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

Search strategy
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.

Selection criteria
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.

Data collection and analysis
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.

Main results
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.

Authors’ conclusions
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.

Plain language summary
Increasing women’s control over their breast compression during mammography reduces the pain of the procedure, but paracetamol as premedication does not help

Screening uses a test to check people who have no symptoms of a particular disease, to identify those who might have that disease. Mammography uses x-ray to try to find early breast cancers before a lump can be felt. For mammography to be accurate, the woman’s breasts are compressed. However this can cause discomfort or pain that might prevent the woman undergoing mammograms in future. The review found that increasing women’s control over their breast compression reduced pain during the procedure, whereas paracetamol premedication did not. Further interventions to make breast cancer screening as painless as possible are needed.

D Miller, I Martin, P Herbison

Cochrane Database of Systematic Reviews 2007 Issue 3

DOI: 10.1002/14651858.CD002942   This version first published online: 21 October 2002 in Issue 4, 2002
Date of Most Recent Substantive Amendment: 21 June 2002

This record should be cited as: Miller D, Martin I, Herbison P. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD002942. DOI: 10.1002/14651858.CD002942.

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