Interventions for relieving the pain and discomfort of screening mammography

Pain of mammography is recognised as a significant deterrent to breast screening and therefore may effect the success or failure of any screening programme.

To review research of interventions related to any aspect of breast screening to reduce or relieve the pain and discomfort of screening mammography.

The Cochrane Breast Cancer Group conducted a search of their specialised register in the Cochrane Library. In addition a wide variety of databases and websites were searched using keywords 'mammography' and 'pain', along with handsearching selected journals. Information was requested from a wide range of interested people and organisations.

Randomised controlled trials and non-randomised trials with a comparison group were considered. Studies had to include assessment of both pain and quality of mammograms.

Identified studies were independently reviewed by two reviewers to determine if they met the inclusion criteria. Additional information was sought from investigators as necessary. Each study was reviewed for quality, including concealment of the allocation sequence, generation of the allocation sequence, comparability between groups at the baseline, inclusion of all randomised participants in the analysis and blinding after allocation.

Three RCTs were identified for inclusion. A well designed study found that patient controlled breast compression gave a significant reduction in discomfort. However, the quality of mammograms was only maintained if the technologist controlled the first compression. Another study involved the technologist reducing compression force for one view. This study was poorly designed and showed no significant differences. The result was the same in a well designed study of the use of acetoaminophen as a premedication. The differences in interventions, and the inconsistency in measures and validation of pain scales and assessment of quality of mammograms, mean that the results of the studies cannot be combined.

The only intervention suggesting significant reduction in the pain and discomfort was of patient controlled compression. Further research is required to determine if these findings can be replicated. Reducing technologist applied compression force did not result in significant reduction in pain suggesting that more than actual compression force is involved in pain and discomfort. However, the poor design of this study could have influenced the results. Premedication with acetoaminophen has no effect on the pain of mammography. More research into interventions to reduce the pain of mammography is needed if this is to continue as the preferred screening method in the detection of breast cancer.