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With self-compression, women suffer less and mammogram quality not at all

(Reuters Health) – There are many reasons women dislike mammograms, chief among them the awkward and often painful process of having their breasts squashed by a technician into a machine that flattens them for the images.

But a trial in France suggests that breast cancer screening might be just as effective and less unpleasant when women can control the compression device themselves.

“Our study did not report any decrease in image quality when self-compression was performed,” said lead study author Dr. Philippe Henrot of the Institut de Cancerologie de Lorraine Alexis Vautrin in Vandoeuvre-les-Nancy.

For the study, researchers randomly assigned 548 women to either get mammograms that allowed them to place their breasts in the machines and control the compression themselves, or to get traditional mammograms with radiologists positioning women’s breasts.

The goal of compressing the breast is to make it as thin as possible so radiologists get a more detailed two-dimensional image that can make it easier to spot any abnormalities that might be cancer.

Two things can go wrong when the breast isn’t compressed enough in the mammogram machine. Either healthy tissues overlap in ways that make it appear as if there are potentially cancerous abnormalities and women get unnecessary invasive follow-up tests, or a real tumor is hidden behind healthy tissue and goes undetected.

In the current study, however, when women compressed their own breasts in the machine, they achieved breast thickness that was within 3 millimeters of what women typically had with the traditional mammogram process. That difference is too small to suggest that self-compression isn’t as good as traditional mammograms, the study authors conclude in JAMA Internal Medicine.

In fact, the researchers found that women compressed their own breasts a little bit more, on average, than radiologists did when they controlled the machines. But women also reported less pain when they handled compression themselves.

“Despite knowing the utility of mammograms, many women dread having this exam, because it can be uncomfortable or painful,” Henrot said by email. “Self-compression could be proposed as an alternative in women who dread having a mammogram.”

There was also no difference between the groups in the image quality of the mammograms or the number of additional images radiologists had to take.

One limitation of the study is that many participants had a personal or family history of breast cancer, which might make their experience different than that of other women, the study authors note.

The study also didn’t assess how much extra time it took to provide mammograms when technicians explained to women how to handle compression themselves. Time constraints might impact how many places could give women this option, the researchers point out.

While more research is still needed to show that self-compression is feasible, the results suggest that self-compression might be a way to make the mammogram experience more tolerable, said Dr. Deborah Korenstein of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College in New York City.

“The benefit of letting women do it themselves is twofold: the main concept is that it will result in a less painful test, which will prevent women from avoiding future mammograms because of fear of discomfort,” Korenstein, who wasn’t involved in the study, said by email.

“It is also possible that women will actually tolerate more compression if they can control it themselves, which would lead to better quality images,” Korenstein added. “That has not been demonstrated but is certainly a possibility.”

While some women may indeed be less reluctant to get mammograms when the experience is more comfortable, it’s impossible to know whether self-compression could make a meaningful difference in the proportion of women who get screening mammograms, said Dr. Karsten Juhl Jorgensen, of the Nordic Cochrane Centre, Rigshospitalet, in Copenhagen, Denmark.

And discomfort during mammograms may not be the most important problem with breast screening to address, Jorgensen, who wasn’t involved in the study, said by email.

“There are much more important harms to consider than pain, for example the possibility to be diagnosed with cancer unnecessarily, a risk that is several-fold greater than the chance to reduce breast cancer mortality,” Jorgensen said.

SOURCE: JAMA Internal Medicine, online February 4, 2019.

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