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No sure answers to reduce Mammography discomfort

Newswise — Health researchers are looking for solutions to a problem that keeps some women from getting routine breast cancer screening.

“Many women will not go or return for a mammogram because of pain or concern about pain from screening,” said Dawn Miller, a physician and women’s health researcher at the Dunedin School of Medicine, University of Otago in New Zealand.

Miller led a review of studies on various interventions designed to relieve the discomfort associated with mammography, an X-ray that can help detect tumors in breast tissue.

“No single answer popped out of the review. We can only say that it’s important to be well prepared … to have as much of a sense of control as possible,” Miller said.

“The message to get across is that the women who were better informed had a better experience — whether that information was written or verbal.”

In everyday practice, the amount of information a woman receives before a mammogram likely depends on the policies of the screening facility or even the expertise and personality of an individual technician.

Nonetheless, Miller says it should be routine practice for women to be well informed about the benefits of mammography, what is involved in the procedure and why, and the possibility of pain or discomfort.

Miller’s team identified seven randomized controlled trials rigorous enough to include in the review. The included studies involved more than 1,600 women.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The reviewed studies explored pain-relief possibilities including written or verbal information provided before the procedure, the use of breast cushions and the use of an analgesic taken before the mammogram.

“There wasn’t enough research in any particular area to combine the data, so this is a review of individual studies, each with limitations,” Miller said.

“Some of the interventions may be beneficial — there are things that might look promising — but the weight of the evidence is not there yet for any one approach.”

During a screening mammogram, a technician uses glass plates to compress each breast firmly to flatten the breast tissue and achieve a clear X-ray image.

One study looked at the effects of cushioned pads positioned between the skin and mammography equipment. The U.S. Food and Drug Administration has approved the use of breast cushions.

The study found that women reported less pain when the cushions were in place, but the X-ray image quality was lower for 2 percent of the women screened.

Miller said that result raises the concern that more women will need to return for repeat screenings.

“Maybe further developments of the breast cushions will improve that. Maybe we need a review of just how the breast cushions are used,” she said.

Women who took acetaminophen (Tylenol) before their mammogram reported the same levels of pain or discomfort as women who took no medication.

In one study, the mammography technician lessened the compression force on the breast, but women reported no significant difference in pain.

Women who were able to control the breast compression themselves reported less pain. However, the quality of the resulting X-ray images remained high only when a technician first demonstrated the proper technique to the patient by controlling the pressure in the examination of the first breast, the study found.

“These are all interesting ideas that need to be perfected. Any of the ideas would have to be well researched,” Miller said.

Radiologist Lawrence Bassett says mammography discomfort varies greatly.

“There are a lot of women who experience no pain; most women get through it just fine; some report quite a bit of pain,” said Bassett, the Iris Cantor Professor of Breast Imaging at University of California, Los Angeles.

Mammography cushions are not available at the imaging center where Bassett practices, but he expects his team to offer them soon. MammoPads, manufactured by BioLucent, are available at the Capital Breast Care Center in Washington, D.C.

“These pads seem to have made a big difference in the amount of discomfort women feel during their mammogram. We have had many patients say that this was the most comfortable mammogram they have ever had. Of course that is not scientific evidence, but we are pleased with the response,” said center Executive Director Amari Sokoya Pearson-Fields.

Miller D, Livingstone V, Herbison P. Interventions for relieving the pain and discomfort of screening mammography (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org  for more information.