Study reports women don’t experience undue pain, anxiety during mammography screening

The assumption that women avoid mammograms for fear of pain is challenged in a study published in the February 2005 issue of The American Journal of Roentgenology, which finds that women undergoing screening mammography report minimal levels of distress.

“I think it’s an old wives tale that mammograms hurt,” says the study’s lead author Alice Domar, PhD, Director of the Mind/Body Center for Women’s Health at Boston IVF and senior psychologist in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center (BIDMC). “Our results showed that women find mammograms to be a very benign experience.”

According to the American Cancer Society, one-third to one-half of women do not follow screening guidelines for mammography, which recommend annual screenings for women over the age of 50. Previous studies had found that the majority of women who fail to return for repeat screenings following their initial mammogram cite pain during the procedure as the reason.

Knowing that relaxation techniques have been effective in reducing pain and anxiety during radiological procedures such as endoscopy, arteriography and nuclear magnetic resonance imaging, the authors hypothesized that listening to a relaxation tape prior to and during mammography would decrease women’s feelings of pain and anxiety and thereby improve their compliance in undergoing routine mammograms.

A total of 150 subjects were divided into three groups: those who listened to a relaxation tape, those who listened to music, and a control group, who were assigned a blank tape. The tapes were played both prior to and during the mammogram screening. When the mammogram had been completed, each subject was asked to fill out two self-report questionnaires, the Spielberger State-Trait Anxiety Inventory and the McGill Pain Questionnaire, and to provide an estimate of how much pain and/or anxiety they had experienced during the test.

Analysis of the results found that – contrary to expectations – there were no significant differences in terms of pain perception between the subjects who listened to the relaxation tape and the other two groups, the reason being that none of the three groups reported undue distress, according to Domar. “Virtually none of the participants experienced pain or anxiety,” she says. “We were quite surprised at the outcome.”

Based on these results, the investigators plan to design a similar study to be tested on a more distressed population, for example, women who have been recalled for an abnormal screening mammogram. In the meantime, she adds, they hope to get the word out about the results of this study. “Perhaps if women learned that. ….routine screening mammography is associated with very low levels of anxiety and pain, their fear may subside enough to comply with screening guidelines,” the authors write. Adds Domar, “My goal would be to see 100 percent of women over 50 undergoing regular screening mammograms.”

This study was funded by grants from the Advanced Medical Research Foundation and the Goodale Fellowship, Harvard Medical School.

Study coauthors include senior author Janet Baum, MD, and Aimee Eyvazzadeh, MD, of BIDMC; Sarah Allen, Kara Roman, and Rebecca Wolf of the Mind/Body Medical Institute; John Orav, PhD, of Brigham and Women’s Hospital; and Nile Albright, MD, of the Advanced Medical Research Foundation.