Intervention Review

Interventions for relieving the pain and discomfort of screening mammography

  1. Dawn Miller2,*,
  2. Vicki Livingstone3,
  3. G Peter Herbison4

Editorial Group: Cochrane Breast Cancer Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 17 MAY 2006

DOI: 10.1002/14651858.CD002942.pub2


How to Cite

Miller D, Livingstone V, Herbison GP. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD002942. DOI: 10.1002/14651858.CD002942.pub2.

Author Information

  1. 2

    University of Otago, Women's and Children's Health, Dunedin School of Medicine, Dunedin, New Zealand

  2. 3

    University of Otago, Preventive & Social Medicine, Dunedin, New Zealand

  3. 4

    Dunedin School of Medicine, University of Otago, Department of Preventive & Social Medicine, Dunedin, New Zealand

*Dawn Miller, Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. dawn.miller@stonebow.otago.ac.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The pain of mammography is recognised as a significant deterrent for women considering this examination, and may affect participation in breast screening.

Objectives

To review interventions to reduce or relieve the pain and discomfort of screening mammography.

Search methods

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.

Selection criteria

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.

Data collection and analysis

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.

Main results

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.

Authors' conclusions

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for relieving the pain and discomfort of screening mammography

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

減輕乳房攝影篩檢所造成疼痛和不適的措施

乳房攝影篩檢所造成疼痛已被認為是婦女考慮接受檢查與篩檢的重要因素。

目標

本綜合回顧文獻研究減輕乳房攝影篩檢所造成疼痛和不適的措施

搜尋策略

為能夠確實更新,2006年5月18日搜尋考科藍乳癌專業小組中的註冊資料。以及搜尋其它資料庫包括MEDLINE(1966年至2006年11月),CINAHL(1982年至2006年12月),EMBASE(1988年至2006年)和文章的參考文獻。 我們也搜尋了Current Controlled Trials (www.controlledtrials.com,2007年九月登入)以及應UK National Research Register (www.updatesoftware.com/national/,2007年九月登入 以找出進行中或已完成的研究。 同時也連絡了這個領域的研究人員。

選擇標準

隨機對照試驗和類似隨機試驗中的對照組進行比較。研究必須包括評估疼痛或不適,並著重在乳房攝影檢查及影像品質的評估。

資料收集與分析

二位作者(DM和VL)檢驗研究確定是否符合納入標準。每個研究品質的分析,包括分派在小組之間的隱匿和分配次序的設定,群體之間的可比性基線,所有參與者隨機分析和致盲後分配。由這兩位作者執行數據抽取。

主要結論

7個隨機對照試驗,1671名婦女確定列入。本綜合回顧文獻研究發現檢查之前告知婦女有關乳房攝影檢查的程序,可減少疼痛和不適。提高婦女對乳房壓縮的控制可減少乳房攝影檢查過程的疼痛。如果技術人員控制第一次壓縮就能維持乳房攝影的圖像質量。如果技術員減少乳房攝影檢查過程對乳房壓縮力,所造成不適仍然不變。使用乳房墊可減少乳房攝影檢查疼痛,然而,判讀者解讀時則認為圖像品質減弱2% 。Acetoaminophen作為檢查前用藥並不影響乳房攝影檢查所造成乳腺不適。不同判讀者,不同度量,研究者所使用疼痛指數不同,不同的評估乳房攝影檢查圖像品質標準,意謂著這些研究的結果不能被結合起來。所有的結果都是基於單一的研究。進一步的研究是必要的。

作者結論

直至目前,很少有效減輕乳房攝影篩檢所造成疼痛和不適的措施被提出,尤其是程序可以很容易地引入篩檢方案。乳房攝影仍是乳癌篩檢首選方法,更多地研究是必要的。

翻譯人

本摘要由中山醫學大學附設醫院蕭品卉翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

乳癌是最常見的婦女癌症,藉著定期乳癌篩檢可降低乳癌死亡率。 沒有症狀的婦女接受乳房攝影,可以檢查出那些人有乳癌。乳房攝影檢查用X射線發來發現早期乳癌。為獲得準確的判讀,乳房X線機器必需壓縮乳房。壓縮乳房可能會導致不適或疼痛,有些婦女決定不接受乳房攝影檢查,就是因為這個原因。一些乳房攝影研究顯示高達35%的婦女感覺疼痛。本綜合回顧文獻研究在釐清那些減輕乳房攝影篩檢所造成疼痛和不適的措施。具備質量標準,確保相關的研究和精心設計,才納入本研究。7項研究符合這些標準。這些研究涉及範圍廣泛,減輕疼痛和不適的的措施,在做乳房攝影檢查前為婦女提供口頭和/或書面資料,使用乳房墊(填充在乳房的表面與X線照相設備),或使用緩解疼痛藥,病人自行控制乳房的壓縮,並減少技術人員壓縮乳房。這些研究評估婦女對疼痛的預期,實際經驗,通過各種研究方法,不同的品質問卷。本綜合回顧文獻研究在釐清那些減輕乳房攝影篩檢所造成疼痛和不適的措施。試驗結果顯示在做乳房攝影檢查前為婦女提供口頭和/或書面資料,可以減輕疼痛和不適。增加病人自行控制乳房的壓縮,可以減輕疼痛和不適,雖然比較由技術人員壓縮之乳房疼痛經驗並沒有改變,使用乳房墊,也可以減輕疼痛和不適,然而,圖像品質減弱2% ,這意味著他們需要有進一步乳房X光檢查。在做乳房攝影檢查前投予Paracetamol並沒有改變婦女疼痛,更多地研究減輕乳房攝影篩檢所造成疼痛和不適的措施是必要的。