Melanie Kwestel’s last mammogram was so excruciating she hasn’t gone back for another in four years.
“My doctor is angry with me," says the 59-year-old from Fair Lawn, N.J. "My gynecologist is angry with me. And I feel guilty.”
No one knows how many women in the U.S. or Europe skip mammograms because they had a painful experience. But it’s enough of a concern that a group of Dutch researchers has come up with a device that measures the amount of pressure applied to a woman’s breast as it is squeezed between two very solid, and usually cold, plates. The researchers wondered: could the pain many women feel during a mammogram be minimized without any loss of image quality?
In a mammogram, a breast is compressed and flattened to avoid motion blurring, to enhance the image and to reduce the dose of radiation. With current mammography systems, technicians depend on the machine’s measurement of force — and their instincts — to get a sense of how much they need to squeeze a woman’s breasts to get a good image, said Woutjan Branderhorst, who will be describing the new device and its potential use Sunday at the annual meeting of the Radiological Society of North America.
Along with the machine's force measurement, "[current] technologists can only use visual and tactile clues to estimate the pressure on the breast," said Branderhorst, a researcher in the department of biomedical engineering and physics at the Academic Medical Center in Amsterdam. The force measurement really doesn’t give any idea of how much pain the woman might be experiencing, because "what the woman feels is not force, but pressure,” said Branderhorst.
Force measurements won't tell you anything about pressure because women's breasts vary in size and density: So a woman with small breasts may feel far more pressure than a woman with larger breasts because the force is spread out over a smaller area.The density of a woman’s breasts will also make a difference in how much pressure she feels.
Branderhorst said it's like the difference a stiletto heel feels stepping on your toe, compared to a sneaker heel. The force — in this case the weight of the person stepping on your toe — is the same, but your toe certainly can feel the difference in pressure.
For Kwestel, it felt like her breast was being squeezed in a vice as the technician increased the compression. Kwestel knows that regular mammograms can catch breast cancer early, but she just can’t get past anxiety about the pain.
Similar complaints, along with a Dutch survey which found that 51 percent of women experienced pain during mammography, prompted Branderhorst and colleagues to test the new device, which measures and displays in real time how much pressure a woman is experiencing during a mammogram.
The researchers ran a test in 433 Dutch women with the new device.
Each woman was imaged four times. The mammogram machines were modified so that instead of the usual force measurement, technicians received a reading that ranged from 0 to 100 percent, with 100 percent being the aimed-for value. In three out of four instances, the percentage was based on reaching an ideal force. The fourth reading was based on reaching an ideal pressure. The order in which that pressure-based reading occurred was randomly determined, and the technicians were not told whether they were getting force or pressure-based readings.
After each mammogram the women were asked how much pain they felt. The pressure-based readings produced good quality mammograms —and the women reported less pain, said Branderhorst,
Dr. Emily F. Conant, professor and chief of the division of breast imaging at the University of Pennsylvania said the device should be studied more, but calls the concept "awesome."
“Anything that can be done to improve the experience for women — we are all for it," says Conant.
Branderhorst said that his hospital has been using the device for the last eight months.
“We haven’t heard any complaints from the radiologists about the quality of the images and the technologists are reporting that patients say that it’s hurting a lot less than the last time they had a mammogram,” he said.
If American hospitals start using the device, Diane Carbo says she might go back to having mammograms. “Wow, I would absolutely be interested in that,” the 61-year-old nurse from Cliffside Park, N.J., said. “I’ve had several mammograms where it was so painful that I actually had bruising afterwards. I stopped having them."
Linda Carroll is a regular contributor to NBCNews.com and TODAY.com. She is co-author of "The Concussion Crisis: Anatomy of a Silent Epidemic” and the recently published “Duel for the Crown: Affirmed, Alydar, and Racing’s Greatest Rivalry”