Do Mammograms Hurt?
Most women say that a mammogram is not painful. However, some women may experience pain depending on factors such as:
- Timing of the menstrual cycle
- Presence of dense breast tissue
- Fibrocystic breasts
- Rarely with implants
Mammography is the best imaging tool for finding breast cancer early. Therefore, it’s important to identify which factors may contribute to your mammogram experience. If your first experience is a positive one, you are more likely to be consistent with preventive mammography recommendations. On the other hand, if the experience is not perceived as comfortable, you might be less likely to follow through with these potentially lifesaving recommendations. It is our job as professionals in the field of breast and women’s imaging to identify these factors and change them where we can.
Why is it Important to Have Routine Mammograms?
We are looking for abnormalities that may represent the earliest signs of breast cancer. The purpose of the x-ray is to distinguish normal structures that are components of the breast such as glandular and fatty tissue from abnormal lesions. As radiologists, we are looking for subtle mammographic differences in the cellular structure of the tissue such as distortion, masses, or extremely small white spots (as small as grains of salt) called microcalcifications.
When Should I Get a Mammogram?
If you are 40 years of age or older at average risk and have no breast symptoms, a screening (preventative) mammogram is recommended every one to two years by the American Cancer Society. Some alternative recommendation bodies such as the American College of Radiology (ACR) or the American College of Obstetrics and Gynecology (ACOG) generally agree with this recommendation. Some women are considered at increased risk because of their family history or other factors such as prior radiation. These women may need mammography earlier based on recommendations from your referring clinician or the radiologist.
Do I Need a Referral For a Mammogram?
At The Women’s Imaging Center, we accept self-referred patients for screening or diagnostic mammograms. We will have a specially trained radiologist on-site at your selected location if we know you have a breast complaint or need further imaging evaluation. Please let the scheduler know ahead of time when she asks if “this is your annual screening mammogram or if you have any breast problems, implants, prior history of breast cancer”. If you are continuing your diagnostic work-up at one of our facilities, please bring your prior mammograms or let us in advance so we can request these.
How is a Mammogram Performed?
In a standard screening (preventative) examination, two mammogram views are performed of each breast. Most mammograms are 3D so each view represents multiple angles at each position. The standard positions are medial lateral oblique (MLO) which is a side-to-side view that includes some of the tissue under the arm. The other view is called cranial-caudal (CC) which means “head to tail” or up and down.
The second type of mammogram is called diagnostic. We perform this type of mammogram to evaluate breast problems like a “lump” or unusual breast discharge or to obtain a better look at an abnormal appearing area on a screening mammogram. This type of diagnostic medical imaging involves additional images such as spot compression or magnification imaging. These specialized diagnostic images are performed in addition to the regular screening mammogram images described above.
If you have breast implants, there is an additional image for each view. For example, the MLO view will consist of the regular view with the implant in the picture AND an added view where the tissue in front of the implant is imaged called a displaced view. This allows the technologist to obtain better compression of different areas and allows the radiologist to see around the implant better. A mammogram with implants is not charged any differently than without implants, but the technologist needs twice as much time to perform so please tell us ahead of time if you have breast implants.
What Happens at the Time of My Mammogram?
The mammography technologist will walk you through the process of what is needed to obtain the best images. She will ensure you are comfortable during your examination. We want you to have the best experience possible.
For every body type, mammogram imaging may be different. Earlier versions of mammogram machines were more box-like while newer mammography systems are more curved, better fitting the angles of a woman’s body.
The technologist will position each breast onto a rectangular curved paddle and then apply gentle pressure. The amount of pressure needed for the correct exposure is based on experience and the machine presets, the tissue density and thickness of your breasts, and if you have breast implants.
We want to keep the breast in the same position, throughout the mammogram. Avoid slight motion that may cause blurriness of the image if you can. The mammography technologist will ask you to hold your breath for a few seconds while she obtains the exposure. There are typically two views of each breast obtained. You will be repositioned four times, once for each view of each breast.
If you have implants, four views will be obtained for each breast for a total of eight images.
What Can You Do to Make Your Mammogram More Comfortable?
- Schedule your mammogram at the optimal time of your menstrual cycle, typically days 6-10 after the first date of your last menstrual period. We typically experience painful breasts one to two times during the menstrual cycle. The most noticeable time is when your period begins which may last for 4-7 days. The second more sensitive time may be around the time of ovulation which is typically 10-14 days after the first date of your last menstrual period.
- Avoid tight bras including sports bras for one to two weeks prior to your mammogram date. Tight or overly compressive clothes retain additional water in the breast and interfere with the normal lymphatic flow of fluid out of the breast to the axillary (underarm) regions.
- Minimize salts or high sugar foods. These also retain extra fluids in the breast and can make compression of the breast more painful.
- Avoid excess alcohol and caffeine. Both are diuretics which means they rid your body of extra water. Dramatic changes in the water content of your body may affect the action of your pituitary and endocrine system which will signal the sodium and the amount of water to increase to accommodate for the loss experienced.
- Eat a light healthy breakfast the day of your examination. If you do not eat or are nervous, your body may experience a vasovagal reaction and you may be more likely to faint. We recommend a light breakfast with protein and/or a complex carbohydrate. For example, an egg on a slice of wheat toast or yogurt with berries would be ideal.
- Relax prior to and during your mammogram. If you are very nervous you will be more sensitive to the amount of compression.
Will My Breasts Feel Sore After a Mammogram?
Most women only experience temporary mild compression during the few seconds pressure is applied for the exam view during the examination. Any pain persisting after the examination is rare and may be related to another internal process such as a breast cyst that was compressed during the mammogram. If any discomfort persists longer than a day or two after the examination, we recommend you call the mammography or women’s imaging center for additional advice. The radiologists or navigators may want to examine the breasts for any other problems or a technologist may perform an ultrasound to evaluate for any cysts or other internal breast problems. In women with larger breasts, thin skin or yeast under the breast may cause the skin to be more friable. For women taking blood thinners, compression from the mammogram may rarely cause tiny microvessel bruises called telangiectasias. These complaints are temporary and will be resolved.
In summary, there are many ways to prepare for your mammogram to make this a more comfortable experience. The more you know, the more you can prepare for your next mammogram.
What Imaging Center Nearby Does Mammograms?
The Women’s Imaging Center uses the highest-rated breast imaging and comprehensive mammography and medical diagnostic imaging exams for women including:
- 3D mammograms
- Body ultrasound
- Genetic counseling and testing
We offer breast MRI and other Medical Diagnostic Imaging MRI services at our Denver/Cherry Creek location. The Women’s Imaging Center also provides most other Women’s Imaging and Mammography Services at our other Denver metro area locations including Women’s Imaging- West/Lakewood, Women’s Imaging-South/Highlands Ranch, and Women’s Imaging-North/Westminster locations, and our Centennial location.
About the Author:
The author of this article is the Medical Director and head radiologist of The Women’s Imaging Center(s) for twenty-six years. Dr. Kelly McAleese is a lifelong advocate for women’s health issues and access for all Coloradans. She has published numerous articles on the topics that affect women’s health and is nationally recognized as one of the founding members of the concept of Women’s Imaging.