Breast compression and reported pain during mammographic screening

Abstract

IntroductionWe aimed to investigate the association between breast compression and experienced pain during mammographic screening. MethodsUsing a questionnaire, we collected information on pain experienced during mammography from 1155 women screened in Akershus, February–March 2018, as a part of BreastScreen Norway. The questionnaire provided information on pain using a numeric rating scale (NRS, 0–10) and related factors. Data on compression force (Newton, N), pressure (kilopascal, kPa) and breast characteristics were extracted from the DICOM-header and a breast density software. Log-binomial regression was used to determine the relative risk (RR) of severe versus mild/moderate experienced pain associated with compression parameters, adjusting for breast characteristics and related factors. ResultsMean score of experienced pain was 2.2, whereas 6% of the women reported severe pain (≥7) during the examination. High body mass index (BMI) (≥27.3 kg/m2) was associated with a higher RR of pain scores ≥7 (RR 1.86, 95%CI 1.02–3.36) compared to medium BMI (23.7–27.2 kg/m2). Low compression pressure (4.0–10.2 kPa) was associated with a higher RR of severe pain (RR 2.93, 95%CI 1.39–6.20), compared with medium compression pressure (10.3–13.5 kPa) after adjusting for contact area, age, compressed breast thickness, volumetric breast density and BMI. The risk of severe versus mild/moderate pain (≥7 versus <7) decreased by 2% with increasing compression force (RR 0.98, 95%CI 0.97–1.00). ConclusionWomen reported low levels of pain during mammography. Further knowledge about factors affecting experienced pain is needed to personalize the examination to the individual woman. Implications for practicePain in shoulder(s) and/or neck prior to screening should be considered by the radiographers in a practical screening setting. A compression force of 100–140 N and pressure of 10.3–13.5 kPa are acceptable with respect to reported pain during mammography.