Discomfort and pain during mammography: description, prediction, and prevention.

Abstract

Objective-To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated.Design-Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort.Setting-Health district in South East Thames region.Subjects-1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire.Main outcome measures-Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist.Results-35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend.Conclusions-The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicised. IntroductionThe national breast screening programme is nearing the end of its first three year cycle. The success of the programme largely hinges on a high level of uptake and continued compliance by the target population, which in turn depends on whether the population finds the service acceptable. The University of Kent at Canterbury breast screening group recently completed a prospective study of more than 3000 women in three centres in the South East Thames region to examine users' responses to and satisfaction with the service.'

The Effect of Access and Satisfaction on Regular Mammogram and Papanicolaou Test Screening in a Multiethnic Population

“…33 Discomfort has little effect on satisfaction or intention to return for repeat mammography. 34,35 Following Lurie's conceptualization of access as those factors facilitating the ability of individuals to receive care, 29 our study assessed the impact of primary and secondary access on breast and cervical screening. We hypothesized that access and satisfaction would mediate the effect of sociodemographic factors on regular mammograms and Papanicolaou tests and would explain racial/ethnic disparities in receipt of regular screening.…”

The impact of screening on future health-promoting behaviours and health beliefs: a systematic review

“…These papers described the health behaviours and beliefs of women who had recently undergone breast screening, [193][194][195][196][197][198][199][200] those who had undergone screening and were recommended to have further follow-up investigations, [201][202][203][204] women who had recently undergone further investigations, and were found not to have cancer, 205 women who had previously received a false-positive screening result, necessitating a breast biopsy, and then were found to not have cancer, 206 and women who had recently not reattended for routine breast screening. 187 An additional cross-sectional survey of a random population sample (not necessarily after screening) studied the level of opinion regarding the acceptability of false-positive results in mammography.…”

“…[193][194][195][197][198][199] All of these papers reported a high proportion of women with positive intentions (89-99%). The descriptive study of women who had a recent false-positive result found the same result, with 96% of the women reporting that they would reattend for routine screening next time.…”

“…199 In women who reported a painful mammogram, a lower proportion of 75% intended to reattend. 197 However, in a crosssectional study of recent attenders (31% of whom experienced moderate or severe pain) only 2.6% (25/945) reported that pain might deter them in the future.…”

“…Most papers in this review that investigated pain used it to explain reasons for non-attendance. 187,195,197,199 Two papers examined pain experienced as a factor in affecting intention to reattend and found no difference in intention between women who reported painful mammograms and those who did not report pain. 130,131 However, intention to attend may not be borne out by actual attendance behaviour.…”