Review: preprocedure information, breast cushions, and patient-controlled breast compression reduce mammography pain
Dr D Miller, University of Otago, Dunedin, New Zealand;
How effective are interventions for reducing the pain of screening mammography?
Studies selected compared interventions to reduce the pain or discomfort of screening mammography (eg, interventions preparing women before the mammogram, affecting staff or the physical environment of the screening facility, or altering aspects of the examination procedure) with placebo or usual care in women of any age. Outcomes were pain or discomfort of the procedure and image quality of the mammogram.
Specialised Register of the Cochrane Breast Cancer Group, Medline, EMBASE/Excerpta Medica, and CINAHL (to 2006); and Current Controlled Trials and UK National Research Register (to Sep 2007) were searched for randomised controlled trials (RCTs), including quasi-randomised trials. Study authors were consulted. Searches of other databases and websites and hand searches of selected journals done in 2002 did not reveal any relevant studies and were not updated. 7 trials (n = 1712, mean age 50–59 y) met the selection criteria. 3 RCTs were placebo controlled, and 3 were crossover studies (different treatment applied to each breast). 2 RCTs reported adequate allocation concealment, 3 used intention-to-treat analysis, and 3 reported blinding of the outcome assessor.
Meta-analysis was not done because of differences in interventions. The table shows results of individual trials.
Provision of verbal or written information about mammography before the procedure, use of breast cushions, and control of breast compression by the patient reduce the pain or discomfort of screening mammography, although the latter 2 approaches may reduce image quality.
Miller D, Livingstone V, Herbison P. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database Syst Rev 2008;(1):CD002942.
Initiatives to reduce pain associated with mammography are particularly relevant because pain is a key reason for women not adhering to breast screening recommendations. The systematic review by Miller et al, which examined the effectiveness of pharmacological and non-pharmacological interventions for pain or discomfort in screening mammography, updates the authors’ earlier review from 2002. The updated review included 7 studies, 4 of which were identified in the earlier review (although 1 study was previously excluded). The review examined the effect of the interventions from 2 perspectives: patient outcomes and mammogram quality.
In all studies, patient outcome measures reflected women’s self-reported pain or discomfort. Pain and discomfort were operationalised as intensity using various rating and visual analogue scales. The authors suggested that pain and discomfort may be related indicators, yet they are conceptually distinct. Conceptual clarification, as well as use of a standardised pain intensity measure, would assist in comparisons across studies.
The 4 categories of interventions (information provision, medication, breast compression, and breast cushions) were implemented by different health disciplines and administered to different subgroups of women in various settings. Although each study provides promising information, collectively, the findings do not assist with the implementation of a change in practice.
Miller et al reported that the included studies were not methodologically sound; therefore, it is reasonable to assume that the available evidence about the effects of these interventions is not strong. More rigorous evaluation of these and other potential interventions will be required to fully inform the assessment and management of pain and discomfort associated with screening mammography.