Mammography has come a long way as it’s moved from film to digital and finally to 3D. The images are clearer than ever before allowing us to find more cancers earlier when they are most easily treated. But the one thing that hasn’t changed is the need to flatten the breast. We refer to it medically as compression, but in conversations other terms are tossed out including squishing, squashing and smashing. It’s not a pretty image. And, in fact, the exam is awkward. But it doesn’t have to be painful.
We have found that one of the best ways to avoid the pain and ease any discomfort is to spend as much time during the exam explaining what we’re doing and why as we do actually doing it.
The reason why we still need to use compression despite all the great imaging advances including 3D mammography is because of the structure of the breast. Within the breast there are various types of tissues bound and wound around. It’s sort of like a woven fabric. In order to see what’s underneath, you need to spread the fabric, opening the weave. That’s what compression does. Another way to think of it is trying to count all the blueberries in a blubbery muffin. The blueberries can hide inside the muffin, but in contrast if you try to count blueberries in a blueberry pancake, you are more likely to be accurate.
The compression also helps in getting a stable image. It’s difficult to stop the slight movements of the body that can create blurring. Although we ask patients to hold their breath for a few seconds as the images are taken, their hearts are still beating creating a slight shake. The compression reduces movement.
The feeling varies from patient to patient based on individual structure. Women who have very dense breasts, for instance, are more likely to feel the compression more than those with fatty tissue. But it is harder to see trouble areas in dense breasts, so it is even more important to spread the tissue out as much as possible.
Breasts are also more sensitive during certain times of the month. We recommend that women make an appointment for just after their period when hormone levels are lower.
The more compression, the better the image, up to a point. And that’s where being aware of the patient and her experience is important. At Ella Health, we move slowly allowing patients to adjust to the compression. We also keep talking to patients to see how they are doing. If you become uncomfortable, we can make adjustments, so don’t be afraid to speak up.