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Mammography Technique and Types

There are two main types of mammography: 2D digital mammograms and 3D mammograms — also called digital breast tomosynthesis, digital tomosynthesis, or just tomosynthesis. The technique for performing them is the same.

Mammography technique

When you have a mammogram, you remove your clothing from the waist up and stand in front of a special machine. A mammogram technician positions and compresses your breast between two clear plastic plates and takes two X-ray pictures — one from the top and one from the side. The technician repeats the process on the opposite breast. For some people, more than two pictures may be needed to include as much tissue as possible.

Mammograms can be painful for some people. Most women and men find them uncomfortable. Still, the discomfort doesn’t last long. Each breast is compressed for a few seconds at a time. From start to finish, the entire procedure takes about 20 minutes.

Mammograms involve a very small amount of radiation exposure. The American Cancer Society (ACS) notes that the dose of radiation people receive during a screening mammogram is about the same amount of radiation people get from their natural surroundings (background radiation) in an average three-month period.

The mammogram images are saved as digital files.

A radiologist reads your mammogram images, usually shortly after your appointment. A radiologist is a doctor who specializes in diagnosing and treating diseases and injuries using medical imaging techniques.

Radiologists use computer-aided detection (CAD) software that highlights potentially abnormal areas on a mammogram image. These highlighted areas help radiologists decide if more evaluation is needed.


Types of mammography

Two types of mammograms are available in the United States: 3D mammograms — also called digital breast tomosynthesis, digital tomosynthesis, or just tomosynthesis — and 2D digital mammograms.

Both 2D and 3D mammograms are done in the same way and take the same amount of time.

A 3D mammogram creates a 3D image of each breast using several X-ray images from different angles around the breast.

A 2D digital mammogram creates a 2D image of each breast using two X-ray images of each breast.

In 2011, 3D mammography was approved by the U.S. Food and Drug Administration (FDA) and later became a standard of care for breast cancer screening. Still, 3D mammography may not be available at all hospitals and mammogram facilities.

To start offering 3D mammograms, facilities must buy new mammography machines or update their existing machines to make them 3D-capable. Not all facilities have been able to make the switch to 3D mammography because of large up-front costs for equipment. In other cases, facilities that have rental agreements for 2D mammography equipment must wait until those leases end before they can upgrade.

According to statistics from the FDA from June 1, 2022, about 83% of U.S. screening facilities now offer 3D mammograms in at least one of their mammography units, but fewer than half of all accredited units are actually 3D-capable.

A number of studies have found that 3D mammograms find more cancers than traditional 2D mammograms and that they also reduce the number of false positives.

A false positive is when a mammogram shows an abnormal area that looks like a cancer but turns out to be normal. Ultimately, the news is good: no breast cancer. But the suspicious area usually requires follow-up with more than one doctor, extra tests, and extra procedures, including a possible biopsy. There are psychological, physical, and economic costs that come with a false positive.

Many doctors recommend having a 3D mammogram, if possible.

It’s important to know that not all health insurance plans cover 3D mammograms, so it makes sense to call and ask if your health plan does. Both Medicare and Medicaid now cover 3D mammograms.

In some states, such as Washington, there are laws that require facilities not to charge more for 3D mammograms than they do for 2D mammograms. So even if your insurance plan doesn’t cover it, you can still get a 3D mammogram for the cost of a 2D mammogram, which in almost all states is free. In other states, such as New Jersey and Pennsylvania, there are laws that require health insurers to cover 3D mammograms at no cost to women.

If you’re unsure about how much, if anything, you might have to pay for a 3D mammogram, call the facility and ask.

— Last updated on June 29, 2022, 3:04 PM