We all know that when talking about the mammogram experience, at some
point in the conversation someone will mention the pain and the squash. And rightly so, it’s part of the examination that causes much angst: how much pain will have to be endured due to the compression so that we can get either an all clear or a diagnosis of cancer?
The #wommen team have been exploring women’s attitudes to mammograms and compression for some time. The research team at the University of Salford have been looking into aspects of compression and breast positioning for several years. Unsurprisingly, compression isn’t popular – it’s the sole cause of the discomfort felt during mammograms. Or is it?
Some researchers have discovered that the way your breast is positioned on the mammogram machine for example could increase the amount of pain felt. Other researchers have discovered that your perception of pain during the mammogram can be altered due to the circumstances that you are in, and this is something that the #wommen researchers have looked at in their publication ‘The Power and the Pain’ in Radiography journal (1).
So, put simply, the pain that you feel can be affected by your emotions. And if your emotions are negative, then your feelings of pain can be increased. If you are calm, or distracted, then your feelings of pain can be decreased. What does this mean for the mammogram? It means that pain may not just depend on the amount of pressure only. How you feel generally could make it feel better or worse.
How about feeling helpless? I would think, and the research has showed that the balance of power lies with the person performing the examination – the mammographer. Nothing more vulnerable for a woman than being half naked having her breast compressed by another woman. The mammographer appears to have the upper hand in this situation, it has to be said.
So, how about if we changed that a little bit? How about if the woman having the mammogram could control the amount of pressure put on? Would you feel better if you could control the amount of compression? If you did it yourself? Well, you can.
There are some simple steps that you can undertake:
By firstly talking with the mammographer, and working together to make sure that you feel that you can say stop if it gets too much for you.
By physically applying some of the compression yourself. How? It’s true that the mammographer brings the compression device down using foot controls, but the compression also has a hand control on some systems that can move the compression down or up by hand. This is where you could join in controlling the compression. This is only achievable though on some systems.
A new Step?
A mammography machine has been developed that has a remote control that allows you to be able to control the amount of compression on the breast. The GE Senographe Pristina see here features a range of ergonomic features which are designed to make the machine more comfortable and an additional self-compression system that gives you a self-control to adjust the amount of compression under the guidance of the mammographer.
The Mammographers Experience:
My experience is that allowing women to apply the compression themselves means that the mammogram can be undertaken with minimal distress. I’ve got experience of allowing patient assisted compression during mammograms. It’s a technique I use with very anxious women, those who have very tender breasts or for those who I judge to be at risk of refusing a symptomatic mammogram because of a previous bad experience. I’ve found that it is surprisingly successful.
For my mammographer colleagues currently scratching their heads in puzzlement, it goes like this:
‘I place the woman in the relevant position, and then manipulate the breast into the correct position. When I am ready to compress, I do so but only until the compression plate touches the top of the breast. Then holding the breast in place, the woman winds the compression plate down until a satisfactory result is achieved’.
It must be stressed that there is the proviso that there must be enough compression on the breast to maintain the breast position and all the time that compression is being applied it’s essential that the mammographer be giving feedback to the woman as to whether or not we’re reaching the correct level; asking if she is comfortable, or if she is struggling, and negotiating if she has reached her limit.
So what are the results?
Well, I find that most women put on a level of compression that I would have applied myself, around 8N; and that never have I taken an image using this technique that required repeating because of too little compression or blurring. I don’t take an image if it’s not justified, so if the compression is quite obviously too little, then no exposure is taken.
As for time taken – it’s a slightly slower examination because of the nature of the person that I am using this technique on; I need more time to counsel and to communicate anyway. However, patient assisted compression doesn’t add appreciably to the time taken overall – compression is applied slowly but not so slowly that the exam takes longer than ten minutes. This echoes the finding by Moisei et al (2011) in a small feasibility study presented to the European Congress of Radiology (2).
What do the women think? Of those that I have used this on, the response is very positive. The mammogram is achieved without overwhelming pain, the person is in control of their own experience and the relief is palpable. I have managed to image women who warned me on entering the room that previously they had ‘screamed the place down’, and those for whom a mammogram ‘just isn’t possible’.
It is possible. A good result is achievable. However, it does mean that mammographers have to relinquish a little bit of the total control that they have over the examination – how do people feel about that?
The Educators Experience
So what does this mean for our future for both patients and #WeMammographers. Well our mammography colleague has shown that patient assisted compression is already occurring. This is not a new concept. Unfortunately though our systems are not designed for this – using the manual hand held control designed for the mammographer is clearly not the most effective way to use self-compression! The concept though is clearly working and this is very positive for the woman that are using this service and for the mammographers themselves in helping improve patient experiences within their service.
The new remote control system on the GE Senographe Pristina has a large amount of potential. On seeing this ‘in action’ it is clearly apparent that once your breast has been positioned on the mammogram machine in the optimal position and compressed to immobilise, you then, as a patient, can be invited to continue to apply the compression with this hand held device. It is really easy to hold in your hand and very comfortable.
This places you in control and you can continue to apply more compression to your breast tissue, under the guidance of the mammographer who is next to you. If the compression becomes a little too much you can then take a little bit off. The mammographer will ensure that you won’t put too much compression on your breast and the machine would not let you apply too much anyway.
A study is being conducted in France at the moment and 100 patients have used this device. One of their breasts was compressed by the mammographer and the other was compressed by the mammographer and then the patient with self-compression. Preliminary results are very positive. With the breast that was self-compressed you actually see the amount of compression increasing compared to the mammographer compressed side, which means you get a reduction in breast thickness, which means a reduction in breast radiation dose.
What does this mean? Well I think that it means that this patient assisted compression device is not just a gimmick. I think that this means that this device has got a large amount of potential in reducing patient anxiety, ensuring ladies have better management and control of their pain and will therefore hopefully attend for mammography again.
The future is a bright one: #self-compression @WeMammographers
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- Robinson, L et al. (2014) The power and the pain: Mammographic compression research from the service-users’ perspective Radiography Volume 19, Issue 3, p190-5 (doi: 10.1016/j.radi.2013.04.005).
- Moisei M, et al. (2011) Feasability study of self-compression in mammography European Society of Radiology Congress Proceedings (doi: 10.1594/ecr2011/C-2295).