Psychological Factors Influencing Pain Perception and Experience in Women Undergoing Mammography: A Systematic Review

Pain during mammography is a common experience among women and has been identified as a potential barrier to adherence to breast cancer screening programs. While technical and biological factors contribute to pain, emerging evidence suggests that psychological factors may significantly influence pain perception and experience during mammography. This systematic review, therefore, aims to examine the association between psychological factors and the experience of pain during mammography, as well as the intensity of pain experienced during mammography, as measured through validated pain scales or self-reported questionnaires. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines were used to conduct the systematic review. The electronic databases PubMed and Scopus were used to systematically search for published articles. Keywords used included (mammograph* OR "screening mammograph*" OR mammogram* OR "breast cancer screening" OR "mammographic screening") AND ("psychological factor*" OR anxiety OR stress OR fear OR "fear of pain" OR pain OR catastrophizing OR "pain catastrophization" OR depression OR "coping strateg*" OR neuroticism OR extraversion) AND (pain OR soreness OR tenderness). Eligibility criteria, including study population, outcome/exposure of interest, study type, language, and publication status, were used to identify relevant literature that measured the association between psychological factors and pain experience. This was a systematic review of publications without year limitations. We found 2,761 articles; 743 were excluded due to duplication. Of the remaining 2,018 studies, 11 were included. Anxiety, pain expectations, previous mammography experience, and nervousness were the most consistently associated psychological factors with increased pain perception during mammography. Coping-related psychological factors showed a consistent pattern: catastrophizing was linked to higher pain intensity, whereas adaptive strategies such as ignoring pain or increasing behavioral activity were associated with less pain. Additionally, higher coping efficacy provided a protective effect on the pain experience. The relationship between depression and pain was inconsistent, and findings regarding personality traits and fear of pain were inconclusive. Pain during mammography was found to be highly prevalent, ranging from 6% to 93% across studies, with moderate to severe pain reported in a substantial proportion of participants. Psychological factors play a significant role in shaping women's perception and experience of pain during mammography. Anxiety, pain expectations, prior painful experiences, and maladaptive coping strategies such as catastrophizing were associated with higher pain intensity, whereas coping efficacy and adaptive strategies appeared protective. Recognizing these psychological influences is important for understanding differences in women's mammography pain experiences.