Having an annual screening mammogram is an important step in detecting breast cancer, particularly in its early stages when it tends to be more easily treatable. But many women dread having to do it because it’s so uncomfortable, if not outright painful.
A 2021 study found that nearly 80% of women experienced pain during mammography. This isn’t a surprise considering that “it is normal and very common for women to have sensitive breast tissue,” Dr. Laura H. Dean, radiologist in the section of breast imaging at Cleveland Clinic, tells Yahoo Life. However, that can create a barrier for women. Research shows that the painful experiences with mammograms prevent some women from returning for future screenings.
Mammograms have been recommended as a screening tool by the American Cancer Society since 1976. Although some technological advancements have been made over the years, including 3D imaging and increased sensitivity at detecting cancers, the discomfort women experience hasn’t significantly improved.
Why is that the case? Here’s what experts have to say — and how to make the experience a more comfortable one.
Why do mammograms hurt?
A screening mammogram takes about 15 minutes to perform and usually involves two mammograms of each breast, Dr. Karla Sepulveda, associate professor of radiology at Baylor College of Medicine and medical director of breast imaging at the Dan L. Duncan Comprehensive Cancer Center, tells Yahoo Life. “With each view, there are brief periods of compression to the breast so that overlapping breast tissue is separated. This compression is what causes discomfort during the exam, but it also helps the radiologist to better visualize findings in the breast tissue.”
Sepulveda says that, overall, “the lifesaving benefits of mammograms far outweigh any potential mild side effects of the exam. Most patients say the discomfort is temporary and tolerate the exam well.”
What can women do to make mammograms more comfortable?
Timing matters in scheduling a mammogram. “Breast tenderness can increase the week before and during your menstrual cycle,” says Sepulveda. “For patients that have discomfort during their mammogram, we recommend that they come for their exam one to two weeks after your menstrual period starts to minimize discomfort.”
However, experts say it’s better to show up for your appointment no matter where you are in your menstrual cycle rather than putting it off. “We discourage women from delaying screening if this occurs at the expense of scheduling,” says Dean.
Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, beforehand can also help ease discomfort. “Some patients will eat before their exam to prevent feeling lightheaded,” adds Sepulveda.
As with most things in life, good communication is key. Experts recommend letting the technologist know if you experience serious discomfort at any point during the mammogram, “as there may be modifications in positioning or in compression that may make the mammogram easier to tolerate,” says Dean. “The amount of compression is also adjustable, and studies have shown that women report a better mammogram experience when they are allowed to control the degree of compression.”
Although it’s easier said than done, Sepulveda recommends trying to relax as much as possible during the exam. “This helps the technologist to position you better, which makes the exam go faster,” she says.
Why hasn't technology evolved much in terms of making mammograms more tolerable?
What makes the mammogram uncomfortable is the compression, explains Sepulveda. “While mammography technology has improved with tomosynthesis (3D) technology and contrast-enhanced mammography, these technologies still require compression in order to separate overlapping breast fibroglandular tissue,” she explains. “This compression allows improved visualization of potential abnormalities in the breast tissue by the radiologist.”
However, knowing that women “report unpleasant experiences” during the mammogram exam, says Dean, research has been done to improve the mammogram experience for patients. These advancements include more flexible compression paddles, patient-controlled compression and faster acquisition times that amount to overall less time in compression, she points out.
What might mammograms of the future look like?
Experts expect that we’ll continue to have faster machines, which allow “even better images with shorter exam times,” says Dean.
Mammograms of the future will also integrate artificial intelligence (AI) in multiple ways: “to ensure technically adequate image acquisition by the technologist, to estimate future risk of breast cancer, to create individual personalized risk-screening protocols and to estimate the probability that an abnormality seen on a mammogram is cancer,” says Sepulveda.
AI may also help with contrast-enhanced digital mammograms, which involve having a contrast dye given intravenously to make it easier to see cancer in the breast, including in women with dense breasts and those with an abnormality that was detected during a traditional mammogram. (The uptake of the dye is higher in tumors than in normal breast tissue, making it easier to spot.) Research shows that AI can “potentially simulate vascularity in the breast without having to administer intravenous contrast,” explains Sepulveda. “This vascular imaging of the breast provides the most sensitive information for detecting breast cancer.”
Of course, as Dean notes, “many women dream of a breast cancer screening tool that doesn't require compression.” However, compression mammography “continues to be the gold standard” for breast cancer screening and “is the only breast-screening tool that has been shown to reduce mortality from breast cancer.”
That said, Dean says that mammography equipment and techniques will continue to improve over the coming decades, “with the goals of further increasing our cancer detection rates while also ensuring a positive experience of the patient.”
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