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sure answers to reduce Mammography
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
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
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
The review appears in the most recent issue of TheCochrane
a publication of The Cochrane Collaboration,
an international organization that evaluates
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,”
“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
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
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
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
“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
“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
“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
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