Do We Have to Suffer Pain in Breast Exams? -Compare the Pain Between Digital Screening Mammography, Automated Breast Ultrasound and Hand-Held Ultrasound

Abstract

Mammography (MAM) and Hand Held Ultrasound (HHUS) are the most common method to screen breast cancer, while Automated Breast Ultrasound System (ABUS) is a new exam for screening. This study aims to compare patients’ satisfaction and comfort associated with ABUS, HHUS and MAM. Explore its relationship with BMI, bra size, existence of nodules, nodule shape and breast density, and to evaluate the diagnostic agreement between ABUS and MAM or HHUS. Retrospective analysis the satisfaction and pain score of 528 women who performed ABUS, HHUS and the elder women received mammogram examination. These women were asked to estimate the level of pain on a scale of 0-10 (0: no, 10: highest pain). We use non-parametric statistic and Spearman correlation analysis to access the pain score difference in three methods and the relationship with some factors, including BMI (Body Mass Index), bra size, breast density, existence of masses, location and size of masses. Finally, we calculate the sensitivity and specificity of MAM, HHUS and ABUS. The average age was 51.0±10.9, and the average BMI index was 23.0±2.9. Among them, nearly half of the participants were B cups (45.5%). In this three inspection methods, the highest pain score was MAM [4.0 (2.0, 6.0)], which much higher than ABUS [2.0 (1.0, 4.0)]. And the pain score of ABUS was higher than HHUS [2.0 (1.0, 4.0) vs. 0.0 (0.0, 0.0)], comparison with statistical difference (P<0.05). The 92.4% cases were preferred to accept ABUS examination which was similar to accepting of HHUS is 94.7%, but this acceptability was much higher than mammography (45.5%). After statistical analysis, we found that BMI can affect the pain score of ABUS. The correlation coefficient of BMI and ABUS is 0.351 (P<0.01), that the heavier the more pain. Bra size is positively correlated with pain of mammography and ABUS (CC=0.120, 0.268; P <0.05). But bra size cannot affect the pain score of HHUS. Besides that, the other four factors don’t have effect on the pain degree of these three methods. Of all the 528 subjects, HHUS detected 71 suspicious lesions, MAM detected 67 and ABUS detected 70 lesions. The Kappa value between ABUS and MAM was 0.560 (P<0.05) and that of ABUS and HHUS was 0.694 (P<0.05). The results show that routine use of ABUS will be well tolerated by patients than mammography and ABUS can be used as a tool in screening for breast cancer.