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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Women's Health 1/2015

Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle

BMC Women's Health > Ausgabe 1/2015
Jerry E de Groot, Mireille JM Broeders, Cornelis A Grimbergen, Gerard J den Heeten
Wichtige Hinweise

Competing interests

C.A. Grimbergen is an employee, founder, board member and patent holder of Sigmascreening. G.J. den Heeten is a founder of Sigmascreening and co-patent holder on behalf of the Academic Medical Center Amsterdam. J.E. de Groot and M.J.M. Broeders have no competing interest to declare.

Author’s contributions

JdG carried out the data acquisition and analyses and drafted the manuscript. MB participated in the design of the study and the statistical analysis. CG and GdH conceived the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.



Many women consider mammography painful. Existing studies on pain-preventing strategies only mention pain scores reported before and after breast compression. Studying the pain dynamics during the entire compression cycle may provide new insights for effective pain-preventing strategies.


This observational study included 117 women who consented to use a custom turning knob to indicate their pain experience during standard mammographic breast compressions in the Academic Medical Center in Amsterdam, The Netherlands. The breast thickness, compression force, contact area, contact pressure and pain experience were recorded continuously. Breast volume was calculated retrospectively from the mammograms. We visualized the progression of pain in relation to breast mechanics for five groups of breast volumes and we performed multivariable regressions to identify factors that significantly predict pain experience.


Breast compressions consisted of a deformation phase for flattening, and a clamping phase for immobilization. The clamping phase lasted 12.8 ± 3.6 seconds (average ± standard deviation), 1.7 times longer than the 7.5 ± 2.6 seconds deformation phase. During the clamping phase, the average pain score increased from 4.75 to 5.88 (+24%) on a 0 – 10 Numerical Rating Scale (NRS), and the proportion of women who reached severe pain (NRS ≥ 7) increased from 23% to 50% (more than doubled). Moderate pain (NRS ≥ 4) was reported up to four days after the mammogram. Multivariable analysis showed that pain recollection of the previous mammogram and breast pain before the compression, are significant predictors for pain. Women with smallest breasts experienced most pain: They received highest contact pressures (force divided by contact area) and the pressure increased at the highest rate.


We suggest further research on two pain-preventing strategies: 1) using a personalized compression protocol by applying to all breasts the same target pressure at the same, slow rate, and 2) shortening the phase during which the breast is clamped.
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