Mammography with breast cushions

Objective: We conducted a randomized clinical trial to determine the impact on pain and image quality when breast cushions were used to pad the surfaces of the mammography equipment during film-screen mammography. Methods: We recruited a consecutive volunteer sample of 394 participants. Breast cushions were used for only one breast, with laterality and sequence of use assigned randomly. Data collected from participants included demographic data, rating of pain from previous mammography, and rating of pain from present mammography using both a numeric rating scale and a visual analogue scale. Research assistants also collected breast compression and radiation exposure data. Radiologists were blinded to the laterality of cushion assignment while reading the mammograms and assessing image quality. Results: Participants were primarily white women (75.3%), mean age 55.4 years. Most (94.4%) reported having previous mammography. Eight percent (n = 32) of those surveyed had thought about skipping or delaying mammography because of the pain involved. The pain associated with mammography was significantly (p <.001) less during oblique and craniocaudal views when breast cushions were used during the procedure. Retakes were required for 2% of the 1576 views with the most common reason being positioning (53%). Conclusion: The use of breast cushions significantly reduced the pain during film-screen mammography. Image quality with the cushions was reduced in a very small subset of women probably due to the difficulty in positioning the breast without visual clues. More research needs to be done prior to the routine use of these cushions in clinical practice.