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Julie Clemons has an appointment for her second mammogram this week and she’s really anxious. Her first mammogram, when she was 38, was no walk in the park.
“It was just agonizing,” recalls the 45-year-old farm owner from Canaan, New Hampshire. “It felt like my skin was going to tear. It was an awful, awful panicky feeling … The whole thing still makes me angry seven years later.”
Clemons ended up with bruises covering her chest after her mammogram. Although pain that extreme is on the far end of the spectrum, many women report pain or discomfort from the test.
Studies on mammography pain and discomfort vary, but according to a 2008 review, up to 35 percent of women report pain from the procedure. Although many women deal with it, some may delay or avoid recommended mammograms altogether. One study found that among women who didn’t return for their second annual mammogram, 46 percent cited a painful first screening as the reason.
Despite the negative impact of discomfort on screening adherence, there’s been relatively little research on techniques to reduce that pain. Taking ibuprofen or acetaminophen before the procedure doesn’t have much effect, studies have shown. The numbing agent lidocaine has been found to reduce pain, but that drug comes with potential safety concerns and should be used only under the supervision of a health care provider.
Device may reduce discomfort by nearly 50 percent
A new device that attaches to existing mammography machines to standardize compression pressure could ease the procedure’s discomfort for many women, according to a new study from researchers in the Netherlands who developed the technology.
Mammograms come with a lot of variability, said Dr. Woutjan Branderhorst, one of the device’s creators and a clinical application scientist at the Academic Medical Center in Amsterdam. That’s due to both variability in breast shape, size and sensitivity among women and in how mammogram technologists operate across different imaging centers.
“The current way of working does lead to an enormous amount of variation,” said Branderhorst, who will present his findings next week at the Radiological Society of North America’s annual meeting in Chicago. “We want to standardize this.”
Branderhorst and some of his colleagues who participated in the study are also employees of SigmaScreening, a Dutch company spun-off from research at the Academic Medical Center that manufactures the device.
The researchers’ device, which attaches to the mammogram machine’s paddles, uses a thin transparent foil to measure the size of the contact area between a woman’s breast and the machine paddles. The device then reads out a number to the technologist to reach a standard amount of compression pressure, eliminating some of the variation inherent in the system.
The researchers tested the device’s effects in a study of 433 Dutch women receiving their annual screening mammogram. A typical mammogram comprises four breast compressions; the researchers used their device in one of those four for each woman without telling the patients or mammogram technologist which compression was which.
On a scale from one to 10, women’s pain scores were 10 to 24 percent lower when the device was used, and “severe pain” – seven or higher on the pain scale – dropped by up to 46 percent, the researchers found. The image quality didn’t suffer when the device was used, Branderhorst said.
The researchers have the most data from their own country, but they collaborated with a breast imaging center in Pittsburgh to ask whether this technique might be useful in the U.S. So far, they’ve found that compression pressure is also variable in the U.S., although the average pressure used at the Pittsburgh site seems to be lower than at their study sites in the Netherlands.
Branderhorst said they haven’t yet tested the device outside the Netherlands, but they are planning to apply for approval from the U.S. Food and Drug Administration next year to sell the product in the U.S. “I expect the situation can be improved in the U.S. as well,” he said, “so a woman can go to any center and she will get the same amount of pressure any time.”
Experience and communication are key
Such a device may be most effective at clinics that see a low volume of mammograms, said Dr. Habib Rahbar, a radiologist at Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center’s treatment arm. In his experience, few patients complain about discomfort to their mammogram technologists, and he credits the high volume of mammograms performed at SCCA and the specialized experience of his colleagues.
“I believe our excellent technologists … are the main reason that patients who come to the SCCA rarely complain about discomfort with mammography,” Rahbar said.
For those women who can’t access a high-volume clinic, one simple technique does seem to help with the pain: talking about it. Studies have found that women given more information about what to expect ahead of their mammogram report less pain.
And keeping the lines of dialogue between patient and technologist open can go a long way, Rahbar said.
“Good communication between the technologist and the patient is essential to allow high quality mammography that minimizes discomfort,” he said.
Kristen Gavern, SCCA’s breast imaging supervisor, agrees.
“The patient just has to be very open with how they’re feeling,” she said. “If something’s pulling or pinching, many times we can do something about that, if we know what it is.”
Bruising like Clemons experienced is definitely not the norm, Gavern said. Clemons didn’t realize her first experience was so atypical, she said, but now she knows to speak up.
For pre-menopausal women, scheduling the mammogram 10 to 15 days after the start of their menstrual cycle also can help, Gavern said. Breasts are less tender overall at that point.
Even when they can’t change the procedure without sacrificing image quality, Gavern said she always reminds patients that the procedure is very quick – once the breast is in place, it’s a matter of seconds to take the image and move on to the next compression.
“I personally feel like it’s awkward and uncomfortable but it’s really quick, and you’re out in just a few minutes,” said Gavern, who says she’s had several mammograms herself. “You can’t get past that awkward and uncomfortable part, but it’s such an important step in detection, and that’s what we’re here for.”
Dr. Rachel Tompa, a staff writer at Fred Hutchinson Cancer Research Center, joined Fred Hutch in 2009 as an editor working with infectious disease researchers and has since written about topics ranging from nanotechnology to global health. She has a Ph.D. in molecular biology from the University of California, San Francisco and a certificate in science writing from the University of California, Santa Cruz. Reach her at firstname.lastname@example.org.
Solid tumors, such as those of the breast, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.
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