The short answer: Yes. Women with a pacemaker or an implanted defibrillator (ICD) can and should keep getting mammograms. The device can make the exam a little more uncomfortable and can hide some tissue on the image, so tell the technologist about it before you start. Breast MRI is a separate question, and it depends on whether your device is labeled MR Conditional.
Is a mammogram safe with a pacemaker or ICD?
For most people, yes. A mammogram uses a low dose of x-rays and a plastic paddle that presses the breast flat. It does not use a magnet or strong electrical currents. The National Heart, Lung, and Blood Institute (NHLBI) lists the medical procedures that can affect a pacemaker. They include MRI, electrocautery during surgery, radiation therapy, lithotripsy, and TENS units. Mammography is not on that list.
The real concern is mechanical. Most devices sit under the skin of the upper chest, often near the top of the breast or the armpit. Firm pressure from the paddle directly over the generator or its wires (leads) is what technologists try to avoid. A single 2005 letter in the New England Journal of Medicine was titled "Damage to pacemaker lead during mammography". That kind of report is rare, but it is the reason the staff need to know the device is there.
In the published studies, the main problem is image quality, not harm to the device.
How can the device hide breast tissue?
Pacemakers and ICDs are metal boxes. X-rays do not pass through them, so they show up as a bright white shape. Anything behind that shape is hidden. The device can also make it harder to pull the breast fully into the picture.
Three studies put numbers on this:
- A 1999 review of mammograms from 74 women with pacemakers found that the pulse generator blocked part of the image in 7 of them (12%).
- A Dutch screening study of women with an implanted device found less breast tissue on the image on the device side. Radiographers rated 25.5% less projected tissue on the outer part of the top-to-bottom view. Contrast was also lower, by 11% to 29%.
- A 2023 Israeli study of ten years of mammograms found that compression force dropped by up to 23.0% on the device side. The pacemaker showed on the angled side view in 96% of cases, but on the top-to-bottom view in only 10%.
The Israeli study also looked at 11 women who had a new breast cancer on the same side as the pacemaker. The device partly overlapped the tumor in two cases. It significantly hid the tumor in two more. That is a small group, but it shows why the device side may need extra care.
Does a mammogram hurt more with a pacemaker?
A little, on average. In the Dutch study, women rated pain and anxiety on a 0 to 10 scale. Both scores were higher for the breast with the device than for the other breast. The difference in pain was about half a point. The difference in anxiety was about 1.3 points.
The same study surveyed the radiographers. They said they felt more cautious and more anxious with these patients, and they used less compression on the device side. Less compression can help comfort, but it can also lower image quality.
If the pressure feels wrong over the device, say so right away. RadiologyInfo.org, run by the American College of Radiology (ACR) and the Radiological Society of North America (RSNA), tells all patients to report pain as compression increases. It notes that less compression will be used if discomfort is significant.
How do technologists position the breast around a device?
There is no single national protocol. A 2025 survey of 220 Australian radiographers found wide variation in how they positioned these women. Only 20% worked at a site with a written protocol for cardiac devices. Only 6% had a form that asked patients whether they had a pacemaker.
Common approaches, described in the studies above, include:
- Positioning the breast so the paddle does not press hard on the generator or leads.
- Using lighter compression on the device side.
- Taking extra or modified views to show tissue the device covered.
The Dutch authors suggested a different trade-off. They wrote that image quality could improve by pulling more breast tissue into the picture, even if that means part of the device sits between the paddles. Whether that is right for you depends on your device and the technologist's judgment.
A 2026 follow-up survey found that 82.7% of the radiographers sometimes or often had more trouble meeting image quality standards with these patients. The authors warned this can lead to repeat or added views, and so slightly more radiation. A callback for more pictures is not a sign of cancer by itself. Our mammogram callback guide explains what happens next.
What should you tell the mammography center?
Many centers do not ask, so bring it up yourself. The NHLBI advises people with a pacemaker to carry the device ID card and show it to any doctor or test provider. Its ICD guidance says the same for defibrillators.
- Mention the device when you book. The center can then plan for it.
- Tell the technologist which side it is on before any positioning starts.
- Bring the ID card with the device type and lead information.
- If the device is new, ask your cardiologist when the incision site will be healed enough for compression.
- Bring or send your earlier mammograms. Comparing images over time helps the radiologist judge the area near the device.
Can you have a breast MRI or ultrasound instead?
A mammogram is still the standard screening test, and a device is not a reason to skip it. If part of the breast is hidden, the radiologist decides whether extra views or another test is needed. Breast ultrasound uses sound waves, not radiation or a magnet, so it avoids the MRI safety question.
Breast MRI is more complicated. The FDA states that patients with implanted devices should not have an MRI unless the device is positively identified as MR Safe or MR Conditional. An MR Conditional device is safe only in a scanner setup that matches its conditions. A device with unknown status is treated as MR Unsafe. The NHLBI notes that people with newer ICD models may be able to have an MRI safely. The whole system (generator plus leads) has to qualify. Your cardiology team and the MRI center check this. Our sister site mri.md covers MRI safety with implants in more detail.
Breast MRI is usually added for women at high risk, not used to replace a mammogram. Read more in can breast MRI replace a mammogram. If you also have breast implants, the positioning issues overlap, and our mammogram with breast implants guide explains those views.
The bottom line
A pacemaker or ICD does not rule out a mammogram. The research shows two real costs: a bit more discomfort and some tissue near the device that is harder to see. The fix is simple. Tell the center about your device, show your ID card, and speak up if the pressure over the device feels wrong. Keep your regular screening schedule.
Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. Talk with your cardiologist and your breast imaging team about your specific device before any imaging test.