Do Mammograms Hurt?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

False-positive results have been described as “the most frequent harm” associated with mammogram screening, but actually it may be pain. “There is a wide variation both in the reported frequency of pain and in…degree of pain felt by women” during mammograms. But, there may be little doubt that “the majority of women feel some degree of pain during” the procedure. Why? Isn’t it just a type of X-ray?

For those unfamiliar, the breast is sandwiched between two plates, and kind of pancaked down. Instructions are typically like, “Slowly apply compression until the breast feel[s] taut,” with a force not exceeding 20 kilograms. That’s 44 pounds! That’s like the weight of a cinder block—I mean, no wonder some women experience pain!

Studies that have attempted to quantify it are all over the place, with the incidence of pain ranging anywhere from 1% to 93%, depending on how they defined it. The discomfort is enough to keep a proportion of women from not coming back. The typical line you hear is that “Although the compression can [be] uncomfortable and even painful for some women, it only lasts…a few seconds”—a sentiment to which one woman replied, “You tell [the] doctor to come on over [here]…he’s got stuff that can be mashed too, you know…”

“Mammogram compression can cause…bruising, and has led to the rupture of breast implants, cyst[s], and…[blood vessels].” “Women with…dense breasts, are often advised to take [painkillers] or tranquilisers to endure the procedure more comfortably.” Yet, you know, pain is there for a reason. It’s trying to warn us about potential “tissue damage.” There’s at least a theoretical concern that tissue inflammation could wake up dormant tumors, but that’s sheer speculation at this point. Still, I mean, we could try to make them less painful.

The reason they do it is to “reduce breast thickness”—purportedly “decreas[ing] the radiation dose and improv[ing]…image quality.” But when it was put to the test and actually measured, one study found “the radiation dose increased [at higher] compression force[s].” Another study found that about a quarter of women “did not experience a difference in the thickness of their breasts when compression was [eased back a bit],” implying that “more compression was applied than…necessary. …[O]nce minimum thickness is achieved [then] further compression only results in more pain with no benefit to image quality.”

The bottom line is that “pain in mammography is an issue to be taken seriously.” “Recognising this in the tone and content of patient information and advising on ways to deal with it would show greater respect for patients than [just] blanket reassurance[s].” The reason women aren’t more up in arms may be that “the majority of women feel compelled (by fear or duty) to comply…”, but this just helps the medical establishment push the pain issue “to the margins.”

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• Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation. Ann Intern Med. 2016;164(4):256-67.
• Waade GG, Sanderud A, Hofvind S. Compression force and radiation dose in the Norwegian Breast Cancer Screening Program. Eur J Radiol. 2017;88:41-46.
• Van netten JP, Hoption cann S, Thornton I, Finegan R. Growing concern following compression mammography. BMJ Case Rep. 2016;2016.
• Morris N. When health means suffering: mammograms, pain and compassionate care. Eur J Cancer Care (Engl). 2015;24(4):483-92.
• Davey B. Pain during mammography: Possible risk factors and ways to alleviate pain. Radiography. Volume 13, Issue 3, August 2007, Pages 229-234.
• Brodersen J, Siersma VD. Long-term psychosocial consequences of false-positive screening mammography. Ann Fam Med. 2013;11(2):106-15.

Image credit: BartekWardziak via iStockPhoto. Image has been modified.

Motion graphics by Avocado Video

• breast cancer
• cancer
• mammograms
• pain
• side effects
• women's health