To wonder why there is no effective alternative to Mammography?

[Charliesunnysky10]

3 years ago, when I was 48, I was delighted to be asked early for a routine mammogram (I had no pain or lumps). I have dense breasts, and the pain during compression was excruciating. I don't even know if the radiographer managed to complete it, because I went faint. I've had pain in my right breast ever since, which I took to be bruising/strain, but when it didn't go I was referred for investigation at the hospital breast unit June 2021. They did ultrasound which was clear as far 'as they could see' but 'mammogram is the gold standard and only that will tell us for certain'. I had to be content with the ultrasound as my fear of the mammogram pain got the better of me. Fast forward to last Sept, I went on combined HRT and have what I took to be hormonal pain in both breasts which masked the targeted pain in my right. However it's coming through more than ever now and I've been referred back to the hospital for the same process as 18 months ago. Part of me is so angry at myself of being fearful of something that could save my life, and the other part is worried sick about how I will cope even with painkillers if I can get over the fear, and wondering why this is the only scan that still compresses tissue; why in over 100 years there is no effective 3D alternative.

You can ask for alternatives but they may need to be paid for privately. It isn't just the image that is important, but the location and contrast.

I'm so sorry to hear of your experience. I hope a mammographer will be able to offer better advice.
The alternative would be MRI .
The waiting list (and reportingist) for MRI for investigation and staging of different diseases is already stretched and it's just not viable to use as a screening tool.

Reporting list

I have found tomosynthesis (or 3D) mammography to be less painful, and it is said to be more thorough than standard mammograms. Ultrasound is an alternative. As is thermography, which I don't know much about. I doubt men would agree to have their testicles crushed every couple of years.

YANBU. I’ve only had one, it was absolutely agonising, and I’m dreading having to do it again. I had no idea beforehand how unpleasant it is, I thought it was just the embarrassment that people disliked.

@Confrontayshunme Thank you - so difficult to find non-compression alternatives in the UK. I'll look into this though.

@TheComptonEffect Thank you for your kind words. And the explanation re MRI.

I need to look into alternatives. I sustained an injury during my last one and not at all looking forward to having another.

I rate ultrasound as far more “gold standard” than mammogram. In America I believe screening consists of both. My cancer was not visible on mammogram - but it was on ultrasound! Now I pay for an ultrasound every year as a back up to mammograms. I trust the ultrasound more.

My father was treated for breast cancer he was never subjected to a mammogram. Crushing delicate breast tissue seems draconian.

I will never go to mammography, I know this for sure. It sounds like torture and it's not even that effective or healthy smashing your breasts. My mum's friend had cancer that wasn't detected by mammogram. You can book private scan or 3d mammogram if you want to have it done anyway.

@milkyaqua No indeed. There are many uncomfortable female procedures I feel would be revised and modernised, even on the NHS, if men had to be subjected to them. Ultrasound & thermography are apparently not as effective with smaller irregularities, though I do wonder if we are sold this as a convenience, because to make exceptions isn't cost effective. I will look into Tomosynthesis a bit further - the research I'd done suggested it was indeed more thorough, but involved the same compression rate - but that only one compression per breast is required.

@PaperMonster I'm so sorry to hear that. The first thing I did when I left the clinic was Google when I'd next be called back. I was shaking, sore and tearful. My boss thought I'd been attacked. I hope that you're feeling better and I'm glad for you too, that there seem to be other options, albeit with caveats.

@MissyB1 I'm so glad your cancer was detected and I hope you made/make a full recovery. I obviously felt reassured enough 18 months ago to leave hospital with only ultrasound results, but they really did (albeit kindly) hammer it home that only compression mammography held the key. Your experience makes me wonder if they are just upholding a general rule about ultrasound v mammography.

I'm in my 60s and the boobies have gone South. I find it both embarrassing and very uncomfortable/painful.

Anyway, I had a mammo a couple of years ago and something needed further investigation (all good thankfully), and I was referred for an ultrasound.

When with the sonographer, I asked why the ultrasound is not the first thing to do and he really couldn't answer that to my satisfaction, other than to say they direct the u/s at the area pinpointed by the mammo. The other thing is the mammo is radiation, and the ultrasound is not.

I now pay for a private 3D ultrasound every two years or so with the breast clinic at a private hospital. They haven't pushed me towards mammo first YET, but they did strongly suggest it.

It was a real shock to me. I imagined you just stood in front of a screen like having an xray.

@StopGo It's interesting to note that your father wasn't subject compression - I do hope your father is well now and wish him all the best.

Some operators are better than others, also. Some are really vicious.

This was my experience too. It helps if you have a hot bath before hand apparently. Or so I read.

@Flowersinthebasement I'm glad all turned out well for you. And yes, everything you wrote resonated with me. I'm glad you've found an alternative too.

I suspect mammogram is the most cost effective tool for a mass public screening programme.

Does it hurt more if you have implants does anyone know?

@Redblanky I thought the same. Believe it or not, I read up on the day before so I was fully prepped - or so I thought. It was still nothing like I imagined!

@MissyB1 I suspect that's the case. The NHS will have invested billions into this equipment, it won't be in there interests to deviate, I guess.

Nothing is 100% but mammograms are highly sensitive and have good specificity. For very high risk women, there is MRI but it’s a time consuming exam involving lying face down in an enclosed tunnel for 20 minutes and can involve an injection of contrast. Ultrasound isn’t really effective as a screening tool. Tomosynthesis is very promising for screening of denser breasts but still involves compression-whoever told you it only involves one compression is mistaken. It also takes longer than a standard mammogram due to the number of images taken.
Have you tried taking pain relief half an hour before your mammogram? It can also depend on the skill of the Mammographer. Especially with the sideways picture, compression in the right place is important for reducing discomfort. Unfortunately, not adequately compressing can result in unclear images. I would tell the Mammographer you’re worried-and you can stop the exam if it’s too much. For most women, mammograms are uncomfortable rather than painful but there is a small number of women who do feel pain. Good luck.