Breast cancer is the most common cancer affecting women. Screening for breast cancer by means of regular mammograms reduces the death rate from this disease. In the screening process, women who have no symptoms of disease undergo a mammogram, which can identify those who might have breast cancer. Mammography uses X-rays to find early breast cancers. In order to obtain an accurate reading, the mammography machine needs to compress the breasts. This can cause discomfort or pain, and some women decide not to have mammograms because they can be painful. In some mammography studies, up to 35% of women report pain with the procedure.This review tried to identify and assess clinical studies of interventions designed to reduce the pain or discomfort that women can experience during mammography. A set of quality criteria were decided to ensure that only studies that were relevant and well designed were included in this review. Seven studies met these criteria and were included. The studies involved a wide range of interventions to relieve the pain and discomfort of screening mammography, such as providing women with verbal and/or written information before the procedure, or pain relief medication taken before the examination, use of a breast cushion (to pad the surface of the mammography equipment), patient-controlled compression of the breast, and reduced compression by the technician. The studies assessed the pain the women expected, and actually experienced, by means of a range of questionnaires of differing quality.
Each study included in this review looked at a different intervention to reduce pain in mammography. The trial results show that giving women written or verbal information about the procedure prior to the mammogram can reduce pain or discomfort of the examination. Also increasing women's control of breast compression could reduce the pain they experience, though there was no change in the pain women experienced when a mammography-technologist reduced the compression force. Use of breast cushions also reduced the pain; however, it caused a poor quality of X-ray in 2% of women screened, which meant that they would need to have a further mammogram. Paracetamol taken before the procedure did not change the pain the women experienced.