A mammogram is an X-ray of the breast that can show a growth that might be cancerous.
More than 500,000 women worldwide died of breast cancer in 2011, making it the most common cancer to affect women.
However, in countries with access to early screening and quality treatment, survival rates from breast cancer are now around 80 percent. This is partly due to the earlier detection abilities.
Mammograms are an invaluable tool for early detection of breast cancer, although many women are concerned about the pain they can cause.
A number of strategies can make mammograms more comfortable. Also, the pain of the procedure is fleeting and not all women find it painful.
How mammograms work
A mammogram takes about 20 minutes from start to finish. During a mammogram, a female technician will place a woman’s breast between two plates. One of the plates takes an image of the breast, and the other holds the breast in place.
Gently compressing the breast allows the technician to get a clearer image that displays all of the breast tissue. It also keeps the breast stable during the test.
Do mammograms hurt?
A number of factors affect whether a mammogram hurts, including:
- the skill of the technician
- anxiety about the mammogram
- breast structure
If the machine is not in the right position, this can also cause issues. For example, some women may have to contort their backs due to the height of the machine. This means they may experience back or neck pain due to muscle strain, not the procedure itself.
As such, it is important to let the technician know if the machine is at the wrong height.
In addition, women with fibrocystic breasts are more likely to experience pain. This condition is where there are harmless cysts in the breasts.
How to reduce pain
Women concerned about the discomfort of a mammogram can take a number of steps to reduce any pain they may experience. These include:
- Timing: schedule the mammogram for the week after a menstrual period. During and immediately before a period, hormonal swings can increase breast sensitivity.
- History: inform the technician about fibrocystic breasts, or about a previous history of painful mammograms.
- Caffeine: if you drink caffeinated sodas and coffee, try to decrease your caffeine intake for two weeks before your mammogram as it can make your breasts more tender, especially if you have cystic breast tissue.
- Drugs: take a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, 45-60 minutes before the procedure.
- Padding: ask the mammography center if it offers padding. Cushioning between the breasts and the plates of the mammogram machine can significantly reduce pain.
- Breathing: take slow, deep breaths during the procedure. This can reduce tension-induced pain.
- Delaying if breastfeeding: women who are breastfeeding but who will wean soon may want to delay mammograms to avoid pain.
What to do if there is pain
Women who experience pain should notify the technician, particularly if the pain feels unbearable. A mammogram should not hurt so much that it deters future tests.
If a technician is insensitive or rushed, a woman should ask for a different technician, or try a different mammography center.
Many sensitive technicians are willing to take their time to reduce pain. A deliberate approach can also ensure proper breast placement in the machine, reducing the risk of pinching and other sources of pain.
Women who have previously undergone a mammogram should take their old images with them, or ensure that their doctor gives the clinic access to the previous images.
This allows the doctor to compare old mammograms with new mammograms, which can increase accuracy and prevent both false positives and false negatives.
A woman with known harmless cysts in her breasts, for example, may get a false positive without a previous mammogram to compare the new images to. Likewise, a small growth might go unnoticed without a source of comparison.
When to expect results
In most cases, the doctor will receive a copy of the mammogram results within 2 weeks, and sometimes much sooner. Some clinics perform the mammogram and a breast examination at the same time, and offer same-day results.
As mammogram result can be complicated, providers often require women to receive results in person. A positive result on a mammogram can be frightening, but does not necessarily point to cancer. Most positive mammograms require further diagnostic tests.
Women whose mammograms show unusual growths will need follow-up tests. These may include:
- breast examination
- breast ultrasound
- MRI scan
- another mammogram
- blood tests
- breast biopsy
Even when cancer is present, the chances of survival with aggressive, early treatment are excellent. Avoiding a mammogram only delays potentially life-saving treatment.
Mammograms are very safe but do require brief exposure to very low levels of radiation. Women who are currently pregnant may need to forgo mammograms. The risk of radiation exposure is minimum and mammograms are still the best screening for healthy women.
The main disadvantage of mammograms is that they do not detect all cancers. About 1 in 5 cancerous growths may not be detected by a mammogram.
False positives are also common, with 50-60 percent of women getting a false positive after 10 mammograms. The high sensitivity of mammograms is a good thing, but false positives can be unnerving.
When to have a mammogram
The 2015 guidelines from the American Cancer Society (ACS) suggest that mammograms are the most important tool for fighting cancer. The ACS says breast self-examinations are not the only way to detect early warning signs.
The mammogram guidelines suggest:
- women aged 40-44 should have the option to begin breast cancer screenings
- women aged 45-54 should get annual mammograms
- women aged 55 and older should switch to mammograms every 2 years, or continue with annual screenings
Women with certain risk factors may need to begin mammograms earlier. These include:
- a family history of breast cancer
- a previous history of breast cancer
Some providers recommend that women at high risk begin annual mammograms as early as aged 25. Women in this category may also need to be screened using magnetic resonance imaging (MRI) tests.