Breast screenings and imaging tests: your questions, answered

By Madhavi Raghu, MD, Breast Imaging, Diagnostic Radiology, Nuvance Health

Mammogram, breast MRI, breast ultrasound, oh my!

As a fellowship-trained, board-certified radiologist who specializes in breast imaging, I know many people have questions about different types of imaging and tests for breasts — whether screening or diagnostic tests or mammography, MRI or ultrasound.

The breast imaging you may have throughout your life depends on your age, risk of developing breast cancer, findings from previous tests or if you have symptoms.

Here is what you need to know about breast imaging and why screening mammograms are so important.

What is a mammogram?

Mammography is a specialized type of medical imaging that uses low-dose X-rays to see inside the breasts. Screening mammograms can detect breast cancer before it causes symptoms.

Who should get a screening mammogram?

Women who are at average risk of developing breast cancer should start annual screening mammograms at age 40. 

A screening means you do not have symptoms of breast cancer. See your doctor right away if you have any symptoms of breast cancer, such as a lump in your breast. They may recommend a diagnostic mammogram and possibly an ultrasound.

Find a primary care provider or gynecologist.

Nuvance Health offers self-referring screening mammograms, which means you can schedule a routine mammogram directly without a doctor’s order.

Find a mammo location near me.

A doctor’s order is required for supplemental tests, such as breast ultrasound if you have dense breast tissue, or breast MRI if you are at increased risk of developing breast cancer.

You may be at increased risk of developing breast cancer if you have a strong family history or a genetic predisposition such as BRCA1 or BRCA2 gene mutations. 

Related content: How do I calculate my breast cancer risk?

Why should I get a screening mammogram?

Except for skin cancer, breast cancer is the most common cancer among women in the United States. Screening mammograms are currently the most reliable and effective way to detect breast cancer early before it causes symptoms.

Results from decades of research show that women who have regular screening mammograms are more likely to have breast cancer found early and have better long-term outcomes.

Learn more about what to expect during a mammogram in this video.

What is 3D mammography?

Tomosynthesis is an advanced 3D mammography technology that can detect small cancers and masses hidden in breast tissue better than standard 2D mammography. Studies have shown that tomosynthesis can detect 40% more cancers compared to a 2D mammogram.

Tomosynthesis also decreases the rate of false positives, which means the interpretation of the image is more accurate. A small proportion of women need additional imaging based on their screening mammography results, which can cause anxiety. Most of the time, the additional imaging shows normal breast tissue, which we call a “false positive.”

Tomosynthesis is the standard of care at all Nuvance Health imaging locations and is available to everyone regardless of their age or breast density.

What is a diagnostic mammogram?

A diagnostic mammogram uses the same equipment as a screening mammogram. The main difference from a screening is the views obtained during a diagnostic mammogram.

Having these symptoms does not mean you have breast cancer, but it is important to see your doctor when you notice changes and tell them how you are feeling. They may recommend a diagnostic mammogram or other tests.

What is a breast ultrasound?

A breast ultrasound uses sound waves to produce images that offer a closer look at breast tissue. 

If you have dense breast tissue, you may be eligible for breast ultrasound. You may also have a diagnostic or targeted ultrasound if your doctor feels a suspicious lump during a physical exam or if a mammogram reveals an abnormal finding. 

What is a breast MRI?

Your doctor may recommend a breast MRI if you are at increased risk of breast cancer. A breast MRI uses magnetic energy to produce more detailed images than 3D mammo. You have contrast dye injected into a vein in your arm or hand that will go into the tissues so the radiologist can see clearly inside the breast. MRI of the breast is very sensitive, which can result in increased false positives. 

What is a breast biopsy?

An ultrasound and mammogram typically answer diagnostic questions most of the time. However, for a small number of people, the radiologist may recommend an image-guided breast biopsy to evaluate better a finding in the breast. 

The radiologist will explain the procedure and carefully perform the biopsy, which they can perform using ultrasound, mammography or MRI. The radiologist will send the tissue sample to the lab where a pathologist will test it. 

At Nuvance Health, your radiologist or referring physician (gynecologist or primary care provider) will contact you with the findings and next steps. In many cases, you may return to annual screenings if the results do not show cancer. If the pathology results show breast cancer or a high-risk lesion, you may need to see a breast surgeon.

At Nuvance Health, nurse navigators contact patients and connect them with the appropriate follow-up care. We aim to streamline the process as much as possible for our patients. 

Learn more about breast cancer nurse navigators, social workers and therapists at Nuvance Health.

Where should I go for breast imaging?

We recommend you go to an accredited breast imaging center that offers 3D mammography and access to highly skilled mammogram technologists and radiologists.

The American College of Radiology has accredited all Nuvance Health imaging locations and they all have 3D mammography. Nuvance Health’s mammography technologists perform mammograms and board-certified, experienced radiologists interpret all images. Our radiologists are usually onsite to answer questions.

Does breast imaging involve radiation exposure?

Yes. However, modern mammography technology uses only a small amount of radiation. On average, the total dose for a screening mammogram is about 0.4 millisieverts (mSv), which is extremely low. For comparison, people in the United States are exposed to about 3 mSv of radiation each year just from their natural surroundings.

The benefits of annual screening mammograms outweigh the risk of possible radiation exposure. It is important to remember screening mammograms are critical in the early detection of breast cancer.

What are common concerns about breast imaging?

In addition to radiation exposure, common concerns about breast imaging are cost, time away from family or work for the test, and anxiety particularly related to callbacks from a screening mammogram.  

We understand!

Anxiety

Talk with your doctor if you have any of these concerns. Radiologists are also available at all Nuvance Health breast centers to address your questions about breast imaging and findings from your images.

Cost

Most health insurance covers screening mammograms. There are also programs for individuals without health insurance.

Time

The total time a breast imaging test takes depends on the type of imaging and facility. On average, an actual mammogram takes about 15 to 20 minutes.

Most Nuvance Health imaging locations offer evening and weekend hours to accommodate your schedule.

The bottom line: Screening mammograms can save lives because they can detect early-stage breast cancer. Start annual screening mammograms at age 40 if you are at average risk for breast cancer and not experiencing symptoms. Talk with your doctor, such as your primary care physician or gynecologist, if you have questions about your risk for breast cancer or about breast imaging.