[Effects of information on and reflection of women's pain experience during mammography]. Impact of patient-controlled compression on the mammography experience. Mammography with breast cushions. Compression in mammography and the perception of discomfort.
At mammography, strong compression of the breasts is required to reduce the radiation dose and to obtain radiographic images of high quality. In recent times the mass media have received a number of letters with complaints about the painfulness of the examination and an unsympathetic reception by the personnel. The aim of this study was to find out what effect information and a special manner of reception ("reflection") had on the experience of pain at mammography. Reflection meant that the X-ray nurse, in an accepting manner, reflected the feelings and facts which the woman expressed. The study was performed as a 2 x 2 factorial design. One independent variable was a letter of information, with the two alternatives letter of information and no letter of information, and another was reflection, with the two alternatives reflection and no reflection. Seventy-six women were randomly allocated to these four conditions. The letter of information stated why the examination was to be performed, how it is done and how it is usually experienced. The results showed that all women in all groups experienced relatively little pain. They considered that they were well received and were satisfied with the information. The difference between the groups was small. There was a tendency for those who were both received with reflection and were given a letter of information to be more satisfied with the examination as compared with the other women. A larger number of women in this former group than in the other groups stated reasons for their assessment. This result was significant.(ABSTRACT TRUNCATED AT 250 WORDS) The authors tested the hypothesis that giving women control over the compression portion of the mammography examination results in a less painful experience, greater overall patient satisfaction, and a radiographic image as good as that produced by means of technologist-controlled compression. One hundred nine women undergoing screening mammography at a hospital-based outpatient clinic were studied. Each underwent two-view, screen-film mammography performed in routine fashion except that, by random assignment, one breast was compressed by the technologist and the other breast, by the patient. Patient-controlled compression was significantly (P = .003) less painful than technologist-controlled compression. Overall patient satisfaction (96% [105 of 109]) and willingness to repeat the experience were extremely high. The majority of images (93.5% [202 of 216]) were rated as having good to excellent compression. With minimal patient education, self-compression resulted in an image at least as good as that produced with technologist-applied compression. Further study of this technique is warranted. We conducted a randomized clinical trial to determine the impact on pain and image quality when breast cushions were used to pad the surfaces of the mammography equipment during film-screen mammography.
                We recruited a consecutive volunteer sample of 394 participants. Breast cushions were used for only one breast, with laterality and sequence of use assigned randomly. Data collected from participants included demographic data, rating of pain from previous mammography, and rating of pain from present mammography using both a numeric rating scale and a visual analogue scale. Research assistants also collected breast compression and radiation exposure data. Radiologists were blinded to the laterality of cushion assignment while reading the mammograms and assessing image quality.
                Participants were primarily white women (75.3%), mean age 55.4 years. Most (94.4%) reported having previous mammography. Eight percent (n = 32) of those surveyed had thought about skipping or delaying mammography because of the pain involved. The pain associated with mammography was significantly (p < .001) less during oblique and craniocaudal views when breast cushions were used during the procedure. Retakes were required for 2% of the 1576 views with the most common reason being positioning (53%).
                The use of breast cushions significantly reduced the pain during film-screen mammography. Image quality with the cushions was reduced in a very small subset of women probably due to the difficulty in positioning the breast without visual clues. More research needs to be done prior to the routine use of these cushions in clinical practice. Breast compression in mammography is an uncomfortable experience for most women. The discomfort experienced has the potential to deter women from attending regular breast screening by mammography. The aim of the present study was to assess factors related to the degree of discomfort experienced by women attending for first-time mammography at the Central and Eastern Sydney BreastScreen Service. Prior to the mammogram, expectations of discomfort, menstrual status, existing breast pain, and other breast problems were recorded on a questionnaire. At the time of the mammogram, breast size and weight were estimated. During the mammogram one of the craniocaudal views of the breast was taken at a slightly lower level of compression and after the procedure the participants were asked if they perceived any difference in discomfort between the normally compressed view and the less compressed view. Radiologists were asked to comment on any differences in image quality between the same two cranio-caudal films. A total of 200 women, including non-English-speaking women, participated in the present study. A total of 29% of women reported moderate, considerable or severe discomfort, a much higher level than reported in previous studies. The source of expectations (P = 0.001) had a significant relationship to the expectation of discomfort. Prior expectations (P = 0.01) and breast weight (P = 0.001) were the only factors found to have a significant relationship to the experience of discomfort. The analysis of differences in level of compression and discomfort indicates that the relationship between mammography discomfort and level of compression is complex and not simply the result of the amount of compression applied. However, analysis of the relationship of varying compression and image quality suggests that a slight lowering in the level of compression is unlikely to significantly compromise perceived image quality. Directions for further research are suggested.
Currently there are very few proven interventions to reduce pain and discomfort of screening mammography, especially procedures that can be readily introduced to screening programmes. With mammography continuing as the preferred method for breast screening, more research on such interventions is needed.