You schedule a routine mammogram, expecting it to be quick and uneventful. But then your provider’s office calls to say you need a diagnostic mammogram.
Wait — what’s that? Isn’t a mammogram just a mammogram?
If you’ve never heard of the difference between a screening and a diagnostic mammogram, you’re not alone. Many women don’t realize there is a difference until they’re suddenly faced with it. Although both types of mammograms are low-dose X-rays to look at the breast, they are designed for different stages of the diagnostic process.
We spoke with Danielle Summers, MD, a breast imaging specialist and diagnostic radiologist with Banner MD Anderson Cancer Center. She explains the differences between mammograms and when and why they’re performed.
What is a screening mammogram?
A screening mammogram is an X-ray exam used to look for changes or signs that may suggest cancer. These include:
- Masses (areas of solid tissue)
- Asymmetries (parts of the breast that look different compared to the rest)
- Calcifications (tiny white spots that can show up as grains of sand)
- Architectural distortion (when tissue looks like it’s being pulled into a star shape)
“A screening mammogram includes four images, two of each breast,” Dr. Summers said. “We use them to find breast cancers earlier when they are smaller and in the early stages, when treatments are more effective and can be less aggressive.”
Who needs a screening mammogram?
Most women should get a screening mammogram once a year starting at 40. This may change based on your personal or family history or genetic risk, so it’s always good to talk to your health care provider about the right timing for you.
Women at higher risk of developing the disease should be screened earlier. This includes those who:
- Have a BRCA1 or BCRA2 gene mutation identified by genetic testing
- Have a parent, sibling or child with a BRCA1 or BRCA2 gene mutation
- Had radiation treatments to the chest before age 30
- Had (or have a family member who has) certain medical conditions, like Li-Fraumeni syndrome and Cowden syndrome
How long does a screening mammogram take?
Screening mammograms are fast — about 20 minutes — and you typically leave right after the images are taken. A radiologist reads the images, then you’ll usually get your results within a few weeks (sometimes as early as a couple days).
What if I get called back?
It’s common to get called back after your first mammogram. In fact, about 1 in 10 women need additional images. This doesn’t mean you have cancer. It just means the radiologist needs more information. You might have dense breast tissue, overlapping structures or a cyst that looks unclear. This is where a diagnostic mammogram can help sort it out.
What is a diagnostic mammogram?
A diagnostic mammogram is different from a screening mammogram. It may include additional angles or magnified images of the area of concern.
“There are two main reasons we use diagnostic mammograms,” Dr. Summers said. “One is when a woman comes in with a symptom and the other is when we see something on a screening mammogram that we need to take a closer look at.”
You may need a diagnostic mammogram if:
- You’ve noticed a lump, pain, skin thickening, nipple changes or discharge
- Your provider has found something during a clinical breast exam
- A prior mammogram showed an abnormality
- You have a history of breast cancer (especially in the first few years after treatment)
- A screening mammogram found something that needs closer evaluation
Diagnostic mammograms do not have a set schedule. They are ordered as needed based on symptoms, risk factors or follow-up plans. If you’ve had a finding that’s likely benign, you might be asked to come back in 6 months for a short-term follow-up.
How long does a diagnostic mammogram take?
Diagnostic mammograms may take longer than screening mammograms. Depending on the number of images needed, it may take 30-60 minutes. Unlike screening mammograms, radiologists typically evaluate the X-rays while you’re still at the testing facility in case they need to request additional images.
Based on the results, your provider may recommend additional tests, such as a breast ultrasound.
What is a breast ultrasound?
A breast ultrasound uses sound waves – not radiation – to create images of the breast. It’s not a replacement for a mammogram, but it’s often used in addition to one.
“Ultrasound is especially helpful when we want to take a closer look at something we found on a mammogram,” Dr. Summers said. “It’s also a great tool for evaluating lumps in younger women with denser breast tissue.”
Ultrasound can:
- Help tell the difference between a solid mass and a fluid-filled cyst
- Provide extra detail about areas that look unusual in a mammogram
- Be used to guide a biopsy if tissue needs to be sampled
Talk to your health care provider if this is something you should consider.
Does insurance cover mammograms?
Most insurance plans cover annual screening mammograms starting at age 40, with no referral needed.
Diagnostic mammograms are usually covered by insurance, but they may fall under your plan’s deductible or coinsurance. Depending on your plan and where you’re getting care, you may need a referral from your provider.
It’s best to check ahead of time with your insurance provider so there are no surprises.
How should you prepare for your mammogram?
- Schedule a time when your breasts aren’t tender. This is usually a week after your period.
- Wear a two-piece outfit. You’ll need to remove your top for the exam.
- Skip deodorant or lotion. These can show up on the images and make them harder to read.
- Bring past mammogram records. If you’ve had a mammogram somewhere else, bring those images or have them sent ahead of time.
When to talk to your doctor
It’s important to talk to your doctor if you notice any changes in your breasts, such as a lump, pain or skin changes. Also, let your doctor know if you have a family history of breast cancer or if you're unsure when to start screening.
Your doctor will help determine what kind of imaging test you need and when. They’re also there to answer any questions or concerns you may have.
Final thoughts
No matter your age or health history, staying on top of your breast health is one of the best ways to protect yourself. Regular screening mammograms are routine and preventive, while diagnostic mammograms are more focused and detailed.
If you’re over 40 or have questions about your breast health, talk with your health care provider or a Banner Health specialist. Getting regular mammograms can give you peace of mind and could even save your life.
