Everything You Need to Know Before Your First Mammogram

Chances are you know someone who has had breast cancer — a relative, a girlfriend, at the very least celebrities including Shannen Doherty and Julia Louis-Dreyfus.

Our many links to the disease aren’t surprising considering roughly 13 percent of women born in the U.S. will develop breast cancer at some point in their lifetime, according to the National Cancer Institute.

The best chance at catching it early for those 21 million people: regular screening via mammograms, an X-ray image of breast tissue.

“The objective of a mammogram is to diagnose breast concerns before cancer or at the earliest cancer stage possible,” says Makeba Williams, M.D., clinical associate professor and director of general obstetrics and gynecology at UW Health in Madison, WI.

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The screening helps prevent and avoid late diagnosis, more intensive treatments, and ultimately, helps to improve a woman’s survival if she does indeed have breast cancer, Dr. Williams explains.

All experts agree that every woman needs to get the exam done regularly. But when women should start getting mammograms and how often is less unified.

"The screening guidelines can be confusing since they differ among professional organizations in the field," Dr. Williams explains.

But since the test is so important for keeping women healthy, we’re here to make it easier for you. Here, everything you need to know about when to get a mammogram, how often, and what you can expect for your first time.

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When should women get their first mammogram?

The recommendation around when you should start getting screened and how often is different depending on which professional organization you’re hearing from.

All the organizations agree women have the option to start screening at 40 years old. That’s a decision you should make with your doctor, Dr. Williams says.

But for women of average breast cancer risk:

• The U.S. Preventive Services Task Force recommends women begin getting mammograms at age 50, then again every 2 years after until at least 75.

• The American Cancer Society recommends women begin getting mammograms at age 45, then again every year. Once 55, get a mammogram every 2 years until at least 75.

• The American College of Obstetricians and Gynecologists recommends women begin getting mammograms at age 40, then again every 1 to 2 years until at least 75.

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Why all the conflicting opinions?

The discrepancy around the best age to start screenings all has to do with balancing the benefit of catching cancer early with the potential harms — cost, anxiety, discomfort of having the actual test itself, overdiagnosis, overtreatment, and false positives, Dr. Williams explains.

“In general, false-positive tests from mammograms may result in additional evaluations and more imaging and biopsies that may be determined to be benign,” Dr. Williams says.

You’re more likely to get a false positive between age 40 and 49 (hence all the differing opinions in that age range). You’re also more likely to get a false positive if you use combination hormone therapy or have dense breasts, which is another reason the right year to start screening is individualized.

That’s not ideal, for starters, because “the call-backs for further evaluation may increase a woman's anxiety and worry about a breast cancer diagnosis,” she adds.

But moreover, there’s the risk of unnecessary treatment if the screening test detects an early-stage cancer that would not have become symptomatic if it weren’t detected.

That risk/benefit is totally individual, so your best bet is to talk to your ob-gyn about what age and frequency is best for you based on your personal and family health history, personal values, and preferences, she adds.

That’s especially important if you’ve been told by your ob-gyn that you have dense breasts — which applies to about 40 percent of women over the age of 40, says the Breast Cancer Research Foundation. If you have dense breasts, you may need more frequent mammograms or additional screening options such as a breast ultrasound or MRI.

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Why don’t you need screening when you’re younger?

The average woman's risk for breast cancer over the next decade is 1 in 208 at age 30, according to the National Cancer Institute. By age 40, that number jumps up to 1 in 65, and up to 1 in 42 by the time you're 50. Because risk is so low before 40 years old, early screening risks overdiagnosis and treatment unless you're specifically high-risk. (More on that later.)

Who is considered high risk?

Anyone with a family history of breast cancer and whose families have a known genetic mutation (BRCA1 and BRCA2) is considered high risk. They should definitely start getting mammograms regularly before 40, along with an MRI and genetic counseling.

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When can you stop getting mammograms?

Most of the professional organizations recommend women get mammograms regularly until 75. After that, talk to your doctor about whether you should continue to get the screening regularly, Dr. Williams advises. Your risk is significantly lower after 75, but not zero.

What to expect during a mammogram:

Like most screening procedures women have to endure, mammograms can be uncomfortable. But luckily, the discomfort is much quicker than, say, your Pap smear.

For your mammogram, you'll need to completely undress from the waist up and put on a gown, then stand in front of an X-ray machine. This can be a very vulnerable experience for some.

Then, one of your breasts will be put between two flat, plastic plates — the pressure here can be uncomfortable for some since the plates are intended to flatten your breast as much as possible. But it's necessary for the most amount of tissue to be visible on the scan, and it’s over pretty quick.

The technician will take an X-ray of the breast, then repeat the steps on your other breast.

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How to prep for a mammogram:

The only thing you need to do to prepare is to avoid wearing powders, lotions, or deodorant the day of your mammogram. These products usually have substances in them that show up on the X-ray and make the reading difficult for your doc, according to the American College of Obstetricians and Gynecologists (ACOG).

Also, be sure to schedule your exam the week right after your period. Your breasts are less tender after menstruating, so that can help with any discomfort from the plate pressure, says ACOG.