Self-Controlled Mammograms: Less Pain, Same Image

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mammogram X-ray

Feb. 6, 2019 — Mammograms that let women control the compression of their breasts cause less pain while maintaining the quality of the image, according to a new French study.

“Women performing self-compression have a greater ability to tolerate the breast compression,” says study researcher Philippe Henrot, MD, of the Institut de Cancerologie de Lorraine in Vandoeuvre-les-Nancy, France. The study is published in JAMA Internal Medicine.


Anxiety about pain or discomfort from compression during the exam is a common reason women skip mammograms, the researchers say.

In the U.S., at least one system that allows self-compression is available.


Study Details

Henrot’s team randomly assigned 549 women, on average about age 61, to either a self-compression group or a standard compression group, where a radiographer applied the compression.



Compression reduces breast thickness and is crucial to produce a good image of the breast and better detect cancer.

The study was done at six cancer care centers in France from May 2013 to October 2015. Women who have had breast cancer or a mastectomy were excluded, as well as those with breast implants.

The researchers looked at breast thickness after compression and found no difference between the self-compression group and the standard group. The radiographer still positions the breasts in the machine according to guidelines, then explains to the women how to apply the compression, Henrot says.

Women applying their own compression actually applied more pressure, Henrot says.

Pain as rated by the women was lower in the group applying their own compression. Women rated pain on a scale of 0-10, with zero being no pain. The median score was 2 in the self-compression group and 3 in the standard compression group.

Pain is one of the main reasons why women don’t get mammograms, Henrot says. “This technique could be proposed to women who dread having a mammogram, and that could make them to return to screening.”

The idea of self-compression dates back decades, Henrot says. In 1993, researchers reported that image quality was maintained when they compared one breast compressed by the patient and the other by the radiographer.


Expert Perspective

If the self-compression technique helps women, “I would applaud it,” says Debra Monticciolo, MD, professor of radiology at Texas A&M, Temple, and a member of the American College of Radiology Commission on Breast Imaging.

Many women do not expect pain during a mammogram, she finds, but she says some women are very sensitive, especially immediately before their menstrual period. “For some women, just that sense of control [with self-compression] is probably helpful.”

The study finding that the compression was higher in those who applied it themselves is important, she says, as “good compression is key for quality.”


Self-Compression Systems

In 2017, the FDA cleared the first 2D digital mammography system that lets patients increase or decrease the amount of compression to their breasts. It’s the Senographe Pristina with Self Compression, also called the Senographe Pristina Dueta, made by GE Healthcare.



The system has a wireless, handheld remote control that is used to adjust the compression after the breast has been positioned. The technologist then checks the compression to see if it is enough.

It is now widely available, says Liza Smith, a GE spokeswoman, and more than 12,000 exams have been performed globally with the system.

Technically, it is possible to allow a patient to control compression on a mammography unit without the special feature, Monticciolo says. “The technologists use a foot pedal to control compression, so if they allowed the patient to use the pedal, one would not need special equipment.” But that would be more difficult, she says, because of factors such as the learning curve. Other foot pedals move the machine up and down, so the patient would have to be careful not to get the pedals mixed up.

Self-compression “may be an effective mammography technique for women who want to take an active role in their own breast examination,” the researchers write. And their discomfort may go down.



Sources


JAMA Internal Medicine: “Self-compression Technique vs Standard Compression in Mammography: A Randomized Clinical Trial.”

Phillipe Henrot, MD, Institut de Cancerologie de Lorraine, Vandoeuvre-les-Nancy, France.

Debra Monticciolo, MD, professor of radiology, Texas A&M, Temple; member, American College of Radiology Commission on Breast Imaging.

News release, FDA.


Radiology, January 1993.

Liza Smith, spokeswoman, GE Healthcare.



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