Should I be concerned about the bad impact from compression as ABUS imaging is extremely painful

aprilwind

I did the breast ultrasound screening a few days ago.

The breast ultrasound screening was *extremely* painful, much more painful than mammo.

In the breast ultrasound screening, I felt that the compression was too much. And I felt so painful that I had to make a tight fist and make a sound. I told the lady I felt very very painful and asked whether she could lift up the machine a little bit so there would not be so much compression. She seemed not to do so, as for 6 scans, I felt the same extent of pain.

She said different people felt different ways.

But I just felt it was not right speaking frankly.

After imaging, I felt fine. But I feel a sporadic light pain which I contribute to the hard compression in the ABUS imaging.

I understand different women have different tenderness of breasts and tolerance level of pain. However, I did numerous breast imaging before, including mammo, and hand-held ultrasound (but no ultrasound screening ABUS); I knew how compression during imaging felt. I have been pretty much tolerant of the previous imaging tests.

For example, for the painful scale, 0-10 (no pain to very painful)

I feel that 

diagnostic ultrasound imaging: 3-4

mammo: 5-6

ultrasound screening with ABUS: 9

For the ABUS, I felt that the probe rolled over my breast so hard.

During the imaging, I even began to worry such compression might cause some bad impact.

So after the imaging test, I went to do some research.

First, from what I read, ABUS is not supposed to be much more painful than mammo. Actually many women feel ABUS is less painful than mammo.

Second, I found some articles talking about possible bad impacts of the compression from diagnostic imaging methods.

Reference:

Growing concern following compression mammography

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015182/

I had a lumpectomy for DCIS last year.

I really do not want such imaging compression to bring a higher risk for cancer occurrence.

What about your experience?

I already wrote messages to my breast surgeon to see her opinions.

moderators

Hi @aprilwind,

I think something to keep in mind is that article is based on a case study, which is only one of 2 cases among many. While they are raising it as a possible concern, they don't have adequate data to determine if compression mammography does indeed lead to higher risk for cancer occurrence. Also based on what they shared, it seems that long-term effects would be in specific cases where one continues to experience pain for a prolonged period of time with the presence of a haematoma, but they don't specify what would be the length of time one would need to begin worrying. Maybe you can check with your breast surgeon once she shares her opinions if there is any way to manage the pain while undergoing the ultrasound breast imaging, or if using the handheld device called a transducer to create images of your breast would be a less painful alternative that could be considered.

Let us know what you learn! We are sorry that you have had to experience so much pain in the process.

aprilwind

Thanks moderators.

My concern is: I already have facts that mammo and hand-hold breast imaging are pretty much OK for me. I am pretty tolerant about them.

If I feel Automated Breast Ultrasound (ABUS) is extremely painful (much more painful) than the imaging I took before, there are must be some reasons.

And if the reason is because of compression, I think I am really worried about the damage caused by such hard compression.

I suspect: The machine did not adapt to my breast shape, or were pressed too hard to my breast.

Personally I hope there could be some reasons other than compression.

Yes, I plan to talk with the surgeon doctor and the radiologist doctor. They might have some ideas about whether the press is too much from the ABUS ultrasound images (e.g. the breast in the images was pressed too flat) or from the ABUS machine parameters.

Thanks!

aprilwind

I did some research.

I think the too much compression from ABUS ultrasound imaging might be from the unfit of the ABUS receptor plate and the breast shape.

"Do we have to suffer pain in breast exams?"
"The breasts are pendulous movable organs with different sizes, shapes, and densities. The receptor plate is not designed to fit all breasts, and the peripheral areas can be missed. In order to cover the entire breast, the technologists select the most suitable setting for each patient according to the breast size (A–D cups) and three to five views of each breast are acquired."

I specifically feel extreme painful for the peripheral area. I can feel the probe pressed the breasts too much against the chest wall, and even the probe was not smooth to move forward. I could feel the bumps in my breast were pressed when the probe was moving.

From this clinic article, Breast ultrasound: automated or hand-held? Exploring patients’ experience and preference
The main disadvantage of ABUS was the pain or discomfort experienced by individuals during the test. This was expected since breast compression of a large part of the breast is necessary in order to obtain high quality images. Compression is performed both during the preparation phase (the probe is positioned on the breast) and during the acquisition phase (the probe moves to collect the images) which may cause further discomfort. Unfortunately, the technician can only slightly adjust the degree of compression; otherwise, examinations can be unreliable. As mentioned previously, five patients requested to interrupt the examination due to the severe discomfort despite technologist attempts to relieve probe pressure over the patient’s breasts. Nevertheless, we underline that test interruption due to severe discomfort happened in a relatively small percentage of patients, i.e., 6.3% (5/79).

You could see about 6.3% of women requested to interrupt the examination.

If this is the case, probably ABUS imaging examination needs to be carefully adapted to different situations for different patients and may be skipped if it could not be adapted, rather than finishing the examination no matter what.

aprilwind

Some updates so that it may help other women who might meet a similar situation.

I talked with the radiologist. He said patients should not feel such pain during scanning.
He apologized for the bad experience I had.
He said he was surprised the technologist did not do anything to reduce the pain I suffered during scanning.
He recommended that I do MRI, and not do ABUS anymore.
In my situation, the guideline recommends 6 months mammo, then 6 months MRI, i.e. yearly mammo and yearly MRI with staggering mode, as I am at high risk group.

I felt discomfort in my right breast and armpit after the painful automatic breast scanning (ABUS) examination. I did a handheld ultrasound examination; they said no abnormality was found.
But I still felt discomfort. I guess it might be like your body hits somewhere and gets bruised, and has some discomfort in that area.
Fortunately I had no cysts during that painful scanning; I highly suspect if I had some cysts, it might have the possibility to rupture with that amount of pressure.

But speaking frankly, I am surprised about two things.
First, the technologist was so chill and so confident about the situation when the patient explicitly expressed her extreme pain.
I needed to make fist, make face and make sound to endure the pain. At some point of the time, I thought I would shed tears.
I told her whether she could lift up the machine a little bit. She said she did not press the machine; the machine pressed to the breast. (But personally I think when the machine initially was located on the breast, it could be made lightly touch the breast)
She was very friendly, she even also made sound along with my sound, possibly with the intention to comfort me during the scans. But, …

Second, the machine, ABUS from GE, was not well designed. The ABUS machine could not detect the pressure and stop when sensing abnormal pressure.
I could feel the friction between the machine probe and the breast as the probe pressed the breast too much. According to Newton's third law of motion "If two bodies exert forces on each other, these forces have the same magnitude but opposite directions", the machine might sustain some pressure, which might be detected by sensors and the machine would lift up.
The mechanism used by automatic sit stand desks. When you press the button to raise the desk, the desk moves up, but it stops once it senses some obstacles.

The radiologist said next time if it happens, I could ask to stop the imaging examination.
If you feel not right, ask to stop.
So hopefully my post could help some women in the future.