Getting a mammogram is straightforward: most people can call a local imaging center or hospital radiology department and book one directly, often without a doctor’s referral. If you’re 40 or older with no symptoms, you’re scheduling what’s called a screening mammogram, and many facilities let you do this online or by phone. Here’s what to know about eligibility, cost, preparation, and what the appointment actually involves.
Who Should Get Screened and How Often
The U.S. Preventive Services Task Force recommends that all women and people assigned female at birth get a screening mammogram every two years, starting at age 40 and continuing through age 74. This applies to people at average risk of breast cancer.
If you have a first-degree relative (mother or sister) who was diagnosed with breast cancer before menopause, screening typically starts 10 years before the age they were diagnosed. So if your mother was diagnosed at 38, you’d begin screening around age 28. Talk to your doctor about an individualized timeline if this applies to you.
If you’re under 30 and experiencing symptoms like a lump, nipple discharge, or a change in breast shape or skin, the first step is usually a breast ultrasound rather than a mammogram, because younger breast tissue is more sensitive to radiation.
Do You Need a Doctor’s Referral?
For a routine screening mammogram, many facilities do not require a referral or doctor’s order. Johns Hopkins, for example, allows patients to self-schedule online. The same is true at many hospital systems and independent imaging centers across the country. You pick a date, time, and location.
However, if you have symptoms like a lump, pain in one spot, or nipple discharge, you’ll want to see your primary care doctor first. Symptoms call for a diagnostic mammogram, which is a different type of exam that requires a doctor’s order and involves additional imaging.
Screening vs. Diagnostic Mammograms
A screening mammogram is for people with no breast symptoms. It takes four standard X-ray images: two of each breast, compressed from top to bottom and side to side. The whole thing takes about 10 to 15 minutes.
A diagnostic mammogram starts with those same four views but goes further. The radiologist reads the images in real time and can request additional views with spot compression or magnification to investigate an area of concern. You’ll typically get a breast ultrasound during the same appointment as well. Because of the extra imaging, diagnostic mammograms take longer.
How to Find a Certified Facility
Every mammography facility in the U.S. must meet quality standards under the Mammography Quality Standards Act (MQSA), which covers equipment, personnel, and practices. The FDA maintains a searchable database where you can enter your zip code and find every certified facility nearby. Look for the MQSA certificate posted at the facility when you arrive. Certification status can change, so checking before your appointment is a good idea.
Beyond FDA certification, practical factors matter too: whether the facility offers 3D mammography (tomosynthesis), how quickly they return results, and whether they have evening or weekend hours.
What It Costs
Under the Affordable Care Act, most health insurance plans must cover screening mammograms at no cost to you. That means no copay, no coinsurance, and no deductible requirement. This applies to Marketplace plans and most employer-sponsored plans.
If you’re uninsured or your insurance doesn’t cover screening, the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offers free or low-cost mammograms. You may qualify if your yearly income is at or below 250% of the federal poverty level and you’re between ages 40 and 64. You can find your state’s program through the CDC website.
One important distinction: diagnostic mammograms are billed differently than screening mammograms and may involve out-of-pocket costs depending on your plan. If a screening mammogram finds something that needs a closer look, the follow-up diagnostic imaging may not be fully covered under the same preventive care rules.
How to Prepare for the Appointment
Skip deodorant, antiperspirant, body lotion, and powder on the day of your mammogram. Many deodorants contain aluminum, and those metallic particles show up on mammogram images as tiny bright white specks that look identical to calcifications, which are small calcium deposits radiologists evaluate as potential signs of cancer. Wearing deodorant could trigger unnecessary follow-up tests for findings that are just product residue.
Lotions cause a different problem. They make the skin slippery, which makes it harder for the technologist to position your breast tissue on the imaging plate. Movement during compression can blur the images. Even “glowing skin” body products with shimmer contain metallic particles that interfere with the X-ray. The safest approach is to skip everything from the waist up before your appointment.
Wear a two-piece outfit so you only need to remove your top. You’ll change into a gown. Leave necklaces at home.
What the Procedure Feels Like
During the mammogram, each breast is placed on a flat plate and a second plate compresses it from above. This compression spreads the tissue so the X-ray can capture a clear, detailed image. You’ll feel pressure, and for many people it’s uncomfortable. It can be briefly painful, particularly if you have larger breasts or fibrocystic tissue. Each compression lasts only a few seconds.
If the discomfort becomes too much, tell the technologist. They can reposition you into a less uncomfortable position. Scheduling your mammogram for a time when your breasts are least tender (generally the week after your period ends) can help reduce sensitivity.
If You Have Breast Implants
You can and should still get regular mammograms with breast implants. The procedure is modified using a technique called implant displacement views: the technologist pushes the implant back against your chest wall and pulls the breast tissue forward around it, so the tissue is visible in the image. Let the scheduler know you have implants when you book so the facility can allot extra time, since the technologist will take additional views.
What Happens After Your Mammogram
Since September 2024, all mammography facilities are required by federal law to include a breast density notification with your results. Your results letter will tell you whether your breast tissue is dense or not dense. About half of women have dense breast tissue, and it matters for two reasons: dense tissue makes it harder to spot cancer on a mammogram, and it independently raises the risk of developing breast cancer. If your tissue is dense, your doctor may recommend supplemental screening with breast MRI or ultrasound.
Most screening results come back within one to two weeks. If the facility needs additional views, that callback does not necessarily mean something is wrong. It often means an area wasn’t captured clearly enough or needs a closer look. About 10% of screening mammograms result in a callback, and the vast majority of those turn out to be benign.