Mammograms are commonly used to detect breast cancer, but they’re not the only screening tool. Doctors also use imaging tests like ultrasounds, MRIs, and molecular breast imaging.

Mammography uses radiation to produce detailed images of the breasts. It’s one type of imaging test used in routine screening and to aid in the diagnosis of breast cancer.

However, your doctor might recommend other tests depending on your medical history, how dense your breasts are, and personal preferences.

Read on to learn more about different types of mammography and the potential benefits and risks of six alternative or complementary screening tools.

Digital mammograms are considered to be the “standard” form of mammography.

You’ll disrobe from the waist up and put on a gown that opens in front. A technician will position your arms and place one breast on a flat panel as you stand in front of the machine. Another panel from above will compress your breast.

You’ll be asked to hold your breath for a few seconds while the machine takes a picture. This will be repeated several times for each breast.

Digital mammography has some advantages over film mammography, which is rarely done now. Digital files can be easily shared among doctors, and the images can be enlarged for better viewing.

Mammograms are a good early detection tool that has been shown to reduce advanced and potentially fatal cases of breast cancer. They can sometimes be uncomfortable but generally don’t cause severe pain or side effects.

There are some concerns, though. Screening mammograms miss 1 in 8 breast cancers, according to the American Cancer Society, which is called a false negative. They can also have false positives, which is when suspicious breast tissue doesn’t turn out to be cancer.

Dense breast tissue increases the chances of a false result. However, having previous mammograms for comparison can cut the chances by about half.

Mammography also uses low doses of radiation. The risk of harm from a mammogram is very small, but it does have the potential to cause cancer when repeated over time.

Learn more about breast mammograms.

3D mammography is a newer type of digital mammography, but it’s performed in much the same way as other mammograms.

Images are taken in thin layers and at multiple angles, then combined to make a complete picture. It may be easier for radiologists to see breast tissue more clearly in 3D.

3D mammography requires about the same amount of radiation as digital mammography. However, more pictures are needed, which may lengthen the testing time and the amount of radiation exposure.

It’s not yet clear if 3D is better than standard digital at detecting early breast cancer or lowering the false-positive or false-negative rates.

It’s a good idea to check with your healthcare team before having a mammogram because it’s not always covered by health insurance.

Learn more about 3D mammography and tomosynthesis.

A breast ultrasound uses high-frequency sound waves rather than radiation to produce pictures of the breast.

For the procedure, gel will be placed on your skin, and a small transducer will be guided over your breast. Pictures will appear on a screen. This is a noninvasive procedure that typically doesn’t cause side effects.

While a mammogram is considered the “gold standard” screening method, your doctor might recommend ultrasound as a supplemental tool. It’s often used in adjunct to a mammogram with women who have dense breast tissue.

Learn more about breast ultrasound.

MRI uses magnets to create cross-sectional images of your breast. It’s noninvasive and normally doesn’t involve side effects.

If you have a breast cancer diagnosis, an MRI can help find additional tumors and assess tumor size.

While it can be useful for finding and measuring tumors, it’s usually not recommended as a screening tool for breast cancer. It’s typically used in screening for people at a higher risk due to its sensitivity and specificity.

A person’s risk is said to be high if they have at least a 20% to 25% chance of developing breast cancer. This can usually be estimated with family history, among other factors.

According to research from 2019, a breast MRI is more likely to produce a false-positive result in people with extremely dense breast tissue compared to a mammogram.

Additionally, insurance may not cover MRI as a breast screening tool.

Learn more about breast MRI.

MBI involves a radioactive tracer and a nuclear medicine scanner. The tracer is injected into a vein in your arm, and if you have cancer cells in your breast, the tracer will light up. Using a scanner will detect those areas.

This test is sometimes used in addition to a mammogram to screen women with dense breast tissue and evaluate abnormalities found on a mammogram.

The test does expose you to a low dose of radiation, and there’s a rare chance of an allergic reaction to the radioactive tracer.

MBI may produce a false-positive result or miss small cancers or cancers located close to the chest wall.

Molecular breast imaging (MBI) is a newer test, so it may not be available in your area yet. It’s also usually not covered by insurance for routine breast screenings.

Contrast-enhanced mammography (CEM) uses X-rays to image your breast, which does expose you to some radiation.

Similar to MBI, CEM injects an iodine-based contrast material into a vein. The iodine helps enhance and create a clearer image of malignant breast tumors, even if you have dense breast tissue.

However, you may be allergic to some of the materials used in this screening type, so check with your doctor or technician beforehand.

A screening CEM can be used as an alternative to a breast MRI in people at high risk. It can also be used to monitor your body’s response to chemotherapy before surgery (neoadjuvant).

According to research, CEM may improve sensitivity and specificity in people with dense breasts compared to digital mammography alone or mammography and ultrasound.

Although general screening guidelines exist, there are many things that can factor into how you should be screened for breast cancer. This is a discussion you should have with your doctor.

Here are some things to consider when choosing breast cancer screening methods:

  • family and personal history of breast cancer
  • doctor recommendation
  • lifetime risk of breast cancer
  • density of your breast tissue
  • experiences and results of previous tests
  • benefits and risks of each type you’re considering
  • existing medical conditions, pregnancy, and overall health
  • what tests are covered under your health insurance policy
  • what tests are available in your area
  • personal preferences

People with dense breasts are advised to have annual film or digital mammograms. It may be harder to detect cancer in dense breast tissue, particularly if there are no earlier mammograms for comparison.

You may not need additional testing, though. Ask your doctor if an ultrasound or MRI is a good idea. This may be particularly important if you’re at a higher-than-average risk of developing breast cancer.

If you have implants, you still need regular breast cancer screening.

Make sure the mammogram technician knows you have implants prior to the procedure. They might need to take extra images because implants can hide some breast tissue.

Although it’s rare, a breast implant can rupture during a mammogram. Ask your doctor if an ultrasound or MRI is advisable.

There’s no one-size-fits-all rule for breast cancer screening. Much depends on your individual risk factors and comfort level with each screening method.

It’s important to note that your risk for breast cancer may be higher or lower depending on your individual risk factors. Your doctor will be your best resource in determining what your personal level of risk is and how to best go about screening.

Learn more about Healthline’s breast cancer resources.