Psychological Factors and Personality Traits Influencing the Experience and Perception of Pain in Women Undergoing Mammography: Protocol for a Cross-Sectional Study

Breast cancer screening through mammography is essential for early detection and improved survival; however, pain and discomfort during the procedure remain major barriers to women's participation. Pain perception during mammography is influenced not only by technical factors but also by psychological variables such as anxiety, depression, pain catastrophizing, and personality traits. Despite growing evidence, findings on the role of psychological factors remain inconsistent, and the contribution of personality traits remains largely unexplored, highlighting the need for further investigation.

This study aims to investigate associations among psychological factors (anxiety, depression, and pain catastrophizing), Ten-Item Personality Inventory personality traits, and pain perception and experience in women undergoing routine mammography at public and private radiology centers in Cyprus. The study hypothesizes that higher anxiety levels and first-time mammography experience are associated with greater perceived pain during mammography.

This cross-sectional study will include approximately 380 women aged 35 to 75 years undergoing routine screening mammography at public and private radiology centers in Cyprus. Participants will complete the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Ten-Item Personality Inventory, and a demographic and clinical questionnaire before the examination. The primary outcome will be perceived pain intensity during mammography, assessed immediately after the examination using a Visual Analog Scale. Psychological factors, including anxiety, depression, pain catastrophizing, and personality traits, will be evaluated as the main independent variables. Secondary analyses will examine the role of demographic and clinical characteristics, as well as previous mammography experience, in pain perception. Descriptive statistics will summarize participant characteristics, and associations between study variables and pain intensity will be examined using Pearson or Spearman correlation analyses and hierarchical multiple linear regression models adjusted for relevant confounders. The study will be conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies.

Participant recruitment and data collection began in March 2026. By June 2026, 50 women had been enrolled in the study. Recruitment and data collection are expected to continue through September 2026. Data analysis is anticipated to be completed by December 2026, with dissemination of findings and manuscript submission planned for 2027. Following study initiation, the study setting was expanded to include a public radiology center to facilitate recruitment and enhance sample representativeness.

If the study findings support the proposed associations, early identification and management of psychological factors related to pain perception during mammography may improve women's overall experience, enhance comfort during the procedure, and potentially increase adherence to breast cancer screening programs.