Breast screening survey finds concerns over pain and accessibility

Women who have accessed the government’s breast cancer screening programme have registered high satisfaction rates with the service, but a survey by the directorate for healthcare services found that the programme needs strategies that minimise pain and discomfort if high levels of satisfaction and attendance are to be maintained.

Women who said they found mammography ‘severely uncomfortable’ also found it to be ‘severely painful’ (67%), while more than half of participants (56%) experienced anxiety prior to mammography and higher anxiety (92%) when recalled.

While the majority of the clients rated the mammogram as ‘slightly uncomfortable’, those who found it ‘severely uncomfortable’ were doubtful of repeat attendance and 2.7% would not re-attend.

The cross-sectional survey of 380 women born between 1950 and 1954 however found overall satisfaction with screening appointments, standard of care (over 99%) and with the whole programme (68%).

But one in three women (29.7%) said they had faced difficulties in accessing the unit due to busy roads, no bus access, a location that was not central, or limited parking. Of this group of surveyed women, more tended to be less satisfied with the programme generally.

“This study found a strong association between discomfort and pain since those who found mammography ‘severely uncomfortable’ also found it ‘severely painful’ and vice-versa, which had a less than excellent score on women’s satisfaction,” the authors of the study, published in the Malta Medical Journal, found.

“While 73.1% of women in this study reported some discomfort, only 22% reported the examination as ‘severely uncomfortable’, whereas of those who reported some form of pain (43.9%), only 11.8% reported the examination as ‘severely painful’. These percentages coincide with other authors’ findings, which ranged significantly from 1.3% to 92.3% for pain or discomfort and specifically between 41% and 76% for discomfort. The above may be due to various reasons, such as age-related anatomic breast differences between younger and older women.”

Nonetheless, this study found no difference between the groups. The findings show that those who found the mammogram ‘severely uncomfortable’ are more likely not to re-attend when compared with those who did not find the test ‘severely uncomfortable’.

The authors of the study said that there was solid evidence that women who face difficulties to access the screening unit are less satisfied with the screening programme.

They also said that a female radiographer was “an impacting factor” towards high satisfaction and a positive experience. Due to the intimacy of the procedure, this factor leads women to feel at ease during screening.”

Pre-procedural information has been shown to be effective to minimise anxiety and is essential for women to make informed choices. “Since the participation rate at the time of the study was 55.9%, urgent research to investigate local reasons for non-attendance is vital in order to increase the screening compliance rate in Malta.”

The authors of the study are Danika Marmarà from the director-general’s office of healthcare, Judi Curtis from Kingston University (UK) and Vincent Marmarà from the University of Stirling (UK).

Mammogram discomfort

Not at all uncomfortable    27.9%

Slightly uncomfortable    51.1%

Moderately uncomfortable    11.3%

Severely uncomfortable    9.7%

Pain felt during mammogram

Not at all painful    56.1%

Slightly painful    32.1%

Moderately painful    3.4%

Severely painful    8.4%