 False positive results have been described as the most frequent harm associated with mammogram screening, but actually it may be pain. There's a wide variation, both in the reported frequency of pain and in degree of pain felt by women during mammograms. But there may be little doubt that the majority of women feel some degree of pain during the procedure. Why? Isn't that just some type of x-ray? For those unfamiliar, the breast is sandwiched between two plates and kind of pancake down. Instructions are typically like slowly apply compression until the breast feels taut, with a force not exceeding 20 kilograms. That's 44 pounds. It's like the weight of a cinder block. I mean, no wonder some women experience pain. Studies have attempted to quantify it are all over the place, with the incidence of pain raging anywhere from 1% to 93% depending on how they defined it. The discomfort is enough to keep a portion of women from not coming back. The typical line you hear is that although the compression can be uncomfortable and even painful for some women, it only lasts a few seconds. A sentiment to which one woman replied, you tell the doctor to come on over, he's got stuff that can be mashed too, you know. Mammogram compression can cause bruising and has led to the rupture of breast implants, cysts, and blood vessels. Women with dense breasts are often advised to take painkillers or tranquilizers to endure the procedure more comfortably. Yet, you know, pain is there for a reason. It's trying to warn us about potential tissue damage. There's at least a theoretical concern that tissue inflammation could wake up dormant tumors, but that's sheer speculation at this point. Still, I mean, we could try to make them less painful. The reason they do it is to reduce breast thickness, purportedly decreasing the radiation dose and improving image quality. But when it was put to the test and actually measured, one study found the radiation dose increased at higher compression forces. Another study found that about a quarter of women did not experience a difference in the thickness of the breast when compression was eased back a bit, implying that more compression was applied than necessary. Once minimum thickness is achieved, then further compression only results in more pain with no benefit to image quality. The bottom line is that pain and mammography is initially to be taken seriously, recognizing this in the tone and content of patient information and advising on ways to deal with it, which show greater respect for patients than just blanket reassurances. The reason women aren't more up in arms may be that the majority of women feel compelled by fear or duty to comply, but this just helps the medical establishment push the pain issue to the margins.