. Follow-up may include another mammogram, an ultrasound or a breast MRI. In some cases, a biopsy may be needed.  

The recall rate of a mammography center is the percent of women who are called back for further tests. Some centers may share their recall rate with you and this information may help you understand your chances of being called back. It is not uncommon to be called back for an abnormal finding. Although there is no “gold standard” recall rate, on average, 10 percent of women are called back [8].  

If you are called back, don’t panic. Most abnormal findings are not breast cancer.  

Learn about follow-up after an abnormal mammogram.   

Mammography results

Breast Imaging Reporting and Data System

Most mammography centers report the results of mammograms using the Breast Imaging Reporting and Data System (BI-RADS®). BI-RADS® was developed by the American College of Radiology to provide a standard way to describe the findings on mammograms (with categories numbered 0 to 6).

Learn more about the BI-RADS® categories for mammography findings.

When to expect mammography results

Some centers may give you the results of your mammogram at the time of your screening. However, depending on the center, it may take up to two weeks to get your results.  

If you do not get your results within two weeks, follow up with your health care provider or the mammography center. Don’t assume the results were normal because you haven’t gotten a report.  

Breast implants and mammography

Mammography is a safe and effective screening tool for women who have breast implants. However, the implants can make it harder to interpret the mammogram. So, if you have implants, it is important to tell the technologist before the procedure. The mammography machine must be specially adjusted to get the best image of the natural breast tissue. Special positioning of the breast may also be required. Four views of each breast will be taken (instead of the standard two).

If possible, choose a center with technologists and radiologists who are experienced in mammography for women with breast implants.  

Pregnancy, breastfeeding and mammography

Screening mammography should not be used in pregnant women. Learn about breast cancer during pregnancy.  

While you are breastfeeding, the tissue in your breasts may appear dense on a mammogram, making it hard to interpret. So, it is best to wait until you stop breastfeeding to get a routine screening mammogram. Discuss the best timing of your mammogram with your health care provider if you are due for screening.  

If you have any concerns about your breasts while you are breastfeeding (such as finding a lump or noting a change), see your provider.       

Physical disabilities and breast cancer screening 

  

Women with Disabilities
Fact Sheet

  

Braille Breast Self-Awareness Brochure 

Some women with physical disabilities have trouble finding a mammography center that meets their needs. Partnering with a health care provider in your search can help things go more smoothly. If access to mammography for disabled women is limited in your area, let your local medical centers know. This may help improve access for you and other women.  

Learn more about women with physical disabilities and breast cancer screening.   

 What is Susan G. Komen® doing? 

In 2008, Susan G. Komen® and the American Association on Health and Disability (AAHD) launched Project Accessibility: Removing Barriers for Women with Disabilities. Project Accessibility staff visited 60 community mammography screening centers in the Washington D.C. area. They provided on-site center accessibility assessments, technical help and project materials. In 2011, Komen and AAHD launched another collaborative project, Bridging the Gap: No Woman Left Behind. Bridging the Gap educated women with disabilities about breast cancer through interactive educational workshops held throughout the Washington D.C. area.

In 2012, Komen and AAHD teamed up again, this time to launch Project Accessibility USA: Removing Barriers for Women with Disabilities. The $500,000, two-year project is currently underway. AAHD is collaborating with Komen Affiliates across the country to identify local grantees that provide mammography screening. They are setting up site visits to support clinic staff to ensure physical accessibility of their clinics. They are also providing technical help and educating clinic staff about meeting the needs of women with disabilities. This work is helping the clinics better serve women with disabilities.

Komen and AAHD are also working to develop a free, online Breast Health Accessibility Resource Portal with materials to help Komen grantees around the globe improve their ability to care for women with disabilities. Through Project Accessibility USA, we are changing the status quo women with disabilities and ensuring access to quality breast cancer care for all.

To learn more about Project Accessibility USA, please contact nationalcapitalarea@komen.org.  

 

Radiation exposure during mammography

A woman is exposed to a small amount of radiation during a mammogram. While the radiation exposure during mammography can increase the risk of breast cancer over time, this increase in risk is very small [9-10]. Studies show the benefits of mammography outweigh the risks from radiation exposure, especially for women ages 50 and older [9-11].  

Although a recent report suggested radiation during a mammogram might increase the risk of thyroid cancer, there is no scientific research to support this claim [12]. Read the statement from the American College of Radiology and the Society of Breast Imaging addressing concerns about this claim.  

Low-cost or free mammography

Medicare, Medicaid and most insurance companies cover the cost of mammograms. As of September 23, 2010, as part of the Affordable Care Act (health care reform), all new health insurance plans are required to cover mammography (with no co-payment) for women ages 40 and older.  

In many parts of the U.S., low-cost or free mammograms are offered through national programs and community organizations.

  • Komen Affiliates fund breast cancer education, screening and treatment projects in their communities for those who need it most. Find an Affiliate in your area to learn what resources are available. Or, call our breast care helpline at 1-877 GO KOMEN (1-877-465-6636) Monday through Friday from 9:00 a.m. to 10:00 p.m. EST and from 6:00 a.m. to 7:00 p.m. PST to help find low-cost options in your area.
  • National Breast and Cervical Cancer Control Program provides access to breast cancer screening to low-income, uninsured and underinsured women.
  • Some local chapters of the YWCA provide breast cancer education and screening to women with limited access to health services.
  • Planned Parenthood offers clinical breast exams and referrals for mammography.

Each October, during Breast Cancer Awareness Month, many imaging centers offer mammograms at reduced rates. To find a certified mammography center in your area, visit the FDA website (www.fda.gov).  

Screening mammography trends

After mammography was shown to be an effective breast cancer screening tool in the late 1980's, the use of screening mammography in the U.S. quickly increased. In 1987, 29 percent of women 40 years and older reported having a mammogram within the past two years [13]. By 1990, use increased to 52 percent and by 2000, 70 percent of women 40 years and older reported having a recent mammogram [13]. After a slight decline in mammography use from 2000 to 2005 (for reasons that remain unknown), rates remained steady. Since 2008, rates may be slightly increasing [13-14]. In 2010, 67 percent of women 40 years and older (67 percent of white women, 66 percent of African American women and 64 percent of Hispanic/Latino women) reported having a recent mammogram [13].  

Learn about disparities in screening mammography.  

Updated 10/04/13

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