Woman receives annual breast exam

What to Expect at Your First Mammogram

Breast cancer is the most common cancer found in women. In 2019, more than 58,000 cases have been diagnosed in Michigan alone. That’s why each October, known as Breast Cancer Awareness Month, highlights education and support services targeting those affected by the disease. This includes preventive care like mammograms, which are critical for early detection.

Who Needs a Mammogram?

Women in their mid-40s and older are encouraged to have regular breast cancer screenings. Yet, a doctor may suggest an earlier exam if the patient’s predisposed to the disease.

  • Women in their 30s: Due to risk factors, such as family and personal history, some women may inquire about mammograms at a younger age. It’s imperative to contact a primary care physician to discuss the need for a potential exam. Some health plans may not cover mammograms for patients who don’t meet a certain age requirement.
  • Women in their 40s: For women ages 40 to 44, breast cancer screenings are considered optional. But by age 45, mammograms should be performed regularly as part of an annual physical.
  • Women age 55 and older: Individuals can continue with annual screenings based on their unique medical history and physician’s instruction. The current recommendation for a mammogram is, at minimum, every two years.

What are the Types of Mammograms?

Prior to the first screening, ask your doctor about the different mammograms available. Discuss their respective benefits and risks, including overdiagnosis and radiation exposure. The most common breast cancer exams are:

  • 3D Mammography: Tomosynthesis, commonly called 3D mammography, is an advanced form of digital imaging. It captures the breast from multiple angles giving doctors a fuller, more comprehensive view of the tissue. It has a higher detection rate than 2D imaging and requires less recalls for additional photography.
  • Film/Digital Mammography: Conventional mammograms consist of low-dose X-ray images of both breasts. Historically, they were recorded on large sheets of black and white film. But today, digital mammograms allow doctors to store images in a computer where they can enlarge, manipulate and examine specific areas. This improves the ability to identify abnormalities or areas of potential concern.
  • Screening/Diagnostic Mammography: A screening is for individuals with no previous signs of breast cancer. It’s often used to detect new lumps, tumors or other suspicious developments. A diagnostic mammogram is for those who’ve already found cancerous tissue. It requires more photos and usually takes longer to perform. For most health care providers, screenings are considered preventive care, which means little to no additional cost. Yet, diagnostic mammograms may come with certain restrictions or payment conditions.
  • Thermography: Thermography, or thermal imaging, uses infrared technology to measure the temperature on the breast’s surface. Cancer cells grow at an accelerated rate, leading to increased blood flow and inflammation. With thermography, the machine can detect the warmer temperature, isolating the affected tissue. The U.S. Food and Drug Administration (FDA) considers thermography an “adjunctive” tool, that works best alongside traditional mammograms. It should not be used as a primary screening method.

What Happens During a Mammogram?

During a mammogram, a technician will place the breast on an X-ray machine, where a plastic plate is lowered to flatten the tissue. This may cause slight discomfort, but the compression is necessary to generate the clearest pictures. If it’s extremely painful, notify the technician so they can adjust the setting accordingly. The process takes about 20 minutes, producing two photos per breast. On occasion, more views are necessary, but that’s not always a cause for alarm.

If a woman has had breast augmentation, it’s critical the doctor and technician are informed prior to the appointment. Implants can impede the view of the breast, making it difficult to note serious issues. It’s also important to have a technician who knows how to maneuver tissue to capture the best images. These patients should expect a longer exam time, as additional photos will be required.

About the author: Dr. Patricia Ferguson, M.D., is a physician consultant at Blue Cross Blue Shield of Michigan.

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