Our guest blog comes from Stafano Pacifici who is the coordinator Radiographer/Mammographer at the Ecotomografia medica Srl in Rome. Like the WoMMeN team, Stafano is concerned with understanding and improving the patient experience of mammography. We asked him to share his observations. It’s interesting to note that women experience mammography the same way across the planet!
Is a mammogram painful?
Mammography is an important tool in secondary prevention of breast cancer. However, a large percentage of women report pain or discomfort that may undermine compliance with screening, periodic or follow-up mammograms.
What might cause pain?
Pain does not just depend on breast compression but on many underestimated risk factors. These may depend on the woman, such as her individual sensitivity, the expectation of pain (or memory of it) and her psycho-emotional status. It also depends on the radiographer’s attitude and their compassionate listening/communication skills. All these factors are able to increase drastically the risk of pain, affecting in turn the expectation/memory of pain and psycho-emotional status.
Psycho-emotional status can be affected mainly by the anticipatory anxiety and any other discomfort. The first of them occurs when woman experiences increased levels of stress by thinking about an event or situation in the future, or when she’s worried about confronting something that has scared her in the past, that usually reappears at each follow up mammogram.
Psychological or physical?
Psychological discomfort too has a multi-factorial cause, such as e.g. the fight-flight response, which is an ancestral, physiological reaction that occurs in response to a perceived harmful event or attack; or a “proximity” violation due to the presence of the radiographer in the woman’s own intimate area, usually combined with the “physical” violation resulting from the positioning maneuvers, involving shoulders, pelvis and, of course, breast.
Following the belief that compression is one of the major risk factors, manufacturers are offering solutions such as soft cushions, adaptive paddles or even remote control to enable the woman to self-adjust the amount of pressure, as in a recent study it was found that women slightly increased compression strength using the self-compression feature.
Mammographers can help reduce the pain
From personal experience we have found that the same result is achievable by giving a woman the chance to stop compression before the onset of pain, after a full explanation about the reasons to compress the breast. Actually, giving the woman the opportunity to control the amount of pressure can cut by half or more the risk of pain.
Don’t be fooled: the compression itself is not the greatest risk of pain factor! A good mammographer would never allow you to get too low a compression, as this could compromise the diagnostic quality of the test. Higher tolerance isn’t due to less compression, rather to the awareness of being able to stop. Nevertheless, even this measure alone is not enough.
Lighting, music and aromatherapy
The mammographer shouldn’t exclude a careful assessment of the woman’s emotional status or appropriate counseling to address those factors which may interfere with future compliance. Suggested interventions include a friendly atmosphere, and compassionate, empathetic, supportive behavior, encouraging the woman to feel more at ease and distracted from pain. In my practice I have begun to perform mammograms in a pleasant setting with appropriate lighting, background music and essence diffusion, according with chromo, music and aromatherapy criteria. Since then, the few women who still complain about pain are those with mastodynia, as well those with very small and/or firm breasts, because of smaller contact surface, as pressure is the result of force-surface ratio.
You might like to read further work by Stefano in his articles:
- Stefano Pacifici (2016) Decreasing Anxieties in Women Undergoing Mammography. Journal of Women’s Health Care, 2016;5(2)
- Stefano Pacifici (2016) Dose, compression and “risk of pain” in mammography. Imagen Diagnóstica, 2016;7:50-3
- Stefano Pacifici (2011) Dose and compression in mammography. The Arab Health Imaging and Diagnostics Magazine, 2011;3:22-23
Call to action: do you have any experiences of having a mammogram that you’d like to share with others? Did you find is uncomfortable or painful? Was the mammographer able to put you at ease?