New study: Not so painful to have a mammogram

Published 20.09.19

The new study has been published in the European Journal of Radiology by a group of researchers and radiographers from the Cancer Registry of Norway and the Mammography Programme at Stavanger University Hospital.

More than 4500 women who attended the Mammography Programme in Stavanger from May to November 2017 participated in the study by completing a regular mammography examination and answering a questionnaire on pain and discomfort.

The main finding was that most of the women thought it was not particularly painful to undertake a mammography examination – on a scale from 0 to 10, the women gave an average score of about 2.5 in their assessment of how painful they thought the examination was.

The exception was women who reported having problems with neck and/or shoulder pain prior to the examination.

These women had a 33% higher risk of experiencing severe pain at the time of the mammography examination, in the study defined as a score of 7 or higher.

"This indicates that information about pain in the shoulders and/or neck should be available to radiographers so that they can adapt how they carry out the examination," says project manager Solveig Hofvind at the Cancer Registry, who is also head of the Mammography Programme.

New technology neither better nor worse for women's experience of pain

When a mammography examination is performed, a disc is used to put pressure on the breast. The pressure is regulated by the radiographer in collaboration with the woman. The pressure is absolutely necessary to, among other things, avoid blurry images and reduce the radiation dose.

Previous studies have shown that some women may experience so much pain and discomfort when they have a mammogram that they do not attend a mammography screening. To remedy the problem, various types of plates have been developed to squeeze the chest.

This study compared the women's experience of pain when using three different plates: a new, firm plate that standardises chest pressure to 10 kPa (which is considered to be an optimal physiological pressure), a flexible disc that regulates the angle relative to the chest, and a regular fixed plate. The study participants were examined with one of these three plates.

The results showed that the pain experience for the women was approximately the same, regardless of which platelet was used.

"This was a bit of a surprise to us, as the hypothesis was that the new record would come out better in terms of pain. However, in general, the women stated that the pain was not so great. Perhaps part of the explanation is that other conditions, such as neck and shoulder pain, are even more important for any pain experiences than we have previously thought," says researcher Nataliia Moshina at the Cancer Registry, who is the first author of the article.

Moshina says that in future studies they will compare image quality for the different plates, but also consider how the experience of pain is affected by the size of the breast and the type of breast tissue.

Less squeezing of the breasts

Radiographer Caroline Hantho from Stavanger University Hospital is one of those who participated in the study. As a radiographer in the mammography screening, she performs many mammography examinations every week.

She therefore knows how important it is to conduct the survey in such a way that the woman's experience will be good.

"The fact that the women are able to relax her shoulders and upper body is crucial in order to place her well into the apparatus and thus get good pictures. The most important thing is that I, as a radiographer, work well with the woman and pay attention if she has sore shoulders/neck. This will achieve good image quality and reduce the woman's experience of discomfort and pain," says Hantho.

She explains that sometimes, for example, a fold of skin can be pinched – it can hurt – and the best thing to do is to start over by placing the woman correctly in the device.

Solveig Hofvind is head of the National Mammography Programme. She explains that in recent years, the Mammography Programme has worked extensively and systematically to find out what is the optimal pressure on the breast when mammography images are to be taken, and what is the best position for the women when they are placed in the device.

A doctoral thesis that has been completed at OsloMet has contributed to this work and provided very valuable knowledge.

"We generally squeeze less now than we did in the past, but we can't see that it has affected the quality of the images," Hofvind said.

She emphasizes that it is crucial to ensure good quality images, since X-ray doctors need good images to be able to detect small, suspicious changes that may be signs of breast cancer. According to Hofvind, the Mammography Programme is now in the process of establishing new and evidence-based guidelines for print and how women should be positioned.

Select: An illustration of the mammography examination further up in the case was taken by radiographer Nina Vårdal, the Breast Centre at St. Olavs Hospital.