As a practicing family physician, I have often heard from women that mammography, in which the breasts are compressed in order to x-ray, is uncomfortable. Occasionally, women have actually declined to get this life-saving measure due to this discomfort. This experience is not universal, however, and many women have told me that while not a pleasant experience, mammography is not painful, and the benefit is clearly worth it.

Many strong research studies have shown that mammography saves lives in women 40 and over; about a third fewer deaths from breast cancer over seven years on average. In some of these studies, mammograms were done along with breast exams by healthcare providers, called “clinical breast exams,” and these studies showed a benefit as well. I have to qualify this next statement by saying that I am not a woman and have never had a clinical breast exam or a mammogram, but I would guess that in most if not all cases, clinical breast exams would be more comfortable than mammograms.

So an obvious question would be “Are clinical breast exams effective by themselves in reducing deaths from breast cancer?” Unfortunately, the research on this question does not provide strong evidence one way or the other, so we just don’t know. Similarly, we do not know one way or the other if breast self exams by women are effective in reducing deaths from breast cancer.

Another possible screening test for breast cancer is magnetic resonance imaging, or MRI. The MRI is more comfortable than a mammogram because the breast is not sandwiched in between two plates, but it is also more expensive (about 20 times more) and produces more tests that are positive when there is no cancer present (false positives) than mammograms do. MRI’s are therefore not recommended routinely for screening, although some recommend them in addition to mammograms as being worth the cost in women at very high risk.

In summary, mammograms, while uncomfortable for many and very uncomfortable for some, are still the best way to screen for breast cancer. If they are very uncomfortable for you, you will just need to decide if they are worth the decreased risk of this potentially deadly disease.

One final note that may be good news is that getting mammograms done every two years seems to be as effective as doing them every year in most women.