Does Mammography Hurt?

Abstract

The documented incidence of pain associated with screening mammography varies from 1% to 62%. Some researchers suggest that pain may undermine compliance with screening mammography. As a part of a quality improvement project, we have surveyed women undergoing mammography in 2 centers in Jerusalem to identify the prevalence, severity, and duration of mammography-associated pain, demographic risk factors, and the degree that this may undermine compliance with breast cancer screening. A 23-item questionnaire was administered to 399 women (32% at the Shaare Zedek Medical Center [SZMC] and 68% at the Rachel Nash Comprehensive Breast Clinic [HALA]). Of the total, 77% of the women reported that the procedure was painful. Of those reporting pain, 60% described pain intensity as moderate or severe. In 67%, the pain resolved within 10 minutes. By univariate analysis, the only significant predictor for pain during mammography was cyclic breast pain (P = 0.053). No significant correlation was identified for age, breast size, pre-mammography counseling, and examination center (SZMC vs. HALA). The prevalence of pre-mammography counseling or explanation was low (51%). Despite that, 61% of the respondents expected that mammography would be painful. Indeed, most of those who anticipated pain reported that the actual severity was not greater than the anticipated severity. Even among women who reported pain of moderate or greater severity, less than 5% expressed preference to receive pre-emptive analgesia prior to their next mammogram. A substantial minority of women acknowledged that the experience of their mammography invoked reactions that may impend future compliance; 26% reported anxiety and 12% reported pain as factors that may interfere with ongoing compliance with regular mammographic screening. These data serve to emphasize the need for appropriate pre-test counseling and suggest a possible role for post-test debriefing to address those factors which may interfere with future test compliance.

Impact of screening for breast cancer in high-risk women on health-related quality of life

“…The documented incidence of pain associated with screening mammography varies from 1 to 62% (Sapir et al, 2003). Patient education by trained nursing counsellors may reduce mammography-related pain and discomfort (Nielsen et al, 1993).…”

Understanding the use of breast cancer screening services by women with intellectual disabilities

“…Despite the benefits of breast cancer screening, a significant proportion of the eligible population choose not to use these services, most of which are free or subsidised. Reasons not to attend screening include lack of encouragement by physicians (Grady et al 1992;Nosek & Howland 1997;Miller et al 1998;George 2000), lack of perceived risk (Orton et al 1991;George 2000;Speedy & Hase 2000), fear (Thompson et al 1997), embarrassment (Orton et al 1991;Nosek & Howland 1997), inconvenience (Speedy & Hase 2000), insensitivity of health care workers (Nosek & Howland 1997;Thompson et al 1997;Williams et al 1997), pain or discomfort (Keemers-Gels et al 2000;Andrews 2001;Sapir et al 2003), physical disability (Nosek & Howland 1997), residence in a nursing home and dementia (Marwill et al 1996). Women with intellectual disabilities are among the least frequent users of screening mammography (Cowie & Fletcher 1998;Piachaud & Rohde 1998;Davies & Duff 2001), perhaps because the standard recruitment strategies are not suitable.…”

Douleurs induites par les soins: épidémiologie, retentissements, facteurs prédictifs

“…Après une mammographie, l'importance de l'anxiété et de la douleur ressenties ont été invoquées par 26 et 12 % des femmes, respectivement, comme facteur de non-compliance aux examens suivants [61]. Aucune mesure préventive de la douleur n'est parfaitement efficace, mais elle a certainement de la pertinence si elle permet de réduire le pic d'intensité douloureuse.…”