If you’re about to get your first mammogram, it’s normal to feel a little nervous. A mammogram is a low-dose X-ray of the breast used to screen for breast cancer, and it’s among the most routine appointments in women’s health. Yet it’s also one of the most dreaded, mostly because of the unknowns: What do you wear? Will it hurt? How much will it cost? To help you feel as prepared as possible, we spoke with two board-certified OBGYNs and a breast surgical oncologist about everything you need to know before your first mammogram.
Featured Experts
- Jennifer Choe, MD is a board-certified OBGYN at Montefiore Einstein Advanced Care in New York
- Lucy M. De La Cruz, MD is a breast surgical oncologist and chief of the Breast Surgery Program at MedStar Georgetown University Hospital in Washington, D.C.
- Dr. Karen Toubi is a board-certified OBGYN at Rodeo Drive Women’s Health Center in Beverly Hills, CA
Before Your First Mammogram: When to Go, What It Costs and How to Prep
When to go
If you don’t have a family history of breast cancer, routine screening starts at 40, says Dr. Choe. If it runs in your family, you may need to start earlier. Starting at 40 also lines up with the U.S. Preventive Services Task Force, which updated its guidelines in 2024 to recommend a mammogram every other year for women ages 40 to 74. Some groups, including the American College of Radiology, recommend going every year, so ask your doctor which schedule is right for you.
Family history isn’t the only reason to start earlier. If you have a known genetic mutation, such as BRCA1 or BRCA2, or had radiation to the chest at a young age, you may need to start screening earlier or go more often, and your doctor may add other imaging, like a breast MRI. Talk to your doctor about your risk well before 40.
Cost
As for cost, a routine mammogram counts as preventive care, so it’s usually covered 100 percent by insurance. Without coverage, Dr. Choe says you can expect to pay between $125 and $400 out of pocket.
2D vs. 3D mammograms
Where it might get a little confusing: When you book, you may be asked whether you want a 2D or 3D mammogram. A 2D mammogram captures a flat image of the breast from two angles, “so all the layers of tissue are stacked on top of each other,” says Dr. De La Cruz.
A 3D mammogram, also called tomosynthesis, takes many low-dose images as the machine sweeps in an arc, then rebuilds the breast into thin slices. Dr. De La Cruz compares it to “flipping through the pages of a book.” Because the radiologist can see through overlapping tissue, the images are easier to read. “3D can find some cancers that 2D misses and leads to fewer false alarms and callbacks,” says Dr. Toubi.
Both types are considered effective screening tools. If you have a preference, ask your doctor or the imaging center what they offer and what your insurance covers.
Prep
A few simple steps can make the appointment more comfortable and help the technologist get a clear image:
- Leave the jewelry at home. Necklaces, chains and nipple piercings all have to come off, so skip them, says Dr. Choe.
- Dress in two pieces. That way, you only have to undress from the waist up.
- Go bare. No deodorant, antiperspirant, powders, lotions, creams or glitter. All of them can look like calcium deposits on the image.
- Time it right. Dr. De La Cruz suggests scheduling about a week after your period, when breasts are less tender. If you’re sensitive, cut back on caffeine beforehand, too.
- Bring your history. If you’ve had breast imaging somewhere else, bring or send those images. “Comparison is gold,” says Dr. De La Cruz.
During Your Mammogram: What Happens and Does It Hurt?
The whole visit takes about 15 to 20 minutes, says Dr. De La Cruz. Here’s how it goes:
- You’ll check in. Expect a few questions about your health history, family history and any symptoms, says Dr. Toubi.
- You’ll change. A technologist will show you to a changing room, where you’ll undress from the waist up and put on a gown that opens in the front.
- You’ll get into position. You’ll stand beside the mammogram machine while the technologist places one breast on a flat, plastic imaging plate. They’ll help you position your arms, head and torso so the machine can get a clear view of the tissue.
- You’ll feel the pressure. A second plastic plate slowly lowers to press and flatten the breast. You’ll hold still and hold your breath for a few seconds per image, usually two views of each breast.
So, does it hurt? It’s uncomfortable but brief, and like anything from a bikini wax to a tattoo, everyone’s experience is different. Dr. Choe compares it to someone pressing firmly on a bruise, while Dr. De La Cruz says her patients describe “a very firm hug, or a tight blood-pressure cuff, but on your breast.”
If it hurts, speak up, says Dr. Toubi: The technologist can adjust. The purpose of the compression is that it spreads the tissue so the radiologist can see clearly and allows for a lower X-ray dose. “A few seconds of pressure for peace of mind is a trade I’ll make every time,” says Dr. De La Cruz.
After Your Mammogram: Results, Callbacks and Dense Breasts
After, a radiologist reads your images, and you’ll typically hear back within a few days, says Dr. De La Cruz, though it can take up to two weeks. Dr. Toubi says results come by letter or through your patient portal. If you haven’t heard anything after two weeks, call your provider.
Callbacks are common, and they’re usually not cancer, says Dr. De La Cruz. They’re especially common after a first mammogram, because the radiologist has no earlier images to compare. Usually, the radiologist just wants a closer look at overlapping tissue or at what’s likely a cyst or benign lump. The next step is typically extra mammogram views or an ultrasound. “Do not ignore [a callback], and do not panic,” says Dr. Toubi. Go to the follow-up appointment, bring your prior images if they were done elsewhere, and ask what they’re looking at. As Dr. De La Cruz puts it, “a callback is the system working the way it should.”
Your results will also tell you whether you have dense breasts. Since September 2024, every mammography facility in the U.S. is required to share this in plain language. Dense breasts have more glandular and fibrous tissue than fat, and they’re normal: about half of women have them, and you can’t tell by feel. Density matters for two reasons, says Dr. De La Cruz. It slightly raises breast cancer risk, and it makes mammograms harder to read. That’s because “dense tissue and tumors both look white,” she says. “Cancers can hide.”
If you have dense breasts, talk to your doctor about your overall risk, including family history and genetics. “Experts do not all agree on what extra imaging, if any, women with dense breasts need,” says Dr. Toubi. Depending on your density and risk, options include a 3D mammogram, a breast ultrasound or a breast MRI. Either way, don’t skip your mammogram. “Mammography is proven to lower breast cancer deaths,” says Dr. Toubi.
The TL;DR: First Mammogram 101
Book your first mammogram at 40 (earlier if you’re at higher risk), wear a two-piece outfit and skip the deodorant. The few uncomfortable seconds are worth it, and with insurance, a routine screening is usually free. It’s worth asking your insurer about coverage for follow-up imaging and 3D, too.
And if you get a callback or learn you have dense breasts, don’t panic. “A callback isn’t a diagnosis,” says Dr. De La Cruz. “Dense isn’t a disease. And a few seconds of squeeze can save your life.”
