What to Expect at Your First Mammogram Appointment

What is a mammogram? And how long does it take? Here, doctors answer all of your burning Qs about the intimidating breast exam.

What to Expect at Your First Mammogram Appointment
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Ask your mother, grandma, sister, or any other middle-aged breast owner in your social circle to describe what it's like to get a mammogram, and they'll probably tell you it hurts like hell. And they may not be exaggerating: A small 2017 study found that, of the participants who did not expect their mammogram to be painful, nearly 56 percent reported experiencing pain after the exam.

Thanks to those stats and grim anecdotes about boobs getting crushed by two cold plates, you might feel incredibly intimidated for your own exam down the road — and be thinking of postponing it for as long as possible. But a mammogram can often detect breast cancer early, even before a lump can be felt (the most common symptom, but not all breast cancers cause a lump, FYI), which is when it's likely the easiest to treat, according to the American Cancer Society.

Below, medical experts break down exactly what to expect at your first mammogram, including what the process entails, the preparation required, and how often you should get an exam, all to help ease your worries and convince you to stay on top of your doctor's appointments. Trust, you'll feel much less intimidated. (

What Is a Mammogram?

Simply put, a mammogram is an x-ray of the breasts, says Anjali Malik, M.D., a board-certified breast imaging radiologist in Washington, D.C. The goal: "Detecting small, invasive breast cancers," says Dr. Malik. "[This is] because we know that when breast cancer is [caught] early, it is manageable and often curable with better outcomes."

Depending on the imaging center, a mammogram may either be two-dimensional — when each breast is compressed from two angles (top to bottom, then side to side) while x-rays are taken — or three-dimensional, when the machine takes multiple x-rays while moving in a small arc around the breast, according to the American Cancer Society. The images from a 3D mammogram are then compiled, allowing the doctor to see breast tissue more clearly, according to the American Cancer Society. And that's why Dr. Malik encourages patients to ask for a 3D scan when possible. "It's more accurate — it's better at detecting small, invasive cancers, which again is the whole point of doing and seeing mammograms, and it also has decreased false-positives," she explains.

Along with the type of imagery, there are two key types of mammograms: Screening mammograms, which are used to look for signs of breast cancer in folks without any symptoms, and diagnostic exams, which are used for people experiencing symptoms (think: a noticeable lump, nipple discharge, skin changes), according to the American Cancer Society. The primary difference is that a diagnostic mammogram often involves taking extra images than what is done during a screening exam. (FTR, the advice found in this article focuses solely on screening mammograms.)

When to Get a Mammogram

Exactly when to get your first mammogram largely depends on your level of risk. Before you turn 30, the American College of Radiology recommends breast owners receive a formal risk assessment from their doctor to determine what their personal screening process should be, says Dr. Malik. Your doc might ask you about your family history, the age you started menstruating, if you've taken oral contraceptives, if you've been pregnant, and other in-depth personal Qs, she adds. "It's a whole litany of questions, and those risk assessments are formal algorithms that basically come up with the percentage risk a woman has based on that information," explains Dr. Malik. "With that score in mind, a screening protocol can be set."

For individuals with an average risk of breast cancer (defined as a 12 percent risk over the course of a lifetime), annual mammograms are recommended, including by the Mayo Clinic, the American College of Radiology, and the Society of Breast Imaging, starting at 40 years old, says Dr. Malik. "The reason we recommend this start age of 40 is because if you look at the data, the average age for the development of breast cancer ranges between 62 and 65," she explains. "But one in six breast cancers is diagnosed in women ages 40 to 49. And the life years that can be saved through early detection of breast cancer in a woman in her forties are obviously really impactful. The data bears out that 40 is the age to start [and] annual is the screening interval."

The starting age is typically earlier, however, for folks with a higher risk of breast cancer, says Dr. Malik. If a family member had premenopausal breast cancer (breast cancer before age 49), it's generally recommended to start receiving mammograms 10 years before they had cancer, she says. For example, if your mom had breast cancer when she was 42, you might start receiving screening mammograms at 32 years old.

That said, people with higher risks typically won't start getting mammograms until they're 30 years old, says Dr. Malik. "The only reason we would do a mammogram on a woman between ages 25 and 30 is if there was a known premenopausal breast cancer diagnosis below the age of 35 or if there is a known BRCA mutation." This genetic mutation (which is associated with an increased risk of breast cancer) has a high penetrance, meaning many of the people who have the mutation will develop cancer during their lifetime, according to the National Library of Medicine. That's why early mammogram screening is so important for those individuals, says Dr. Malik. (

Can You Get a Mammogram During Pregnancy?

If your upcoming annual mammogram appointment is booked while you're expecting, you don't have to postpone it. Mammograms can be performed safely at any point during pregnancy, according to guidelines from the American College of Radiology. "Studies have shown that the low dose of radiation that comes with the mammogram is safe to the fetus," says Dr. Malik. "Women are shielded during a mammogram, so they're wearing a lead apron which protects them and the fetus." That said, some imaging centers are hesitant to perform the x-ray on pregnant folks, so make sure to talk with your doctor and radiology center about receiving your annual screening prior to your appointment, she suggests.

Receiving a mammogram while lactating, however, does come with some challenges. "It does obscure detail, [as] the breasts are engorged with milk," says Dr. Malik. "So we know there are going to be some limitations with the accuracy of that mammogram." To reduce the amount of milk in the breast — and increase visibility — it's recommended to pump or feed immediately before the x-ray. Still, some centers prefer breastfeeding individuals wait three to six months after weaning to receive a mammogram, says Dr. Malik. TL;DR: Chat with your doctor about keeping or rescheduling your yearly mammogram if you're pregnant or lactating.

How to Prepare for a Mammogram

Since the breast compression involved in a mammogram can be quite painful for some, consider scheduling your appointment roughly halfway through your menstrual cycle (near day 14 if you have a regular 28-day cycle), suggests Dr. Malik. At this point, the breasts tend to be less tender and sensitive, so you may experience less pain and discomfort during the exam, she says. "Taking acetaminophen or ibuprofen before your exam can also help minimize any pain," she adds. (Dealing with breast pain? These factors could be to blame.)

You may also want to consider wearing a two-piece outfit, as you'll need to remove your top for the screening and you might get cold (or feel awkward) standing in the exam room without any bottoms on, she says. And make sure to skip the deodorant and antiperspirant the day of your appointment. "Most centers will ask that patients not wear deodorant or wipe it off if they have it on," says Dr. Malik. "It's not because deodorant causes breast cancer — it's because deodorant can cause artifacts on our images." Specifically, your doctor will look for calcium deposits, which appear as white spots or flecks on a mammogram and can be a sign of breast cancer, within the breast tissue, she explains. The problem: "Deodorant will show up looking similar to calcium deposits and can just create confusion," she adds.

As for mental preparation, head into your mammogram appointment knowing that call-backs for further examination are common, particularly if it's your first time, says Dr. Malik. In those cases, "it's our first time seeing inside the breasts, and we just need to get used to the lay of the land" and get an idea of what your normal looks like, she adds. After you've had a few mammograms, make sure to bring the digital or physical images from your prior examsif you switch to a new imaging center. (Just ask your previous doc for copies.) "It's always helpful to have a comparison, and it can prevent unnecessary further imaging, follow-ups, and biopsies," says Dr. Malik.

What to Expect During a Mammogram

Before you break out your breasts, you'll fill out a patient information and history form — whether it's yourfirst mammogram or your tenth. "Something that seems minor to a patient — a small change in their family history [or] their personal history — can impact their health, their risk, or the appearance of their mammogram," says Dr. Malik. "For example, [with] starting or stopping birth control, the removal of an IUD, things like that, we oftentimes will see changes in the breast — not dangerous, not bad — but it does help put things in perspective for us."

Once it's time for the exam, you'll go over any questions or concerns you may have, remove any jewelry that may interfere with the exam and clothing from the waist up, and change into a gown, says Dr. Malik. From there, you'll head into the imaging room and step in front of the mammography machine. Your technologist will place one breast on the x-ray plate, and a separate flat plate will press down on top of the breast to compress it against the plate, according to John Hopkins Medicine. "The reason they're squeezing the breasts is that things that are bad [re: signs of cancer] and dense breast tissue can look the same," explains Ann Chuang, M.D., F.A.C.S., a board-certified surgeon who specializes in breast surgery. "So if they squeeze harder, they can [distinguish] it from the dense tissue and it's easier for the radiologist to call it nothing versus cancer."

With a standard 2D mammogram, your technologist will typically take two images of each breast — one when it's compressed from top to bottom, another when it's compressed from side to side. That said, they may take additional images when necessary (e.g. if you have larger breasts) to ensure they have a view of all the tissue, says Dr. Malik. "We think of the breast just as the spherical part [of the chest], but it really does actually extend from the underarm, all the way down to the tissue below the breast, and then from the sternum and/or breast bone, all the way to the side," says Dr. Malik. "We are doing our very best to be able to get all that tissue into view because I can't detect what I can't see." (BTW, there's no breast size that's too small to get a mammogram, either, says Dr. Malik.)

If you're getting a 3D mammogram, your breasts will still be compressed from top to bottom, but an x-ray arm will sweep in a slight arc over the breast, taking multiple images, according to John Hopkins Medicine. With both types of mammograms, this x-ray process is repeated on both breasts, and the entire exam takes less than 10 minutes, says Dr. Malik.

What Doctors Look for In a Mammogram

After the imaging process, your radiologist will look at your breasts for any abnormalities, including those calcium deposits. "We can have those in the breast for a lot of different reasons, most of which are benign, but they can be an early sign of breast cancer," says Dr. Malik. "Calcium deposits are not always bad — it's certain types — and that requires extra imaging that we often ask women to come back in for."

They'll also examine your images for masses (areas of breast tissue that have a shape and edge that look different from the rest of the tissue), asymmetries (white areas on a mammogram that appear different from the normal breast tissue pattern), and distortions (breast tissue that appears distorted) — all of which may be potential signs of cancer, according to the American Cancer Society.

Finally, they'll check your breast density, which is the proportion of fat to fibroglandulartissue (the mix of connective tissue and the tissue that produces milk) in the breast, says Dr. Malik. "The reason that breast density is relevant is that, on the x-ray of the breast or the mammogram, the tissue is white, fat is black, and cancer is white," she explains. "So in a woman who has way more tissue than fat, it can be like finding a needle in a haystack — it can make the detection challenging." Folks with higher breast densities also have a slightly higher risk of developing breast cancer, which is why your doctor will likely have a conversation about your screening procedure moving forward if you're found to have dense breasts, says Dr. Malik.

What Happens After a Mammogram

How soon your imaging center sends your results over to your doctor depends on its practices and patient volumes, says Dr. Malik, but you'll generally receive them within a few weeks, according to the Centers for Disease Control and Prevention. If there are any concerns or abnormalities, you may need to go back for additional imaging, says Dr. Malik. But don't immediately assume the worst: "If 1000 women get a screening mammogram, 100 to 200 of those will be called back, 20 of those will need to biopsy, and only five will have cancer," she says. "So a call-back exam does not mean breast cancer."

If all is normal, you can go on with receiving a mammogram annually, but individuals who are called back for a second look may need an ultrasound or breast MRI, both of which provide a more detailed look at breast tissue, says Dr. Malik. "A mammogram detects six to eight breast cancers per 1000 women screened, an ultrasound can detect, in women with dense breast tissue, three additional breast cancers per 1000 women screened, and a breast MRI can detect about 15.5 breast cancers per 1000 women screened," she explains. Though the latter exams have higher detection rates, they're not as quick, cheap, or easily accessible as mammograms, which is why they're the go-to technique for regular screenings, says Dr. Malik.

The Takeaway on Mammograms

Despite the horror stories you may hear from family and friends, mammograms are quick and easy, and there are steps you can take to reduce the pain you may experience. And even if you're a decade or two away from hitting the suggested starting age for mammograms, Dr. Malik still encourages you to start taking charge of your breast health and asking those important questions about risk factors as early as you can.

"Finding out about genetic mutations or getting women screening protocols, if they're going to be high risk, is really important to do as early as possible," she adds. "We can turn women into previvors rather than survivors if they are found to have a genetic mutation and would benefit from a mastectomy or would benefit from increased high-risk screening. So I think being in your twenties is the perfect age to start thinking about this."

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