乳癌是台灣第四大癌症死因，乳房攝影可有效的篩檢乳癌！然而乳房攝影過程中的疼痛不適降低了婦女接受篩檢的意願，乳房攝影的疼痛發生機率約28-77%，發生嚴重疼痛的機率約9.3%，嚴重疼痛的經驗使婦女不願意再次接受篩檢。許多因素和乳房攝影的疼痛有關，過去曾發生過乳房脹痛、曾有乳房疾病的家族病史、曾經歷過疼痛的乳房攝影、高教育水準的婦女比較可能在乳房攝影中抱怨明顯的疼痛，受檢者對檢查感到焦慮不安、檢查前三天乳房脹痛、檢查前技術師給予受檢者較少關注都是造成檢查中疼痛的可能因素，而偏頭痛病患則有較高機率產生劇烈疼痛。許多研究試圖找出降低疼痛的方法，研究顯示檢查前技術師如果曾經解釋檢查步驟可以有效降低疼痛發生，可能是檢查前良好的溝通可以減少受檢者的焦慮感，因此也減少檢查中的疼痛感，技術師對疼痛處理的態度也直接影響乳房攝影的執行，技術師必須接受持續的訓練及再教育。乳房攝影前在胸前皮膚塗抹4% lidocaine凝膠可以有效降低疼痛感，但是口服止痛藥(包括acetaminophen 及ibuprofen) 則無證據顯示有效。檢查時在乳房和檢查檯間置放緩衝墊可以減少疼痛感，但是有報告顯示可能會降低影像品質。有些檢查機構建議讓受檢者自行控制乳房壓迫的程度，有些研究則建議檢查前告知病患可以在壓迫過程中隨時喊停，兩者都被證實有效，受檢者如果知道可以隨時中止檢查，似乎對疼痛的忍受力比較強。檢查中的疼痛大部分發生在乳房被壓迫時，但是多數研究顯示壓迫的力量和疼痛無直接關係，減少乳房的壓迫並無法減低疼痛感。總而言之，乳房攝影前技術師和受檢者良好的溝通是減少疼痛最簡單、便宜而有效的方法！

Breast cancer is the 4th leading cause of cancer deaths in Taiwan. Mammography is the most useful tool for breast-cancer screening. However, pain and discomfort can decrease the compliance with mammograms. The reported prevalence of pain varies 28%~77%. Severe pain was reported in 9.3% of women. Severe pain significantly decreases the re-screening rate. Many factors are associated with pain during mammography. Women with sensitive breasts, a family history of breast diseases, expected pain based on a former mammogram, and a higher educational level tended to experience severe pain. Anxiety, breast sensitivity before mammography, and insufficient attention by the technician are also factors associated with pain. A higher risk of pain was also reported in women who experience migraines. Several studies tried to decrease the pain of mammography. Most studies revealed a lower risk of pain if the procedure is explained by the technician before the examination. Good communication and adequate information reduce the anxiety of patients. Women may therefore feel less pain. The attitude of technicians toward pain also changed their behaviors during mammography. Continued training and education aimed at reducing discomfort during mammography are important for technicians. Topical application of a 4% lidocaine gel to the skin of the chest before a mammogram significantly decreased discomfort. No significant effect of oral medication before a mammogram, including acetaminophen and ibuprofen, was noted. Use of a radiolucent cushion pad during mammography can decrease pain, but slightly decreases the image quality. Some facilities allow the patient to control breast compression herself during mammography. Informing the patient to say ‘stop’ during the examination is another option. Women tolerate more pain if they can intervene. Most pain occurs when the breasts are compressed. However, most studies showed no correlation between the compression pressure and pain. Reducing breast compression had no significant effect on the discomfort of mammography. In conclusion, providing sufficient information before the examination is an easy, inexpensive, and effective way to decrease pain.