Abstract
The X-ray mammogram remains the cornerstone of most public health programmes aimed at the early diagnosis of breast cancer. Its virtues of safety, reliability and cheapness maintain its established position, and Western social and cultural traditions of ambivalence to pain push any questions concerning the painfulness of the procedure into the background. As part of a larger UK/USA-based empirical study, we undertook a qualitative analysis of women's accounts of pain experienced in mammograms and their reaction to it, comparing their accounts with professional views and advice to patients as reflected in interviews, patient leaflets and practice guidelines. We found considerable variability of experience and reaction to pain among patients, and indications of similar variability in professionals' views and practice, contrasting with a uniformly reassuring message in formal institutional advice. We suggest that in practice professional work-arounds and patients' felt obligation to tolerate pain bridge this gap, but that action to tackle the problems of dropout and the emotional and operational costs of the current system is nonetheless needed. The need is for concerned groups to combine to establish a serious and sustained programme of amelioration and innovative technological development to assure more compassionate patient care and operational efficiency.
Highlights
Cancer is recognised as a major public health risk in most advanced societies, and national health-care policies actively promote early diagnosis and treatment
The mammogram is well established as the principal instrument for early diagnosis and is widely used in mass screening programmes as well as in clinical diagnosis
Participating patients’ views on pain in mammograms not homogenous share common themes
Summary
Cancer is recognised as a major public health risk in most advanced societies, and national health-care policies actively promote early diagnosis and treatment. The mammogram is well established as the principal instrument for early diagnosis and is widely used in mass screening programmes as well as in clinical diagnosis. Mammogram use is not without controversy, with. European Journal of Cancer Care, 2014 concerns centring principally on diagnostic accuracy, risks from radiation and ‘overdiagnosis’, leading to unnecessary treatment (Jørgensen et al 2011). Amidst these concerns and controversies, there has been little room for critical consideration of the physical demands of the procedure itself and what that means for patients. There is a background rumble of discussion in the scholarly literature and less formal sources, which suggests that pain in mammography is not a negligible issue for patients and not without costs
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