Dr. Anat Kornecki believes mammograms are not something women should dread. In fact, quite the opposite.
"Screening should be almost like a patient going to get a spa manicure, massage or whatever," says the London, Ont., radiologist. "This is a treat for ourselves, not a threat."
As the regional breast-imaging lead for Ontario's South West Regional Cancer Program, Kornecki wants to change a commonly held view of mammograms – that they're an awkward, anxiety-inducing test, for which one's breasts are exposed and compressed, sometimes painfully, in a cold, hard imaging machine. Since last summer, she and the breast-imaging team at St. Joseph's Health Care London have been offering a new screening environment designed for patient comfort. Video monitors in the exam room play nature clips with bird sounds, patients gowns are designed to make it for easy for them to expose their breasts and the mammography machines are quiet and ergonomically friendly.
Their emphasis on providing a tranquil experience is part of a growing effort to encourage women to get mammograms by making them more comfortable. Although mammography is recommended for all women age 50 and older, hundreds of thousands of Canadian women do not undergo this exam, which requires compressing the patient's breasts to obtain an adequate image.
"The real drive behind trying to address comfort is trying to drive patient compliance to make sure that women get their mammogram every time they need to … so cancers can be detected as early as possible," says Tracy Accardi, global vice-president of research and development at Hologic, a maker of mammography machines and equipment.
Having long focused on advancing the technical aspects of mammography, such as image quality and speed, companies such as Hologic and General Electric are turning their attention to improving the patient experience. Hologic, for instance, is awaiting regulatory approval in the United States and plans to seek approval in Canada for its new SmartCurve breast-stabilization system, which involves a curved piece of equipment that is used with the company's 3-D imaging machines and is designed to reduce pinching and allow for better distribution of force over a patient's breast.
Meanwhile, St. Joseph's was the first site in Canada, in July, 2017, to install GE's Senographe Pristina mammography machines, which the company touts as engineered "by women for women."
The Senographe Pristina was created with the input of around 1,000 patients, as well as technologists and radiologists, says Heather Chalmers, vice-president and general manager of GE HealthCare Canada, noting these machines have now been installed at various sites in Ontario, Quebec and Alberta. Among its features are rounded corners and a hand rest, instead of a traditional hand grip, as the latter can cause women to contract their pectoral muscles when anxiously holding on. A separate device that looks like a small, wireless remote control, called the Pristina Dueta, allows patients to control the pressure of their own breast compression with a technologist's help.
When given this device, patients tend to compress their breasts as much or even more than a technologist would on his or her own, and they report less discomfort, says Kathleen Schindler, GE's global mammography clinical product leader. The psychological effect is analogous to pinching yourself rather than having someone else pinch you, Schindler says; you feel less pain when you know what's coming.
But while some women may avoid getting mammograms because of the anticipated pain and discomfort, there are many other barriers. Shawn Chirrey, senior manager of analysis at the Canadian Cancer Society, says other reasons women report for not getting mammograms include thinking they're not necessary, simply not getting around to doing them, lengthy wait times, language barriers and costs in the form of transportation, child care and taking time off work.
He adds there is a broader push to ensure women are making informed decisions about whether to get the exams. While mammography is considered the best way to detect breast cancer early, women should also be aware of its limitations, such as false positives, false negatives and the issue of overdiagnosis, where cancers that may not spread are treated aggressively as though they are life-threatening, Chirrey says.
"We think it's still the best method currently to detect cancer and it's an important thing that women should do, but [women should be] informed about the benefits and limitations," he says.
Back at St. Joseph's, Kornecki, who is the medical director of breast imaging at the health-care organization's Breast Care Program, agrees mammograms are not perfect. For instance, she says, they are not ideal for women with dense breasts. But, she says, they allow doctors to get a baseline of what's going on inside a patient's breasts and are, so far, the best tool available to identify precancerous conditions in the breast and the only proven tool for screening for breast cancer.
Even with her centre's new machines and serene ambience, Kornecki acknowledges mammograms aren't exactly enjoyable, but they don't have to be awful either. Her goal is to ensure women have a positive experience so that they will come back.
"Nobody will say this is heaven," she says. But "it's really not that bad."
Regardless of where you get a mammogram or what brand of equipment is used, there are certain measures you can take to make sure it goes as smoothly and painlessly as possible. Shawn Chirrey of the Canadian Cancer Society offers the following tips:
Avoid using deodorant, antiperspirant, body lotions and talcum powder on your underarms and around your breasts. These products can interfere with the accuracy of the exam. If you do use them, use wet disposable towels to remove them before the exam.
Wear clothes that are easily removable from the waist up, and remove any jewellery.
Schedule your appointment for when your breasts are less sensitive. For most women, this is seven to 10 days before your period, and within 10 days of your last period.
Avoid caffeine for five to seven days before the exam. Caffeine may make you more sensitive to pain.
Your doctor may suggest taking mild pain medicine, such as ibuprofen, about an hour before the exam.
Compression of the breasts isn't the only cause of pain and discomfort. If the height of the plate, on which you place your breast, is at the wrong level, this can lead to discomfort. Awkward angling can also cause neck and back strain. If you feel uncomfortable, be sure to let the technologist know.