What type of breast screening do you need?

You've undoubtedly heard the mantra: mammograms save lives. And it's true — screening mammograms lower breast cancer death rates in women 40 and older by 40% when compared with no screening. The imaging test is still considered the gold standard to find breast cancer early, when it's most treatable.

But that's only part of the picture. Even if you diligently schedule an annual mammogram, you might also need other types of imaging, depending on your individual risk factors.

"Women aren't always aware of this unless a physician has actually spoken to them about it," says Dr. Vandana Dialani, chief of breast imaging and co-director of the Breast Care Center at Harvard-affiliated Beth Israel Deaconess Medical Center. "It's important they know who should be getting additional tests."

In 2022, about 2.3 million women were diagnosed with breast cancer worldwide. Who's at greater risk? Chief among us are the nearly 50% of women over 40 whose mammograms indicate dense breasts. This means your breasts have a relatively high proportion of glandular and connective tissue compared with fat. Women with dense breasts are up to twice as likely to develop breast cancer as are those whose breast tissue is more on the fatty side, according to the National Cancer Institute.

In some countries, women whose breasts are deemed dense after a mammogram may receive a recommendation for additional screening — typically with either ultrasound or magnetic resonance imaging (MRI). "Ideally, that's when you should be having a conversation with your physician about what supplemental tests should be done," Dr. Dialani says.

In addition to dense breasts, certain women are prime candidates for extra screening because they have other breast cancer risk factors, such as

• a mother or sister who developed breast cancer before menopause
• a genetic mutation known to increase breast cancer risk (such as in the BRCA gene)
• significant radiation to the chest before age 30

Your doctor should devise a personal breast cancer screening strategy for you that takes this information into account, Dr. Dialani says. 

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Copyright © 2025 by Harvard University. Original work prepared by Harvard Health Publishing in English. 

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