October is Breast Cancer Awareness Month, and for many people, it comes with reminders to schedule a mammogram or discuss screening with their healthcare provider. But breast cancer screening is not always as simple as getting one test. Depending on your age, symptoms, breast density, and personal health history, your provider may recommend different types of breast imaging. Understanding the purpose of each test can help you feel more informed and confident if additional imaging is recommended.
The importance of breast cancer screenings
Breast cancer remains one of the most common cancers among women, but advances in screening have made early detection more effective than ever. Screening can help identify changes in breast tissue before symptoms appear, when treatment is often simpler and outcomes may be better.
If you’ve ever received a call for additional imaging after a mammogram, it’s important to know that follow-up testing is common and does not necessarily mean cancer is present. Different imaging tools provide different types of information, helping healthcare providers get the clearest picture possible.
Screening mammograms
A screening mammogram is the most common type of breast cancer screening test, and oftentimes the starting point for many people. It is designed for people who do not have symptoms or known breast concerns.
During a screening mammogram, low-dose X-rays create images of the breast tissue that radiologists review for any changes or abnormalities that may require further evaluation. A screening mammogram can help detect:
- Small tumors that may not be felt during a physical exam
- Changes in breast tissue
- Early signs of breast cancer before symptoms develop
For many people, a screening mammogram is the first step in routine breast cancer screening and serves as a baseline for future comparisons.
Diagnostic mammograms
A diagnostic mammogram uses the same technology as a screening mammogram but is performed for a different reason. Your healthcare provider may recommend a diagnostic mammogram if:
- You have a breast symptom, such as a lump or pain
- An area of concern was identified on a screening mammogram
- Additional images are needed to evaluate a specific finding
Diagnostic mammograms typically involve more images than a screening mammogram and focus on a particular area of the breast. The goal is to gather more detailed information and determine whether additional testing is necessary.
One of the most important things to remember is that being called back for a diagnostic mammogram is relatively common. In many cases, the additional imaging reveals a benign finding rather than cancer.
Breast ultrasound
A breast ultrasound uses sound waves, rather than radiation, to create images of breast tissue. Ultrasound is often used alongside mammography and may be recommended when:
- A mammogram identifies an area that needs further evaluation
- A patient has a palpable lump
- Providers want to determine whether a finding is solid or fluid-filled
- Additional imaging is helpful due to dense breast tissue
Unlike a mammogram, an ultrasound does not compress the breast. A technologist applies a gel to the skin and moves a handheld device over the area to capture images. Breast ultrasounds can provide valuable information that complements mammography, helping providers better understand what they are seeing on imaging studies.
Why would someone need more than one imaging test?
Each breast imaging tool has strengths and limitations. Rather than replacing one another, mammograms and ultrasounds are often used together. Think of these tests as pieces of a puzzle:
- A screening mammogram helps identify potential areas of concern.
- A diagnostic mammogram provides a closer examination when needed.
- A breast ultrasound offers additional detail that can help clarify findings.
Using multiple imaging techniques allows providers to evaluate breast tissue more thoroughly and make more informed recommendations about next steps.
What happens after screening?
After your imaging exam, a radiologist reviews the images and sends a report to your healthcare provider. Results may include:
- Normal findings
- Benign changes that require no immediate action
- A recommendation for additional imaging
- A recommendation for follow-up with a specialist
Receiving a request for further testing can feel stressful, but additional imaging is often performed to gather more information and ensure the most accurate assessment possible.
Questions to ask your healthcare provider
If you’re preparing for a breast imaging appointment, consider asking:
- Which type of breast screening is right for me?
- How often should I be screened?
- Do I have dense breast tissue?
- What should I expect during the exam?
- If additional imaging is recommended, what happens next?
The more you understand about breast screening, the easier it can be to navigate the process and make informed decisions about your health.
Breast cancer screenings are not one-size-fits-all. Factors such as age, family history, breast density, personal medical history, and other risk factors help determine which screening tools may be most appropriate. At EHE Health, breast cancer screening recommendations are guided by an annual breast cancer risk assessment for female members beginning at age 25. Risk level may influence whether additional screening, such as breast ultrasound or breast MRI, is recommended alongside routine mammography. For some higher-risk individuals, screening may begin earlier than standard age-based recommendations.