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Minimizing Pain and Discomfort During Mammography (dateline July 26, 2000)

Mammography, an x-ray exam of the breasts, is currently the only exam approved by the U.S. Food and Drug Administration (FDA) to screen for breast cancer and is considered by physicians to be the “gold standard” in breast cancer detection.  Mammography can help detect approximately 85% of all breast cancers, often before a lump can be felt.  While many women over age 40 are familiar with the benefits of yearly screening mammograms,  the exam can be uncomfortable and even painful for some women. 

Unfortunately, some studies have shown that the discomfort some women feel during a mammogram can deter them from receiving future mammograms.   This, in turn, can lead to delayed breast cancer diagnoses and worse prognoses (expected outcomes) for some women.  

Studies Pinpoint Causes of Mammogram Discomfort

Several studies over the last 10 years have isolated a number of factors that influence a woman’s comfort level during mammography.  These factors include:

  • Breast compression
  • Friendliness and sensitivity of the mammography technologist(s)

  • Facility atmosphere and procedures

Studies on discomfort/pain and mammography reveal that many women experience discomfort during a mammogram; however, few women find the exam extremely painful.  In a study conducted by Duke University Medical Center researchers, 93% of 125 women over the age 50 reported pain during the mammogram exam.  Most of the women describe the pain as low to moderate.  In another larger study, 52% of 1,800 women surveyed reported moderate to extreme discomfort during mammography.  Researchers have also found pain is a key factor in determining whether women in breast cancer screening programs will return for future mammograms. 

How Discomfort During Mammography Can Be Minimized

By surveying women about their experiences with mammograms, researchers offer suggestions on how to minimize discomfort during mammography.

To alleviate much of the pain associated with mammography, patients may wish to:

  • Find a “friendly” mammography facility with knowledgeable mammography technologists
  • Control the breast compression themselves during mammography
  • Change mammography facilities when dissatisfied with care/service

  • Use calming self-statements and learn distraction techniques to use during mammography

Breast compression, which is necessary to flatten the breast so that the maximum amount of tissue can be imaged and examined, is a major cause of fear and discomfort during mammography.  

Breast compression is necessary during mammography in order to:

  • Flatten the breast so there is less tissue overlap for better visualization of anatomy and potential abnormalities. For example, inadequate compression can lead to poor imaging of microcalcifications, tiny calcium deposits that are often an early sign of breast cancer.
  • Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged
  • Immobilize the breast in order to eliminate image blurring caused by motion
  • Reduce x-ray scatter which also leads to image degradation

While breast compression can be temporarily uncomfortable for some women, it should not cause significant pain.  If a woman experiences pain during a mammogram, she should notify the technologist immediately.

Patient-Controlled Breast Compression

Some mammography facilities will allow the patient to control the breast compression herself during mammography.  This can greatly reduce anxiety, making the woman feel more comfortable during the procedure, both physically and emotionally.  Women should feel free to ask the technologist about controlling breast compression herself before the exam begins or when scheduling the exam. 

Researchers have found that a woman often feels more comfortable during a mammogram with a courteous technologist who can provide thoughtful answers to her questions.  Knowledgeable technologists can also help women with distraction techniques to take their minds off the exam.  In a study published in the February 2000 issue of the journal Radiology, researchers found that factors associated with mammogram discomfort included the facility itself, satisfaction with care, and the patient’s perception of the technologist’s “roughness.”

If women are not satisfied with the quality of care they receive at one facility, they should feel free to change facilities.  However, it is important that a patient obtain her original mammogram films if she changes facilities so that future films may be compared to them.  

Please see the section, Key Steps For An Optimal Mammogram, for more information on minimizing pain during a mammogram.

Mammography Guidelines For Women

Mammography is extremely important in helping to detect breast cancer early.  The earlier breast cancer is detected, the greater the chance for minimally invasive treatment and survival.

The American Cancer Society, the American Medical Association, the American College of Radiology, and other several healthcare organizations and associations suggest that all women receive annual mammograms beginning at age 40, in addition to yearly clinical breast exams and monthly breast self-exams.   

Women who are at high risk of breast cancer (such as those with a strong family history of the disease or those who test positive for BRCA1 or BRCA2 gene mutations) should ask their physicians about beginning screening mammograms at a younger age, as early as age 25 in some cases.  All women under age 40 should also perform monthly breast self-exams and receive physician-performed clinical breast exams at least every three years. 

Additional Resources and References