7 Myths About Mammograms, Busted

The best available breast-cancer screening tool continues to be the subject of misinformation. Here, a local breast surgeon clears things up.

October, Breast Cancer Awareness Month, brings pink ribbons and plenty of reminders about the importance of breast health. And for good reason: Aside from skin cancers, breast cancer is the most common cancer in women in the United States. The American Cancer Society estimates that more than 321,910 women will be diagnosed with invasive breast cancer in 2026, and approximately 42,140 will die from the disease.

Mammograms are an important tool in detecting breast cancer, sometimes finding abnormalities before they can be felt or cause symptoms. But for something so routinely recommended, mammograms can still raise plenty of questions in the public mind. For example, do they really need to start at 40? How often should you get one? Does having dense breasts complicate the process? Does a mammogram hurt—and can it actually cause harm?

MONMOUTH spoke with Genevieve A. Fasano, M.D., a surgical oncologist at Monmouth Medical Center, to separate fact from fiction and tackle some of the most common misconceptions surrounding mammograms. The goal isn’t to add to the noise, but to provide some clarity—and hopefully encourage readers to have informed conversations with their own health care providers about what screening is right for them.

• Myth: “Breast cancer doesn’t run in my family, so I don’t need mammograms.” Not having a family history of breast cancer does not mean a woman is at low risk. In fact, roughly 85 percent of women who are diagnosed with breast cancer have no known family history of the disease. “While family history is important to understand personal risk, even women without a family history of breast cancer should undergo screening mammography,” Dr. Fasano says.

While family history can certainly increase a woman’s risk, it is only one piece of the picture. Getting older is also an important risk factor. “Current guidelines recommend that women at average risk should undergo annual mammography starting at age 40,” she says.

• Myth: “The radiation from a mammogram could cause breast cancer.” It’s understandable that some women may have concerns about radiation exposure, as mammograms do use X-rays—but they involve a very small dose. “Screening mammograms use low-dose radiation with a negligible cancer risk,” says Dr. Fasano. “The benefit of finding and treating breast cancer at an early stage outweighs any small theoretical risk of causing cancer from a mammogram.”

To put the exposure into perspective, the radiation from a typical screening mammogram is comparable to the amount of natural background radiation a person encounters over roughly one to two months.

• Myth: “Mammograms are very painful.” One reason many women delay scheduling a mammogram is the fear of physical discomfort. While breast compression can be uncomfortable, the experience varies from person to person, and the compression itself lasts only a few seconds for each image.

The compression that women may feel helps create clearer images while also reducing the amount of radiation needed to produce those images. If the compression during testing creates significant pain, however, the patient can ask the technician to make adjustments. In addition, the doctor says that timing your mammogram for when your breasts are less tender may help make the experience more comfortable. “Optimizing scheduling can help reduce the chance of pain,” Dr. Fasano says. “It is best not to schedule a mammogram in and around your menstrual period as the breasts can become swollen or tender during this time.”

• Myth: “Dense breasts mean something is wrong.” The term “dense breasts” can sound concerning, but breast density is not a disease or an abnormality. It describes the relative amounts of fibrous and glandular tissue compared with fatty tissue in the breast. Dr. Fasano says having dense breasts is “extremely common, occurring in nearly half of women over 40.”

There are, however, two important things women should know about breast density. First, dense breast tissue is itself a risk factor for breast cancer. Second, it can make some cancers more difficult to see on a mammogram because dense tissue and many breast abnormalities both appear white on the image.

But that doesn’t mean mammography stops being useful. Medical professionals agree a mammogram is still the best screening tool for all women, including those with dense breasts. Mammograms can still identify many cancers in women with dense breasts, and newer technology can improve the ability to detect abnormalities. Three-dimensional mammography, also known as tomosynthesis, can be particularly useful in women with dense breast tissue.

In some cases, additional screening may be recommended. A woman’s overall risk—including factors such as family history—can influence that decision. Dense breasts are more likely to hide a cancer where a mammogram, which is a type of X-ray, doesn’t see it. “Supplemental imaging with breast ultrasound or MRI can sometimes be helpful to help improve cancer detection rates,” says Dr. Fasano. “However, it is important to balance personal risk when making these decisions. Along with being more sensitive for finding certain cancers, MRI carries the risk of false positives, which can lead to additional testing. When making any recommendations for MRI screening, shared decision-making is key.”

• Myth: “Mammograms often find cancers that never would have caused a woman any harm, meaning that breast cancer screening can do more harm than good.” Breast cancer screening reduces mortality by finding cancer early when it is treatable and curable, our experts says. “Screening mammograms help identify cancer before it has spread outside the breast; however, we have no way to tell which cancers will be life-threatening and which may remain localized. Currently, the benefits of testing outweigh any risks of overtreatment.”

• Myth: “Artificial intelligence can read my mammogram just as well as—or better than—a radiologist.” Artificial intelligence is increasingly being incorporated into breast imaging, but it isn’t intended to replace the physician interpreting the study.

AI can analyze mammograms and flag areas that may deserve additional attention. But interpreting what an abnormality means—and determining what additional testing or follow-up may be appropriate—still requires the expertise of a radiologist.

“Many patients prefer human oversight and still would favor human involvement, especially when it comes to callbacks,” says Dr. Fasano. “Realistically, AI will serve as a useful adjunct in high-volume screening settings to help improve cancer detection rates and to optimize radiologist workload, but not as a standalone tool.”

• Myth: “If I’m called back after my mammogram, it means I have cancer.” Getting a callback can be unsettling, but it does not mean that cancer has been found. “Callbacks after screening mammograms are very common—in fact more than 3.8 million patients are recalled each year for additional imaging,” says Dr. Fasano. “While this often leads to significant anxiety, a callback doesn’t mean you have breast cancer, it simply means more images are needed for the radiologist to interpret.”

A radiologist may recommend additional imaging because an area wasn’t completely clear on the original images, because dense breast tissue makes interpretation more difficult, or because a finding such as a cyst or a calcification needs a closer look. Followup testing may include additional mammographic images or an ultrasound, allowing the radiologist to examine the area in greater detail.

And the odds are reassuring: “Just because you have a callback after a screening mammogram does not mean you have cancer,” Dr. Fasano says. “Less than 1 in 10 women that are called back for more images are found to have cancer.”