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By Arpana M. Naik, MD

Assistant Professor of Surgery Oregon Health & Science University Portland, OR

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Q: I had my yearly mammography yesterday and went to a different facility than I've used in the past. I have always experienced pain, but this time there was only a slight pinch. I wonder if it was done properly. Can you explain why there was no pain?

First, let me congratulate you for getting regular mammograms. As you know, screening mammograms are one of the best ways to insure that any cancer is caught early enough to insure a good outcome. In fact, a woman whose breast cancer is detected through screening alone is, on average, 50 percent less likely to die from the disease.

Now, as for the pain you typically experienced. There is a lot of anecdotal discussion about pain during breast imaging. However, researchers find that few women feel actual pain. One study published in 1988 in the Archives of Internal Medicine surveyed 1,847 women at seven breast-imaging centers and found that 88 percent experienced either no discomfort or only mild discomfort, and no woman had pain severe enough to keep her from having another mammogram.

Any discomfort during a traditional mammogram (not an MRI or breast ultrasound) comes when the breast is compressed between the film paddle and a piece of plastic. This flattens out the breast, enabling the technician to film the maximum amount of tissue. But you're right, it can be uncomfortable.

The amount of discomfort you feel is likely related to several things, including the skill of the technician and the time of month in your menstrual cycle (if you're still menstruating). You'll likely have less discomfort if you schedule your mammogram a week after your period, when your breasts are least tender. You may also have discomfort if you have fibrocystic breast disease, or "lumpy" breasts. Make sure you tell the technician before the scan, so that can be taken into account. If you really do have pain, bad enough to make the experience very unpleasant, you might want to talk to your health care professional about other options, such as MRI or breast ultrasound.

However, it sounds like, for whatever reason, your problems may be solved. Maybe the imaging center where you had your most recent exam used Mammo-Pads. These soft foam pads create a cushion between your breast and the surfaces of the mammography device without interfering with the x-ray. Studies find that about 74 percent of women experienced a 50 percent decrease in discomfort when using the pads.

Bottom line: The fact that you felt minimal discomfort during your mammogram in no way reflects on the quality of the image. If there was a problem with the mammogram, your technician or radiologist would have retaken the image. Before you schedule a mammogram, be sure to ask if the mammogram facility is accredited by the U.S. Food and Drug Administration. This means that it meets high professional standards of safety and quality.