Mammograms: What You Need to Know

Houston Methodist breast care experts recommend women with an average risk of breast cancer should start having annual screening mammograms at age 40. If you have a higher risk for cancer (such as family history, increasing age, certain genetic mutations linked to breast cancer, like BRCA1 and BRCA 2, being overweight, a sedentary lifestyle or a poor diet), your doctor may recommend you start screening as young as age 30. 

You should have a diagnostic mammogram if you get called back for more imaging after your screening mammogram, notice any changes at all in your breasts or show symptoms of breast cancer. Early signs of breast cancer include a lump in the breast, bloody discharge from the nipple, new pain in one spot that does not go away, and changes in the shape or texture of the nipple or breast.

The mammogram process is relatively quick and easy. Your technologist will walk you through each step during your appointment, but here is what you can expect when you get a mammogram at a Houston Methodist Breast Care Center:

• First, you will remove your top and bra and put on the provided robe.
• Then, a mammogram technologist will help position one of your breasts on the specialized X-ray machine.
• Next, the machine will compress your breast for just a few seconds while the technologist takes an X-ray. This process is then repeated about two or three times for each breast. Each compression is very quick, and the entire imaging process lasts about five minutes.
• Finally, you will get dressed and continue on with your day. 
  
  

On the day of your exam, make sure to wear comfortable clothes — you will only need to remove your bra and top. And don’t use deodorant, antiperspirant, powders, lotions, creams or perfumes under your arms or on or under your breast — they can interfere with your test results.

Read our On Health blog article on What to Expect During a Mammogram.

Radiologists use a standard system to describe mammogram findings and results — and this scoring system is the same for both screening and diagnostic mammography. This system (called the Breast Imaging Reporting and Data System or BI-RADS) sorts the results into categories numbered 0 through 6.

With these categories, doctors can describe what they find on a mammogram using the same words and terms, making communicating about the test results and following up after the tests easier.

• BI-RADS 0-2: At Houston Methodist, if our radiologists see something on a screening mammogram and want patients to come in for additional images, they are given a BI-RADS 0. This means they will come in for a diagnostic mammogram to evaluate the area of concern. For "normal" mammograms that don't show any abnormal or questionable findings, a BI-RADS 1 or BI-RADS 2 is given.
• BI-RADS 3: A BI-RADS 3 means the radiologist would like to follow something — it is called a “probably benign” category and means that the finding has a 98% likelihood of being benign.
• BI-RADS 4-6: A BI-RADS 4 means the findings are indeterminate and a biopsy is recommended. BI-RADS 5 means it is almost definitely cancer and needs a biopsy, while BI-RADS 6 is only used for findings on a mammogram (or ultrasound or MRI) that have already been shown to be cancer by a previous biopsy. Imaging may be used in this way to see how well the cancer is responding to treatment.

There are other breast screenings that typically occur in conjunction with mammograms. These include:

• Breast ultrasound – uses sound waves and their echoes to make computer pictures of the inside of the breast. A breast ultrasound can show certain breast changes, like fluid-filled cysts, that can be more difficult to see on mammograms. Read our On Health blog article How Is a Breast Ultrasound Different From a Mammogram?
• Breast magnetic resonance imaging (MRI) – an extremely sensitive test to look for breast cancer indicators using magnetic fields to view the body. It also may be used for breast cancer treatment planning and performing an MRI biopsy
• Molecular breast imaging (MBI) – a technique used to identify tumors in dense breasts.