Mammogram-Related Pain and Anxiety
For many women, getting a mammogram can induce a lot of unexpected emotions along with pain and discomfort. However, routine screening is crucial in preventative medicine. The American Cancer Society discusses the importance of early detection and how mammograms have assisted in preventing cancer spread: “Finding breast cancer early and getting state-of-the-art cancer treatment are the most important strategies to prevent deaths from breast cancer... Regular mammograms can help find breast cancer at an early stage when treatment is most successful. A mammogram can often find breast changes that could be cancer years before physical symptoms develop. Results from many decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found early, are less likely to need aggressive treatment like surgery to remove the breast (mastectomy) and chemotherapy, and are more likely to be cured” (“ACS Breast Cancer Early Detection Recommendations”).
Despite mammograms being the best way to prevent cancer spread, they’re not the most comfortable or perfect. The results can be inconclusive and require further investigation. They can result in false positives inducing tremendous apprehension. Additionally, it can be quite a painful experience and leave some women wondering if it is worth it? Doctors and researchers alike understand the less than ideal patient experience of getting a mammogram and it has inspired new research on the topic. In recent years the number of studies evaluating the relationship between anxiety, pain, and mammograms has increased with hopes to encourage solutions for a better patient experience.
One study completed by the Department of Public Health and Caring Sciences at Uppsala University not only looked at how mammogram-induced anxiety could affect women in the short term but in long-term circumstances as well. The study aimed to “investigate the psychological consequences after breast cancer screening” particularly in women “recalled due to suspicious findings on screening mammogram” (Lampic et al.). The study matched a control group with women in the sample and psychological distress was “prospectively assessed with the Hospital Anxiety and Depression Scale (HADS)” (Lampic et al.). It was reported that 46% of the women had borderline or clinically significant anxiety prior to the recall visit. Post-recall visit, the anxiety levels varied and were largely influenced by the results of the recall. Anxiety and depression decreased significantly (P<0.01) in women informed about normal or benign results at the recall clinic, while reported distress remained at relatively high levels in women referred to surgical biopsy, understandably. Overall, the results demonstrated that there were significant “adverse short-term effects of a delay in receiving false-positive results, but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women” (Lampic et al.).
Doctors have been utilizing this information to shape their practice especially during the mammogram itself. The discomfort caused by the mammography unit doesn’t help with the anxiety already at hand (preceding the mammogram). Anxiety is known to affect pain levels, “with state anxiety leading to self-reports of higher pain, lower pain tolerance, and reduced thresholds for pain” (Tang & Gibson, 2005). However, pain and anxiety can be directly influenced by the reward pathways of the brain. Listening to music affects these pathways. It is understood that music has the power to create an experience of pleasure by activating regions of the brain associated with the neurochemistry of our reward circuitry (“Music and the Brain’s Reward and Bonding Systems | Psychology Today”). This is great news seeing as most people have music at their fingertips thanks to portable cell phones and tablets.
A study from the Clinical Journal of Oncology Nursing demonstrates the potential for music therapy as a solution for high levels of pain and anxiety. The study included “100 participants from a convenience sample, 50 in the experimental group who received the music of their choice, and 50 in the control group who did not receive any music” (Evanovich Zavotsky et al.). The participants were instructed to listen to music on Mondays, Wednesdays, and Fridays, and not to listen on Tuesdays and Thursdays. Following the mammogram, the researcher turned off the music and all participants rated their pain and anxiety experienced during the screening mammogram. A Likert-type tool was used which had a scale from 0 (no pain or anxiety) to 10 (extreme pain or anxiety). Results showed that “between the experimental and the control group, this study showed that anxiety scores were lower for the music therapy group” (Evanovich Zavotsky et al.). In addition to music therapy, the study advocated for nurses to discuss anxiety-reducing strategies to help patients post-screening.
Overall, the use of music therapy to assist patients with their anxiety during the mammogram is promising. I believe further benefit can be provided by nurses or physicians through discussing strategies to cope with anxiety following the appointment.
References:
“ACS Breast Cancer Early Detection Recommendations.” American Cancer Society | Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin, https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Accessed 17 Mar. 2021.
Evanovich Zavotsky, Kathleen, et al. “The Effects of Music on Pain and Anxiety During Screening Mammography.” Oncology Nursing Society | CJON, 2014, https://cjon.ons.org/cjon/18/3/effects-music-pain-and-anxiety-during-screening-mammography.
Lampic, C., et al. “Short- and Long-Term Anxiety and Depression in Women Recalled after Breast Cancer Screening - ScienceDirect.” European Journal of Cancer , 2000, https://reader.elsevier.com/reader/sd/pii/S0959804900004263?token=348F8A1AD51B6FA9439A1886F15CAB9392AFEBE464A32119AD558DAE73916BF066702ADBDCAFAB961E0F2EA02F7C4293.
“Music and the Brain’s Reward and Bonding Systems | Psychology Today.” Psychology Today, https://www.psychologytoday.com/us/blog/neurosagacity/201604/music-and-the-brains-reward-and-bonding-systems. Accessed 17 Mar. 2021.
TANG, J., and S. GIBSON. “A Psychophysical Evaluation of the Relationship Between Trait Anxiety, Pain Perception, and Induced State Anxiety.” The Journal of Pain, no. 9, Elsevier BV, Sept. 2005, pp. 612–19. Crossref, doi:10.1016/j.jpain.2005.03.009.
