Mammograms Are Less Painful, Just as Effective When Women Control Compression

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Right now, mammograms are likely the most important tool doctors have to screen for and diagnose breast cancer, as well as evaluate and follow people who have been diagnosed. Still, many women don’t like getting a mammogram because the test involves compressing the breast between two clear plates, which can be uncomfortable or even painful for some women.

A French study suggests that mammograms are just as effective and cause less discomfort when women can control the amount of compression.

The study was published online on Feb. 4, 2019, by the journal JAMA Internal Medicine. Read the abstract of “Self-compression Technique vs Standard Compression in Mammography: A Randomized Clinical Trial.”

How mammograms are done

When you have a mammogram, a skilled technologist positions and compresses your breast between two clear plates. The plates are attached to a highly specialized camera that takes X-ray pictures of the breast from two directions. Then the technologist repeats the technique on the opposite breast. For some people, more than two pictures may be needed to include as much tissue as possible.

Compressing the breast is necessary to flatten and reduce the thickness of the breast. The X-ray beam should penetrate as few layers of overlapping tissues as possible. If a breast isn’t compressed enough during a mammogram two things can happen:

  • overlapping healthy tissues can look like cancer
  • healthy tissue can hide a cancer and it goes undetected

The compression can make a mammogram painful for some women, but for most it is mildly uncomfortable, and the sensation lasts for just a short time. Still, some women may skip regular mammograms because they’re anxious or stressed about the discomfort.

So researchers are always looking for ways to make mammograms as comfortable as possible.

How this study was done

This study included 548 women who were scheduled to have a mammogram at one of six cancer care centers in France between May 2013 and October 2015. None of the women had had breast surgery or breast cancer treatment within the past 3 years. The average age of the women was about 61 years.

The women were randomly assigned to one of two groups:

  • 275 women controlled the compression of the mammogram
  • 273 women had a standard mammogram

For the women who controlled the compression of the mammogram, the technician positioned them in the mammography machine. Then the women took charge of the compression process.

For the women in the standard mammogram group, the technician controlled the compression process.

The researchers measured the thickness of the breast at four viewpoints and then calculated an average thickness during compression.

The researchers also collected information on:

  • the quality of the mammogram image
  • the need for additional images
  • the level of compression
  • the level of pain the women felt
  • the women’s satisfaction with the mammogram

Study results

The results showed that the mammogram image quality was the same for the two groups, as was the average breast thickness during compression.

Interestingly, the average level of compression was higher in the group of women who controlled the compression of the mammogram, possibly causing more discomfort in this group. But women who controlled the compression of the mammogram reported less pain and discomfort than women who had a standard mammogram.

“Our study did not report any decrease in image quality when self-compression was performed,” said lead author Philippe Henrot, M.D., of the Institut de Cancérologie de Lorraine Alexis Vautrin in Vandoeuvre-lès-Nancy.

What this means for you

The results of this study echo earlier research that found allowing women to control compression during a mammogram doesn’t reduce the quality of the image but does reduce the level of discomfort women report during the procedure.

In September 2017, the U.S. Food and Drug Administration gave clearance to a digital mammography system that allows women to increase or decrease the amount of compression applied to the breast before the mammogram starts.

There's only one of you, and you deserve the best care possible. Don't let any obstacles get in the way of your regular screening mammograms.

  • If you find mammograms painful, ask the mammography center staff how the experience can be as easy and as comfortable as possible for you. You may want to ask if the center has a system that allows you to control the pressure of the mammogram.
  • If you're worried about cost, talk to your doctor, a local hospital social worker, or staff members at a mammogram center. Ask about free programs in your area.
  • If you're having problems scheduling a mammogram, call the National Cancer Institute (800-4-CANCER) or the American College of Radiology (800-227-5463) to find certified mammogram providers near you.
  • If you’re concerned about unknown results or being called back for more testing, talk to your doctor about what happens when mammogram results are unclear, as well as what to expect if you’re called back for more testing.

For more information on mammograms, including where to get one and the benefits and risks, visit the Breastcancer.org Mammograms page.

Written by: Jamie DePolo, senior editor


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