Mammography screening vs diagnostic

Overview

Mammography is a special type of X-ray that takes pictures of the inside of the breast. There are two main types: screening mammography and diagnostic mammography. Screening mammography is used to check for breast cancer in women who have no symptoms. It is done regularly as a check-up. Diagnostic mammography is used when a woman has a symptom (like a lump or breast pain) or when a screening mammogram shows something unusual. It takes more pictures and gives more detail.

Mammography is a common procedure. Many women will have a screening mammogram at some point. Diagnostic mammograms are less common but are important for following up on symptoms or abnormal results.

Mammography is mainly used for women, though men can also develop breast cancer and may sometimes need it. Screening is typically offered to women over a certain age (often starting at age 50 in many health systems). Diagnostic mammography can be used at any age if there is a concern.

Symptoms

Common symptoms

• No symptoms – screening is for women without symptoms.
• A new lump or thickening in the breast or armpit.
• Change in the size, shape, or feel of the breast.
• Nipple discharge (especially if it is bloody or comes from one nipple only).
• Nipple that turns inward (retraction).
• Skin changes on the breast, such as dimpling, redness, or scaling.
• Breast pain that does not go away (though most breast pain is not cancer).

Symptoms in children

• Breast cancer is extremely rare in children. Mammography is not used in children.

Symptoms in older adults

• The same symptoms apply to older adults. However, as women age, routine screening mammograms are still recommended until about age 70 or 74, depending on health guidelines.
• Older women may notice breast changes more easily because breast tissue becomes less dense with age.

Causes

Main causes

• Breast cancer is usually not linked to a single cause. It happens when cells in the breast grow out of control.
• Screening mammography does not cause breast cancer – it is a safe low-dose X-ray.
• Diagnostic mammography is needed when there is a symptom or an abnormal screening result, which may be due to various reasons including benign (non-cancerous) conditions.

Risk factors

• Being older (risk increases with age).
• Having a close family member (mother, sister, daughter) with breast or ovarian cancer.
• Having certain genetic mutations (like BRCA1 or BRCA2).
• Having dense breast tissue (which can make mammograms harder to read).
• Previous breast cancer or certain benign breast conditions.
• Hormonal factors: starting periods early (before age 12), late menopause (after age 55), or using certain hormone therapies.
• Drinking alcohol, being overweight after menopause, and not being physically active.

When to see a doctor

See a doctor urgently if:

• If you notice a new breast lump that feels hard or is fixed in place.
• If you have nipple discharge that is bloody or comes on its own.
• If the skin on your breast looks like an orange peel (dimpled) or is red and swollen.
• If your nipple becomes inverted (turns inward) when it was not before.

Book a routine appointment if:

• For screening mammography, follow the schedule recommended by your health service (usually every 2 to 3 years starting at age 50).
• If you have a family history of breast cancer or other risk factors, ask your doctor when to start screening — it may be earlier.

Diagnosis

Mammography is the main test. For screening, a standard mammogram takes two or three pictures of each breast. For diagnostic mammography, more images are taken from different angles, and sometimes a special technique called compression or magnification is used to focus on a specific area. If the mammogram shows something suspicious, you may need more tests like an ultrasound or a biopsy (taking a small tissue sample for lab analysis).

Tests that may be done

• Screening mammogram (routine check).
• Diagnostic mammogram (more detailed).
• Breast ultrasound (uses sound waves to see lumps better).
• Breast MRI (magnetic resonance imaging, sometimes used for high-risk women).
• Biopsy (needle or surgical removal of tissue to check for cancer cells).

What to expect at your appointment

During a mammogram, you stand in front of the X-ray machine. A technologist places your breast on a flat plate, and another plate presses down to flatten the breast. You may feel some pressure, but it lasts only a few seconds. Two pictures are usually taken of each breast. The whole appointment takes about 15 to 30 minutes. For diagnostic mammography, expect more pictures and possibly an ultrasound. The radiologist (a doctor who reads the images) will review the results and send a report to your doctor, usually within a few days.

Treatment

If a mammogram finds breast cancer, treatment depends on the type, stage, and your overall health. Treatment options are explained by a specialist team. Common approaches include surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. The goal is to remove or destroy the cancer while preserving as much healthy breast tissue as possible.

Self-care at home

• Follow the recommended screening schedule.
• Learn how your breasts normally look and feel, and report any changes.
• Maintain a healthy weight, be physically active, and limit alcohol.
• Eat a balanced diet with plenty of fruits, vegetables, and whole grains.

Medical treatments

Treatments are tailored to each person. They include surgery (removing the tumour), radiation (high-energy rays to kill cancer cells), chemotherapy (drugs to kill cancer cells throughout the body), hormone therapy (if the cancer is hormone-sensitive), and targeted therapy (drugs that attack specific cancer cells). Your doctor will discuss the best options for you. Always follow your treatment plan.

When is surgery considered?

Surgery is often the first step for breast cancer. Options may include lumpectomy (removing only the tumour) or mastectomy (removing the whole breast). The choice depends on the size and location of the tumour and your preferences. You may also have lymph nodes removed to check if the cancer has spread.

Living with this condition

If you are having regular screening, you can continue your normal life. If you are being treated for breast cancer, your daily routine may change. You may need time off for appointments and side effects. Many people manage to work and take care of family with some adjustments. It is important to communicate with your healthcare team and ask for help when needed.

Lifestyle tips

• Stay as physically active as you can – even a walk each day helps.
• Eat a healthy diet with plenty of fruits, vegetables, lean protein, and whole grains.
• Get enough rest and sleep.
• Avoid or limit alcohol.
• Quit smoking if you smoke.
• Manage stress with relaxation techniques, hobbies, or support groups.

Diet and exercise

A balanced diet can help you maintain a healthy weight and support your immune system. Aim for at least 150 minutes of moderate exercise each week, like brisk walking, swimming, or cycling. If you are undergoing treatment, check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

A breast cancer diagnosis or even an abnormal mammogram can cause anxiety, fear, and stress. It is normal to feel worried. Talk to your healthcare team about your feelings. They may refer you to a counsellor or support group. Remember that most women with breast cancer survive and lead full lives.

Prevention

There is no guaranteed way to prevent breast cancer, but you can reduce your risk. A healthy lifestyle – being active, eating well, limiting alcohol, and maintaining a healthy weight – can help. Some women at very high risk (e.g., with BRCA gene mutations) may consider medications or preventive surgery. Talk to your doctor about your personal risk.

Vaccines

There is no vaccine for breast cancer.

Screening programmes

Screening mammography is the most important tool for finding breast cancer early. Early detection saves lives. Follow the screening recommendations for your age and risk. If you have symptoms, do not wait for a screening – go for a diagnostic mammogram.

Complications

If left untreated

• A breast cancer that is not treated can grow and spread (metastasize) to other parts of the body, such as the lymph nodes, bones, liver, or lungs.
• Advanced breast cancer can cause pain, weight loss, and other serious health problems.

Long-term outlook

The outlook for breast cancer is generally very good, especially when found early through screening. Most women treated for early-stage breast cancer live for many years. Treatment continues to improve, and many people with advanced breast cancer also have effective treatment options. With modern medicine, breast cancer is often curable or manageable.

Find support

International organisations

• World Health Organization (WHO) – Breast Cancer ↗

Local organisations

• NHS Breast Cancer Screening ↗ · United Kingdom
• Cancer Research UK – Breast Cancer ↗ · United Kingdom

Helplines

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