New breast screening methods ‘should be encouraged’

New breast screening methods should be pursued, a case study has said.

Published this month in BMJ Case Reports, the case study examined a patient who developed a haematoma, or blood clot, after a mammogram, the second such case the authors had seen. After complaining of pain, screening clinic staff advised her to take analgesics. Three months after this procedure, the patient was diagnosed with an aggressive cancer in the injury area, and she died four years later.

The case study concluded that the patient’s concerns were not appropriately addressed, and questioned how often postmammography pain was discounted. School of Population and Public Health clinical associate professor, and one of the authors of the case study, Dr. Stephen Hoption Cann, said judging from women who had contacted the authors, he suspected this was under-reported. “Many women report prolonged pain after compression mammography that lasts months, sometimes longer. This may be due to the development of a hematoma or an injury to the nerves.”

The case study concludes that newer technologies for breast cancer screening that require less compression should be considered, as evidence supporting their efficacy is reported, and prolonged pain after mammography should be monitored and evaluated. Dr. Hoption Cann said such technology, such as 3D ultrasound and 3D tomography, exists and is currently being evaluated. “There are of course costs to its introduction, but the pain many women endure during mammography has been swept under the rug. They are told to take tranquilizers or pain medication beforehand so that they may better tolerate the pain, rather than saying, ‘Maybe there is a better way to do this’.”

The case study suggests that further research should occur on two fronts, Dr. Hoption Cann said; how common is prolonged pain following compression mammography and what are the underlying causes; and what influence compression has on the growth dynamics of a tumor.

A spokeswoman for the Canadian Breast Cancer Foundation encouraged women to speak with their technologist during the mammogram if they experience pain and to schedule their appointment within 10 days of their last period, when some women find their breasts are less sensitive.
She noted, “Many women experience varying levels of pain/discomfort during mammography. It is important to note that a sufficient amount of compression is required during a mammogram – for reducing the breast thickness to optimize the image quality and minimize the amount of radiation needed.”

Existing technologies that involve less compression are sometimes used in conjunction with or as a follow up to a mammogram in women known to be at increased risk for breast cancer, she said, but these technologies are not suitable for screening average risk women without symptoms as they are prone to a much higher rate of false positives.
 
Mammography continues to be the current gold standard for breast cancer screening, the spokeswoman said.

According to the B.C. Cancer Agency website, the effectiveness of screening mammography has been established by several large clinical trials across the world, which found a relative risk reduction of breast cancer deaths of between 15-25% for women aged 50-69. “Of eight randomized control trials for screening mammography, seven showed that screening mammography is beneficial.”

It recommends that women aged 50 to 74 without a family history of breast cancer get a mammogram every two years. Women aged 40 to 49 and over 74 without a family history of breast cancer should talk to their doctor about the benefits and limitations of mammography.