Know the Facts about Mammograms

What is a mammogram?

A mammogram is an x-ray picture of the breast. There are two types of mammograms; screening and diagnostic. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram.

A diagnostic mammogram is used to check for breast cancer after a lump or other sign or symptom of the disease such as breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape. These signs may also be benign conditions.

How are screening and diagnostic mammograms different?

The same machines are used for both types of mammograms. However, diagnostic mammography takes longer to perform than screening mammography and the total dose of radiation is higher because more x-ray images are needed to obtain views of the breast from several angles.

What are the benefits and potential harms of screening mammograms?

Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread. Studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50. However, studies have not shown a benefit from regular screening mammography in women under age 40.

False-positive results.

False-positive results occur when a mammogram shows an abnormality but no cancer is actually present. All abnormal mammograms should be followed up with additional testing like diagnostic mammograms, ultrasound, and/or biopsy.

False-positive results are more common for younger women, women with dense breasts, women who have had previous breast biopsies, women with a family history of breast cancer, and women who are taking estrogen (for example, menopausal hormone replacement therapy).

False-negative results.

In cancer screening, a negative result means no abnormality is present. False-negative results occur when a mammogram appears normal even though breast cancer is present.

One cause of false-negative results is dense breast tissue. This occur more often among younger women than among older women. Breasts usually become more fatty, and false-negative results become less likely with age.

Radiation exposure.

Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is low, but repeated x-rays have the potential to cause cancer. Although, the potential benefits of mammography nearly always outweigh the potential harm from the radiation exposure, women should talk with their health care providers about the need for each x-ray.

Should you do self-breast exams?

Many women choose to examine their own breasts.

Women who do know that breast changes can occur because of:

-Menstrual cycles

-Birth control pills




-Hormone replacement therapy

It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. Whenever any unusual changes occur, contact your health care provider.

We cover mammograms based on what you and your healthcare provider decide is best for you, your risks and preferences.

If your screening mammography reveals any abnormalities, your doctor might follow up with a diagnostic mammogram, which would be billed as a medical cost and is subject to coinsurance or deductible.

Sometimes a doctor will recommend an ultrasound or magnetic resonance imaging (MRI) in addition to a mammogram. That is typically billed as a diagnostic test and is subject to coinsurance or deductible. It’s not covered as preventive.

When is genetic testing appropriate?

Breast cancer due to a genetic disorder accounts for only 5-10 percent of all breast cancers. If you are concerned about a family history of breast and other cancers, including ovarian, tubal and peritoneal, talk to your doctor about your risk and the possibility of being tested for BRCA1 and BRCA2, genes that increase risk of breast and ovarian cancers.

Speak with your agent more about coverage of genetic testing. When done without a cancer diagnosis, the test is considered preventive and covered at 100 percent under most health plans. Breast cancer preventive medications, such as Raloxifene, Soltamox, and Tamoxifen are covered for women who have had breast cancer or whose BRCA test revealed higher risk.


If you decide a mammogram is right for you, one mammogram per year is considered preventive care under most health plans, and will be paid in full by your plan.

There are many organizations and professional societies, including the United States Preventive Services Task Force (which is convened by the Agency for Healthcare Research and Quality, a federal agency) that have developed guidelines for mammography screening. You can visit their website to read more about guidelines.

Your health plan covers preventive care services as required by state and federal law. For more information, please review the “A” and “B” rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on