Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

The Top 4 Mammogram Myths and Misconceptions —Commentary

10/18/18 Kathleen Kirtek, MD, Oncologic Radiologist, Breast Radiologist, Karmanos Cancer Institute, Wayne State University

Let’s start with a fact: Early detection saves lives.

This is the single most important thing for women to remember about breast cancer and deciding when to begin cancer screening. Today, mammograms are the gold standard in breast cancer screening.

The American College of Radiology (ACR) and Society of Breast Imaging (SBI) point out that the breast cancer death rate in the U.S. has dropped by 43 percent since the 1980s, when mammograms became widely used. However, breast cancer is still the most common form of cancer and the second deadliest cancer (behind lung cancer) in women in the US. Screening is therefore crucial to saving lives.

Due to conflicting recommendations on when to start and how often to get screenings, changes in mammogram technology, concerns about pain or radiation exposure, and alternative screening procedures, many patients have misconceptions about breast cancer screening.

Here are four common breast cancer screening myths and the facts to set the record straight.

1. Myth: Women don't need to think about mammograms until they turn 40

Fact: Long before her 40th birthday, every woman should start talking with her doctor about her specific breast cancer risks and when to start getting mammograms.

Although the ACR and SBI recommend that women at average risk (lifetime risk < 15%) of breast cancer begin annual mammograms at age 40 (and the U.S. Preventive Services Task Force recommends mammograms only starting at age 50), younger women, especially those with risk factors, can get breast cancer. And research suggests that younger women are more likely to develop more aggressive forms of cancer.

Thus, women should sit down with their doctor at age 30 to talk about their specific risk of developing invasive breast cancer. Physicians use various assessment tools to determine a patient’s risk based on a number of factors, including medical, reproductive, and family history.

Based on this information, doctors make specific screening recommendations for each woman. For example, if a woman has a family history of breast cancer in a close relative (mother or sister), her doctor may recommend she start screening at a younger age. African-American women face a higher risk of developing more aggressive types of breast cancer due to genetic predisposition. They should talk to their doctor about their specific risks no later than age 30 and may need to begin screening much earlier than age 40.

Here’s one more crucial preventive step to start early – self-breast exams (SBEs). SBEs are a good way to detect potential issues to bring up with a doctor. Women should know what healthy breasts feel like so they can better identify lumps, changes, or other early breast cancer symptoms.

2. Myth: All mammograms are the same

Fact: Two-dimensional digital imaging was the first to replace film-based mammograms. Today, three-dimensional mammography (also known as breast tomosynthesis) has emerged as an even more effective tool for detecting cancer.

The good news is all major insurance carriers now cover 3-D mammograms. Women should ask about the kind of imaging that will be used when considering where to have a mammogram, including mobile units, freestanding centers, and hospitals.

3. Myth: Mammograms are painful and dangerous

Fact: The benefits of mammograms at the right age far outweigh the brief discomfort and minimal radiation exposure.

During a mammogram, the breasts are firmly flattened to allow the maximum amount of tissue to be examined. This can create a stretching and tension sensation some women say is painful. Other women feel no pain at all. This stretching is critical to get the best image and lasts for a few seconds at most. Otherwise, the procedure is painless—no knives or needles.

Women may also be concerned about the dangers of radiation exposure during a mammogram. However, a typical mammogram exposes a woman to the same amount of radiation as a chest X-ray (a very small amount). Research has found that for women over 40, the benefits of mammography far outweigh the risks of low-dose radiation exposure. Still, it’s important for women to talk to their doctor about the amount of radiation in the particular mammogram procedure and if there are ways to make the process more comfortable.

4. Myth: Thermography is an OK alternative to mammograms

Fact: Thermography is a test that displays heat and blood flow. Some women believe this test is a good alternative to a mammogram because it’s painless and doesn’t expose them to any radiation. However, it is not an effective substitute to mammograms. In fact, the U.S. Food & Drug Administration recently issued a warning about misleading claims around thermography. The FDA stated that thermography is not an acceptable alternative to mammograms for screening for breast cancer.

Early detection is key

Every woman’s approach to breast cancer screenings will be a bit different. It’s important for women to start having conversations with their doctor early. The Manuals has valuable information on screening recommendations and alternatives, self-breast exams, and other topics. And remember—early detection saves lives.