Getting a mammogram is straightforward: in most cases, you can call a mammography facility directly and schedule one yourself without a doctor’s referral. If you’re 40 or older and haven’t had a recent screening, you’re a good candidate to book one now. Here’s everything you need to know about who should get screened, how to find a facility, what it costs, and what to expect.
Who Should Get Screened and How Often
The U.S. Preventive Services Task Force recommends that all women get a screening mammogram every two years starting at age 40 and continuing through age 74. This applies to women at average risk for breast cancer, meaning no strong family history, no known genetic mutations, and no prior breast cancer diagnosis.
If you have a higher risk profile, your doctor may recommend starting earlier or screening annually instead of every two years. Risk factors that could change your screening schedule include a first-degree relative (mother, sister, daughter) with breast cancer, a known BRCA gene mutation, or a history of chest radiation therapy before age 30. For these situations, you’ll want to discuss a personalized plan with your healthcare provider.
Do You Need a Doctor’s Referral?
A doctor’s referral is generally not needed for a screening mammogram. You can make an appointment yourself by calling a mammography facility or booking online. Many imaging centers, hospitals, and women’s health clinics accept self-referrals for routine screening.
The exception is a diagnostic mammogram, which is a different type of exam. You’ll need a doctor’s order for a diagnostic mammogram, and one is typically required if you have breast symptoms like a lump or discharge, a personal history of breast cancer, or if a previous screening came back with unclear results. Mammograms done within nine months of a prior mammogram are also classified as diagnostic rather than screening.
How to Find a Certified Facility
Every mammography facility in the United States must be certified under the Mammography Quality Standards Act (MQSA), which sets baseline quality standards for equipment, staff training, and imaging practices. The FDA maintains a searchable database at fda.gov where you can enter your zip code and find all certified facilities near you. When you arrive for your appointment, you can also look for the MQSA certificate posted in the facility.
Options for where to go include hospital radiology departments, standalone imaging centers, breast health clinics, and mobile mammography vans that travel to workplaces and community centers. If you’re unsure where to start, your primary care provider or gynecologist can point you to a facility, and your insurance company’s website will list in-network locations.
What It Costs
Under the Affordable Care Act, most health insurance plans must cover screening mammograms with no copayment, coinsurance, or deductible. This applies to marketplace plans, employer-sponsored insurance, and Medicaid expansion plans in most states. Coverage at zero cost isn’t guaranteed in every situation, so it’s worth confirming with your insurer before your appointment, particularly if your plan is grandfathered or you’re getting a diagnostic rather than screening mammogram.
If you’re uninsured or underinsured, the CDC’s National Breast and Cervical Cancer Early Detection Program provides free or low-cost mammograms to women with low incomes who lack adequate coverage. Each state runs its own version of this program with slightly different eligibility rules. You can find your state’s program through the CDC website or by calling 1-800-CDC-INFO. Many hospitals also offer free screening events, especially during October (Breast Cancer Awareness Month).
How to Prepare for Your Appointment
Skip deodorant, antiperspirant, lotion, and powder on your chest and underarm area the day of your mammogram. Antiperspirants contain aluminum compounds that show up on the X-ray image as tiny white spots, mimicking the appearance of calcifications that radiologists look for as potential signs of cancer. Solid stick antiperspirants cause the most interference, though all types can affect the image. You can bring your deodorant along and apply it after the exam.
Wear a two-piece outfit so you only need to remove your top. You’ll change into a gown from the waist up. If you’ve had mammograms at a different facility in the past, try to have those images transferred or bring the films with you. Having prior images for comparison helps the radiologist spot changes more accurately. The entire appointment usually takes about 20 to 30 minutes, with the actual imaging portion lasting only a few minutes per breast.
What Happens During the Exam
A technologist will position one breast at a time on a flat plate, then lower a second plate to compress the tissue. The compression spreads the tissue out so the X-ray can capture a clearer image with less radiation. It’s uncomfortable and sometimes painful, but each compression lasts only a few seconds. Two images of each breast are standard: one from top to bottom and one from side to side.
If you have breast implants, the technologist will use a technique called implant displacement views. The implant is pushed back against your chest wall while the breast tissue is pulled forward around it, allowing the tissue to be seen more clearly. This means a few extra images per breast, so your appointment will take slightly longer. Let the facility know you have implants when you schedule so they can allot enough time.
Understanding Your Results
Mammogram results are reported using a standardized scoring system called BI-RADS, which ranges from 0 to 6. Your results letter may reference this score, and understanding what it means can save you a lot of anxiety.
- Score 0: The images weren’t complete enough to make a determination. You’ll be called back for additional views or an ultrasound. This is common and doesn’t mean something is wrong.
- Score 1: Negative. Nothing abnormal was found.
- Score 2: Benign findings. Something was seen, like a cyst or calcified tissue, but it’s clearly not cancer. You return to your normal screening schedule.
- Score 3: Probably benign, with less than a 2% chance of cancer. You’ll typically be asked to come back in six months for a follow-up to confirm nothing has changed.
- Score 4: Suspicious. The chance of cancer ranges from 2% to 95% depending on the subcategory (4a, 4b, or 4c). A biopsy is usually recommended.
- Score 5: Highly suspicious, with greater than a 95% likelihood of cancer. A biopsy will be performed promptly.
- Score 6: Cancer that has already been confirmed by biopsy. This score is used for tracking during treatment.
Getting called back after a screening mammogram is common, especially for your first one, since there are no prior images to compare against. Roughly 10% of women are recalled for additional imaging after a screening, and the vast majority of those turn out to be benign. Results are typically mailed within a few weeks, though some facilities offer online portals where you can check sooner.