Breast cancer is the most common cancer affecting women. Screening for breast cancer by means of regular mammograms reduces the death rate from this disease. In the screening process, women who have no symptoms of disease undergo a mammogram, which can identify those who might have breast cancer. Mammography uses X-rays to find early breast cancers. In order to obtain an accurate reading, the mammography machine needs to compress the breasts. This can cause discomfort or pain, and some women decide not to have mammograms because they can be painful. In some mammography studies, up to 35% of women report pain with the procedure.This review tried to identify and assess clinical studies of interventions designed to reduce the pain or discomfort that women can experience during mammography. A set of quality criteria were decided to ensure that only studies that were relevant and well designed were included in this review. Seven studies met these criteria and were included. The studies involved a wide range of interventions to relieve the pain and discomfort of screening mammography, such as providing women with verbal and/or written information before the procedure, or pain relief medication taken before the examination, use of a breast cushion (to pad the surface of the mammography equipment), patient-controlled compression of the breast, and reduced compression by the technician. The studies assessed the pain the women expected, and actually experienced, by means of a range of questionnaires of differing quality.
Each study included in this review looked at a different intervention to reduce pain in mammography. The trial results show that giving women written or verbal information about the procedure prior to the mammogram can reduce pain or discomfort of the examination. Also increasing women's control of breast compression could reduce the pain they experience, though there was no change in the pain women experienced when a mammography-technologist reduced the compression force. Use of breast cushions also reduced the pain; however, it caused a poor quality of X-ray in 2% of women screened, which meant that they would need to have a further mammogram. Paracetamol taken before the procedure did not change the pain the women experienced.
Further research is needed on interventions to relieve the pain and discomfort of screening mammography.
阅读完整摘要
The pain of mammography is recognised as a significant deterrent for women considering this examination, and may affect participation in breast screening.
研究目的
To review interventions to reduce or relieve the pain and discomfort of screening mammography.
检索策略
For this update, the Cochrane Breast Cancer Group Specialised Register was searched on the 18th May 2006. Other databases searched were MEDLINE (1966 to November 2006), CINAHL (1982 to December 2006), EMBASE (1988 to 2006) and reference lists of articles. We also searched Current Controlled Trials (www.controlled-trials.com, accessed September 2007) and the UK National Research Register (www.update-software.com/national/, accessed September 2007) for ongoing and completed research projects. Researchers in the field were also contacted.
纳入排除标准
Randomised controlled trials and quasi-randomised trials with a comparison group were considered. Studies had to include assessment of pain or discomfort and, if the intervention could have impacted on the quality of the mammograms, an assessment of image quality was also required.
资料收集与分析
Two authors (DM and VL) reviewed identified studies to determine whether they met the inclusion criteria. Each study was reviewed for quality, including concealment and generation of allocation sequence, comparability between groups at baseline, inclusion of all randomised participants in analysis and blinding after allocation. Data extraction was performed by these two authors.
主要结果
Seven RCTs, involving 1671 women were identified for inclusion. The review found that giving women information about the procedure prior to the mammogram may reduce pain and discomfort. Increasing women's control over breast compression could reduce pain experienced during the procedure, though mammogram image quality was only maintained if the technologist controlled the first compression. If the technologist reduced compression force of the mammogram, discomfort experienced was unchanged. The use of breast cushions reduced pain of mammography; however, image quality was impaired in 2% of women in the intervention group. Acetoaminophen as a premedication did not affect discomfort of mammography. Differences in interventions, and inconsistency in measures, validation of pain scales, and in assessment of mammogram quality, mean that results of these studies cannot be combined. All results are based on single studies. Further research is required.
作者结论
Currently there are very few proven interventions to reduce pain and discomfort of screening mammography, especially procedures that can be readily introduced to screening programmes. With mammography continuing as the preferred method for breast screening, more research on such interventions is needed.
