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Sitting vs standing during screening mammography.

Article Excerpt
There is no guidance in the field of mammography as to whether women should stand or sit while having a mammogram. As mammography equipment has developed over the years, it has become traditional for women to stand during the procedure. Thus, seated mammography is a variation on the conventional standing method taught to radiographers.

However, seated mammography is an important option for certain groups of women, such as those in wheelchairs. Elderly women also may need to be seated because of problems such as dizziness or loss of physical strength. Aside from the physical and age-related reasons for seated mammography, there also might be benefits for women in general. Thus, it is worth considering seated mammography as an alternative position.

Literature Review

Very little literature on the topic of seated mammography exists, and it is not known to what extent it is used in breast screening or how it affects the experience of the woman and the radiographer.

In a search of the Medline and CINAHL databases, only 1 article could be found that looked specifically at seated mammography. This small pilot study (N = 33), carried out by Evans in the United States, (1) reported that elderly women (mean age 69.6 years, standard deviation [SD] 4.6) who were seated during mammography were equally satisfied with the procedure and had images of comparable quality to those of women who stood.

The main limitation of this study was its small sample size, which precludes any firm conclusions regarding the effects of seated mammography. There were also methodological problems with the study. In particular, a nonconcealed allocation process was used during randomization, with women being allocated to a group on the basis of a coin toss. The focus of the study was women aged 65 years and older, making findings less relevant to the wider group of women who have routine mammography. Therefore, generalizability of the study results was limited.

In the absence of other directly relevant studies, articles were selected from the general literature relating to the mammography experience to establish what problems are reported with mammography and how seated mammography might affect these. The majority of studies reported on the pain experienced during mammography and the most common method for measuring pain, which was the 10 cm visual analog scale (VAS). (2)

Kashikar-Zuck et al, (3) for example, studied 125 women, aged 50 years or older, who were having screening mammograms in the United States. Participants were asked to rate their pain immediately after the procedure using 4 measures of pain: the VAS, the adjective list of the McGill Pain Questionnaire, the Pain/ Discomfort Rating Scale (PDRS) and the Brief Pain Inventory. It is not clear whether pain measurements were made via questionnaire, and if so, where and by whom this was administered. Women with a history of breast cancer and those presenting with breast symptoms were excluded. The mean age of the participants was 61 years (SD 8.87, range 50 to 87 years). Ninety-three percent had at least a high school education, and 97% had previous experience of mammography. The authors reported that 88% of women found the mammogram procedure painful based on the VAS scores (ie, score [greater than or equal to] 2 cm), although the pain was reported to be low to moderate on average, with a mean VAS score of 2.9 cm (SD 2.5). These findings are not likely to be generalizable to women having a first mammogram.

In another American study, Sharp et al (4) invited 223 women older than 40 years to participate in interviews immediately after their mammogram...

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