Coping with the Discomfort of Mammograms

Q:  I would like to know if there is a new mammogram procedure available to women, other than flattening our breasts into two painful pancakes, in order to take an X-ray. For me it is a painful and frightening procedure (I have large breasts), and I have had negative experiences in the past. Of course we need to detect cancer at the earliest possible time; however, I am certain that the aforementioned prevalent compression procedure could actually cause more cancer than it detects. I would guess that there are thousands of women, like myself, who avoid GYN check -ups just because this test is standard procedure.

It seems to me, that I have heard about a technique where the patient lies on her stomach and the machine somehow circles the breast while taking pictures. I don't believe that there is any compression involved. At least, I hope not. Forgive me for saying this, but if a man had to put his private parts into a machine which compressed them into an 1/8th inch diameter, you can bet that someone would come up with a better and safer way to take his needed pictures.

I really need you help because I just left the radiologist's office, tearful and in pain, and I cancelled the mammogram. I will not return nor subject myself to this tortuous procedure again. I would sincerely appreciate your professional reply. I am looking for a better, safer and pain-free way to do this test.

A:  Most women, including myself, would agree with you that a mammogram is not the most comfortable experience; neither is a pap smear or a colonoscopy, but we go through those tests because we want to be screened for early cancers. With mammography, the breasts are compressed to spread the tissue apart to allow for better views and lower doses of radiation. The actual pressure is only for a few seconds, and there is no evidence that the pressure or the radiation can cause cancer! If you avoid having the procedure the week before your period when your breasts are most sensitive, you shouldn't have pain that persists afterwards.

Magnetic resonance imaging (MRI) is one of the new methods being studied to examine the breasts and is probably the technique you heard about where the woman lies on her stomach. It was hoped that MRI would be more accurate than mammography, but it has not yet been developed to that point and costs over a $1000! It is useful in detecting rupture of breast implants.

Ultrasound, which uses sound waves, is very good at evaluating if breast lumps are fluid-filled cysts or solid masses, but is not accurate enough for general screening because calcium deposits which can be one of the earliest signs of cancer are not visible.

Mammogram is still the gold standard, combined with monthly self-breast exam and a yearly exam by your physician for detecting breast cancer. I hope you will try again. Tell the technologist about your breast sensitivity and work with her so she can help you achieve the best position and relax your arm and chest muscles. That alone can make all the difference in the world.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.