What are the contraindications for a mammogram (breast x-ray)?

Mammography Contraindications

Mammography has no absolute contraindications—it can be safely performed even during pregnancy with appropriate shielding, and the primary limitations are relative considerations based on life expectancy and the balance of benefits versus harms rather than true contraindications. 1

Key Clinical Considerations

Pregnancy is NOT a Contraindication

• Mammography can be performed safely during pregnancy with lead shielding 1
• The fetal radiation dose from a 4-view mammogram is <0.03 mGy, well below the 50 mGy threshold where teratogenic effects have been demonstrated 1
• Screening mammography should be considered in pregnant women at high risk for breast cancer, even before age 30 1
• The National Comprehensive Cancer Network explicitly states that mammography with shielding can be done safely in pregnant women 1

Lactation is NOT a Contraindication

• Screening mammography may be performed in lactating women according to standard screening guidelines 1
• Women should be encouraged to breastfeed or pump before the examination to minimize breast density and optimize sensitivity 1
• While physiologic changes during lactation increase background parenchymal enhancement and breast density, this does not preclude mammography 1

Relative Limitations (Not True Contraindications)

Limited Life Expectancy

• There is likely no benefit to regular mammograms for women with life expectancy less than 5 years 1
• In this population, the harms of mammographic screening among asymptomatic women probably outweigh any potential benefits 1
• This represents a clinical judgment about appropriateness rather than a contraindication 1

Age-Related Considerations

• For women aged 75 years or older, evidence of mammography benefits is lacking, though this does not constitute a contraindication 1
• The decision to continue screening should be based on overall health status and whether the woman would be a candidate for breast cancer treatment 1

Important Clinical Pitfalls

Common Misconception About Radiation Risk

• Radiation risk from mammography is negligible, even with multiple screenings at current doses 2, 3
• No direct evidence links cancer risk with radiation exposure from mammography 1
• For women beginning annual screening at age 50 and continuing until age 75, the benefit exceeds radiation risk by a factor of almost 100 3
• Even for women beginning at age 35, the mortality benefit exceeds radiation risk by more than 25-fold 3

Dense Breasts Are NOT a Contraindication

• While increased breast density may reduce mammography sensitivity and specificity, this does not preclude screening 1
• Women with dense breasts have higher rates of false-positives and may benefit from supplemental screening modalities, but mammography remains appropriate 1

Pain or Discomfort Is NOT a Contraindication

• Although breast compression causes discomfort in 28-77% of women, pain is rarely described as a disincentive for future screening 1, 2
• Discomfort is a minor adverse effect that does not outweigh screening benefits 2