Elsevier

Social Science & Medicine

Volume 49, Issue 7, October 1999, Pages 933-941
Social Science & Medicine

Risk factors of pain in mammographic screening

https://doi.org/10.1016/S0277-9536(99)00181-1Get rights and content

Abstract

Mammography is an important tool in the secondary prevention of breast cancer. However, earlier research has pointed out that an unpleasant experience during a previous mammography can deter women from returning for mammography screening. It is known that mammography can be a painful examination for some women. The research presented in this article focuses on the experience of pain during and after mammography (247 patients). Firstly, the study sets out to determine the extent to which women actually experience pain as a result of mammographic examination. Secondly, it focuses on identifying the factors that determine the risk of a painful experience during the screening procedure. A pain model was developed that takes into account a broad range of potential pain factors, including other than woman-related factors and factors associated with the actual examination. Special attention was paid to the examination context, the mammographic procedure and the screening staff. The research results show that the majority of women experience pain during mammography. With a logistic regression a number of women-related factors, staff-related and procedural factors were found significant in assessing the pain risk during mammography.

Introduction

Breast cancer is an important health issue in most European countries. In Flanders, it is the most common type of cancer in women and it is responsible for the loss of more potential years of life than any other cause of death (Ministry of the Flemish Community, 1996). Early detection is until today the only efficient means of (secondary) breast cancer prevention. The earlier breast cancer is detected, the earlier treatment can be started and the greater the chance of cure. Together with self-examination and clinical examination by physicians, mammographic examination (i.e. an X-ray of the breast) is regarded as the most effective way of detecting breast cancer. In 1996 a total of 628.602 mammographies were taken in Belgium (approx. 10 million inhabitants) (Ministry of the Flemish Community, 1998). As such, mammography is an important tool in breast cancer prevention policy today (Hakama et al., 1997). The drawback from the mammographic screening procedure is the intrinsic motivation of women to take part in it. In Belgium only 20–33% of the women contacted to participate in a screening respond. Painful experiences with mammography are considered to be a crucial factor for no longer participating in the program. This article searches for the main sources of pain in the mammographic procedure.

Section snippets

Literature review

Women who have an average risk of developing breast cancer are recommended in Belgium to go for a regular screening mammography from age 50. Women under 50 are primarily advised to regularly examine their own breasts; in their case, mammography is only required if there is an increased breast cancer risk (Drossaert et al., 1996), or if a suspect lump is discovered or other breast cancer symptoms are noticed. Regular screening under 50 is discouraged because of the multiple adverse effects (

Study objective

In the course of 1996, a study of mammography pain was carried out at the Department of Political and Social Sciences at Antwerp University (UIA). The purpose was to gain insight into why some women feel pain during mammography and others do not. Firstly, the study set out to determine to what extent women actually experience pain as a result of mammographic examination. Secondly, it focused on identifying the factors that determine the amount of pain that a woman experiences. This article will

Results

Before we turn to the analysis of the different pain factors, we will first present a descriptive overview of the different subjects within our sample.

Discussion

Since pain during mammography is an important element for the success of breast cancer prevention campaigns (Rutter et al., 1992), it is of special importance to gain insight in the different factors that can influence the experience of pain. A woman’s perception of mammography, how she assesses the procedure and the way in which she relates the event are partly determined by the degree of pain she felt during the examination. Moreover, it appears that the whole mammography experience

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    Most cases of DCIS will not be associated with subsequent invasive breast cancer,67–69 but almost all women diagnosed with DCIS undergo lumpectomy with radiation therapy and a substantial proportion are treated with mastectomy. Women having mammograms often experience pain from compression of the breast70,71 and for 20% to 30% of women the pain is moderate to severe.72,73 In addition, it has long been recognized that exposure to ionizing radiation through mammography, although limited, may be associated with a small increased risk of cancer, particularly if the exposure occurs at a young age.74–76

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