Experience of pain during mammographic screening by three different compression paddles

Experience of pain during screening mammography is shown to affect further attendance negatively. We aimed to explore the experience of pain during screening mammography using three different breast compression paddles.

Using a self-report questionnaire, we collected information on pain experienced during mammography from 938 women screened in Bodø at Nordland Hospital County in 2018, as a part of BreastScreen Norway. Pain was assessed by a numeric rating scale (NRS, 0-10). A fixed paddle, a flexible paddle or a fixed paddle standardizing pressure (study paddle) were used during screening. Compression force (kg) was recorded by the radiographers for each screening examination. Log-binomial regression was used to determine the relative risk (RR) of severe (≥7 on NRS) versus mild/moderate (<7 on NRS) experience of pain associated with type of compression paddle, adjusting for breast tenderness, shoulder(s) and/or neck pain prior to screening, compression force, age, body mass index and screening history.

Mean score of self-reported experienced pain was 2.8 for the fixed, 2.3 for the flexible and 2.8 for the study paddle (p < 0.03 for fixed versus flexible and for flexible versus study paddle). Adjusted RR of severe pain was higher for the fixed (RR^Adj 2.01, 95%CI 1.13-3.59) and the study paddle (RR^Adj 2.52, 95%CI 1.44-4.42) compared to the flexible paddle. Breast tenderness was associated with a higher risk (RR^Adj 1.93, 95%CI 1.04-3.58) of severe pain compared to no breast tenderness.

Women screened with the flexible paddle reported lower experience of pain than those screened with the fixed or study paddle.

The flexible compression paddle might be the best choice regarding experience of pain in screening mammography. Breast tenderness should be considered by the radiographers in a practical screening setting.