Mammograms are an essential part of our breast cancer screening and prevention strategy during and beyond the menopause transition. This is because breast cancer risk increases with age. But it can be difficult to know exactly when mammograms are necessary, how often to have them, and who needs them. Various medical organizations offer different perspectives, but it's your unique healthcare circumstances that determine the best screening schedule. In this piece, we’ll explore common questions about mammograms and why they're important tools in menopausal care.

‍How often do I need a mammogram?

This is the million-dollar question, and a source of much debate among researchers and public health experts. Broadly speaking, medical experts recommend that you begin (or consider beginning) annual mammograms at age 40 if you’re at average risk. From age 50 to age 75 (when virtually all women enter menopause if they haven’t already) it’s recommended that you get a mammogram at least every other year, or annually to be safer. 

After age 75, there is less clear data on the benefits of mammograms. Some organizations, like the American Cancer Society, recommend that you continue to get them as long as you’re in good health with a 10+ year life expectancy. Others, like the American College of Obstetricians and Gynecologists (ACOG), recommend that you and your doctor decide together to stop mammograms whenever that makes sense given your health and longevity. Still other groups, like the US Preventive Services Task Force, make no recommendation one way or the other for people over 75 years old.

To align with the mammogram frequency recommendation from health organizations such as the American College of Obstetrics and Gynecologists and the American Cancer Society, we require mammograms every two years at Evernow (for those for whom this is applicable). However, we highly encourage getting mammograms on at least an annual basis.

The most important thing to understand is that there’s no one-size-fits-all answer. When to begin and end mammograms, as well as how often to get them, are personal decisions you’ll need to make with your doctor. Your choices will be influenced by your own risk factors for breast cancer, including your family history, genetic profile, and current health circumstances. 

Are there any mammogram alternatives? 

Mammograms have some drawbacks, such as the mild discomfort of the procedure and the use of radiation, albeit a very small amount. And for that reason, researchers continue to explore alternative technologies. However, at this time, it is still the preferred screening tool for women at average risk for breast cancer.  Other tools are used as adjuncts (e.g., ultrasound, MRI) to support the mammogram rather than replace it.

A breast ultrasound creates very high-frequency sound waves through a wand (it does not use radiation). The device then captures those echoing sound waves and reconstructs an image of the breast. This technique can be helpful in identifying potential abnormalities seen on mammography or breast MRI.

Similarly, MRI scans—which produce images via strong magnetic fields and radio waves—may outperform mammograms in detecting an early form of cancer called Ductal Carcinoma in Situ. But they also have a significantly higher false positive rate. For this reason, MRIs are typically used in combination with mammograms to detect cancer for patients who are deemed high risk (e.g., BRCA mutation carriers). 

2D vs. 3D mammograms: What’s the difference?

In recent years, healthcare providers have been rolling out a new type of technology called the 3D mammogram. The experience is very similar to a standard, 2D mammogram: Your breasts are placed between two plates and the machine takes a series of pictures. But unlike a 2D mammogram—which only takes images of the breast from the front and sides—a 3D mammogram rotates to view the breast from multiple angles. The computer then assembles these pictures into a complete, 3D image of the breast.

The 3D imaging process offers some advantages over 2D imaging. The higher level of detail increases cancer detection across all breast densities. In addition, using 3D imaging may reduce the need for additional breast imaging, saving patients from a lot of stress and anxiety.

Research shows that women in their fifties who get regular mammograms have a 14% lower risk of dying from breast cancer than women who did not get mammograms.

Breast Cancer Risk & Menopause

Menopause does not increase your risk of breast cancer. However, your risk does grow with age, just as it does for many other types of cancer. Unfortunately, that risk is fairly high: one in eight women will get breast cancer at some point in their lives. Among people in high-risk groups, those odds are even higher. 

This is why mammograms are such a crucial screening tool. Research shows that women in their fifties who get regular mammograms have a 14% lower risk of dying from breast cancer than women who did not get mammograms. That number goes to 33% among women in their 60s who get regular mammograms. To put it simply, routine mammograms can save lives and the life-saving benefit of mammography grows with age.

There are people who avoid or delay mammograms because they’re uncomfortable, but I would gently urge people to consider how much pain can be avoided in the long run by detecting cancer early, while it’s still easy to treat. —Dr. Leah Millheiser, Clinical Professor of OB/GYN and Chief Medical Officer of Evernow.

Mammogram FAQs

How should I prepare for my mammogram?

On the day of your mammogram, don’t use any personal care products on your chest or underarms. That includes deodorant, perfume, and lotion. These products can look like calcifications on mammogram, leading to stressful false positive results. You can eat and drink as you normally would. Some people find that caffeine makes the breasts more tender and therefore avoid coffee or tea beforehand. 

What should I wear?

It’s best to wear a two-piece outfit, such as a skirt or pants with a separate top. This makes it much easier to undress from the waist up and change into a gown.

Do mammograms hurt?

It’s normal to experience some mild discomfort during a mammogram due to the pressure placed on the breasts by the machine, however most people tolerate the experience quite well. For some people, mammograms can be uncomfortable  Bear in mind that the procedure itself only lasts a few minutes. If you’re concerned about the pain, consider taking an over-the-counter pain reliever an hour beforehand. It can also be helpful to schedule your mammogram for the week after your period to avoid breast tenderness.

What should I bring to my mammogram?

You should always bring your ID, insurance card, and paperwork from the doctor who ordered the test (if you were given any). If it’s possible, you should bring the images from your last mammogram. This will allow your medical team to compare the images and track any changes.

Where can I get a mammogram?

Many different medical or imaging centers offer mammograms. That includes hospitals, radiology centers, and dedicated mammography clinics. Some physicians also have mammogram equipment on-site. The doctor who ordered your mammogram (such as your primary care doctor or your OB/GYN) should be able to direct you to the nearest mammogram provider.

Insurance covers most mammograms, but the CDC has a list of resources for people who need a mammogram at low or no cost.

Final thoughts

Mammograms are a crucial part of breast cancer detection, especially during the menopause transition. Women aged 40-75 should know their risk factors and get annual or biennial mammogram screenings.

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Reviewed by Dr. Leah Millheiser, MD, Evernow Chief Medical Officer, May 2022