Easing Discomfort of Mammograms

< July 23, 2008 > -- It is a fact of life that mammograms are uncomfortable, but a new study suggests that applying a topical analgesic before the test could significantly ease the discomfort associated with the test.

And a test that is less painful may encourage more women to get screened, the researchers suggest.

Results of the study are published in the medical journal Radiology.

Breast cancer affects more women than any other non-skin cancer and, according to the American Cancer Society (ACS), accounts for more than 40,000 deaths annually in the US. Most experts agree that the best way to decrease breast cancer mortality is through early detection using mammography and clinical breast exam.

"Mammography saves lives, and we would like women to know that if they're delaying or avoiding mammograms because they expect higher discomfort, they should try this product and see if it can become a better experience. It makes mammograms much more tolerable," says study author Colleen Lambertz, MSN, MBA, FNP, a nurse practitioner in the radiation oncology department at St. Luke's Mountain States Tumor Institute in Boise, Idaho.

Breast Discomfort Can be Relieved

For a mammography exam, a radiologic technologist positions the patient's breast on a platform in a mammography unit. The breast is then gradually compressed with a paddle. The patient may feel pressure and occasionally some discomfort or pain.

Fear of this discomfort leads many women to avoid mammograms altogether. Studies have shown that as many as two-thirds of women do not follow established guidelines for mammography.

In an attempt to make the procedure less painful, Lambertz and her colleagues recruited 418 women between the ages of 32 and 89 who expected mammography to be painful and unpleasant. This group was randomly divided to receive pre-mammography acetaminophen, ibuprofen, a topical 4 percent lidocaine gel, or an oral or topical placebo.

The gel was applied to the skin of the breasts and chest wall and then removed 30 to 65 minutes before mammography. The gel had no effect on subsequent image quality.

Women who used the lidocaine preparation reported significantly less breast discomfort, according to the study.

How Effective is the Gel?

Dr. Julia Smith, director of the Breast Cancer Screening and Prevention Program at the New York University Lynne Cohen Breast Cancer Preventive Care Program, points out that the lidocaine did not make a dramatic difference. She says that although women reported less discomfort with the lidocaine gel, they did not report significantly higher satisfaction.

"What this study does highlight is that women shouldn't have to undergo this kind of pain. We should have an improvement in technology. Mammograms are unpleasant, and it's going to take more than giving people Tylenol; we need better technology," Dr. Smith says.

Dr. Smith also expresses concern that the gel might affect the quality of the mammogram, and that no large-scale study has been done to assess whether or not such a gel could interfere with image quality.

Lambertz says no difference in image quality was found for the women they studied.

Mammography Saves Lives

"Mammography is the only screening tool proven to reduce mortality from breast cancer in women over 40," says study co-author Dr. James R. Maxwell, medical director of St. Luke's Breast Care Services. "Annual screening is the most important option available to a woman to best ensure early detection and decrease the chance of being diagnosed with an advanced stage breast cancer."

Lidocaine gel is a readily available, over-the-counter anesthetic that is easy to apply and remove. For the study, the gel was applied by the attending nurse; however, women could apply the gel at home one hour prior to appointment time and remove it right before undergoing the exam.

"We designed this study around safe and available over-the-counter products in order to put women more in control, so they may have a more comfortable and satisfactory experience," Lambertz says.

Eighty-eight percent of study participants indicated they would definitely get a mammogram the following year, and 10 percent said they would probably get a mammogram the following year.

"Women can now take charge of the situation," Lambertz says. "They can schedule a mammography appointment for a time in their cycle when their breasts are least tender, apply the gel at home and drive to the appointment knowing they have taken steps toward a positive experience with this potentially life-saving procedure."

Always consult your physician for more information.

More about Mammography

A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints.

Mammography cannot prove that an abnormal area is cancer, but if it raises a significant suspicion of cancer, tissue will be removed for a biopsy. Tissue may be removed by needle or open surgical biopsy and examined under a microscope to determine if it is cancer.

Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results. Today, dedicated equipment, used only for breast x-rays, produces studies that are high in quality but low in radiation dose. Radiation risks are considered to be negligible.

There are different types of mammograms. According to the National Cancer Institute (NCI):

• A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs of breast cancer. It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.
• A diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as: a lump, pain, nipple thickening or discharge, or a change in breast size or shape. A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman's age.

The recent development of digital mammography technology shows promise for improved breast imaging. Digital mammography provides electronic images of the breasts that can be enhanced by computer technology, stored on computers, and even transmitted electronically in situations where remote access to the mammogram is required.

X-rays of the breast are different than those used for other parts of the body. The breast x-ray does not penetrate tissue as easily as the x-ray used for routine x-rays of other parts of the body. The breast is compressed by the mammogram equipment to spread the tissue apart. This allows for a lower dose of radiation.

Compression of the breast may cause temporary discomfort, but is necessary to produce a good mammogram. The compression only lasts for a few seconds for each image of the breast. A breast health nurse or x-ray technologist usually takes the x-rays, but the resulting films are read and interpreted by a radiologist, who reports the results to your physician.

The NCI recommends that women age 40 and older should have a screening mammogram on a regular basis, every one to two years.

The American Cancer Society (ACS) recommends women 40 years of age and older should have a screening mammogram every year.

Consult your physician regarding the screening guidelines that are appropriate for you.

Always consult your physician for more information.