Experience of pain during mammographic screening by three different compression paddles.

INTRODUCTION: Experience of pain during screening mammography is shown to affect further attendance negatively. We aimed to explore the experience of pain during screening mammography using three different breast compression paddles. METHODS: Using a self-report questionnaire, we collected information on pain experienced during mammography from 938 women screened in Bodø at Nordland Hospital County in 2018, as a part of BreastScreen Norway. Pain was assessed by a numeric rating scale (NRS, 0-10). A fixed paddle, a flexible paddle or a fixed paddle standardizing pressure (study paddle) were used during screening. Compression force (kg) was recorded by the radiographers for each screening examination. Log-binomial regression was used to determine the relative risk (RR) of severe (≥7 on NRS) versus mild/moderate (<7 on NRS) experience of pain associated with type of compression paddle, adjusting for breast tenderness, shoulder(s) and/or neck pain prior to screening, compression force, age, body mass index and screening history. RESULTS: Mean score of self-reported experienced pain was 2.8 for the fixed, 2.3 for the flexible and 2.8 for the study paddle (p < 0.03 for fixed versus flexible and for flexible versus study paddle). Adjusted RR of severe pain was higher for the fixed (RRAdj 2.01, 95%CI 1.13-3.59) and the study paddle (RRAdj 2.52, 95%CI 1.44-4.42) compared to the flexible paddle. Breast tenderness was associated with a higher risk (RRAdj 1.93, 95%CI 1.04-3.58) of severe pain compared to no breast tenderness. CONCLUSION: Women screened with the flexible paddle reported lower experience of pain than those screened with the fixed or study paddle. IMPLICATION FOR PRACTICE: The flexible compression paddle might be the best choice regarding experience of pain in screening mammography. Breast tenderness should be considered by the radiographers in a practical screening setting.

Breast compression and reported pain during mammographic screening.

INTRODUCTION: We aimed to investigate the association between breast compression and experienced pain during mammographic screening. METHODS: Using 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. RESULTS: Mean 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). CONCLUSION: Women 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 PRACTICE: Pain 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.