A friend told me that mammograms are very painful, but that there is another method that is not painful. Do you know which test is she talking about?

Personally I have a mammogram every year, and I don't think it's painful. But it depends on the technologist. If it's painful where you go, tell the technologist she's hurting you and she can make an adjustment. If you are premenopausal, try to have your mammogram when your breasts aren't hurting, usually in the first half of the cycle. Some women take a Tylenol before they go in. Try refraining from caffeine if that makes your breasts hurt. I work in a center where my technologists only do mammograms. They don't do any other kind of X-rays, and they are good at what they do. So find a place where the technologists are good at what they do and they won't hurt you.

Remember that many factors affect a person's experience of pain. Fear is a big factor; being afraid of the outcome, or of in the test, can heighten fear and pain. The technologist can calm you down and take it slowly. The mammogram has to press the breast tissue down tightly; it has to be tight because in order to get a sharp image, you want the X-ray to travel the smallest possible distance. Cancer can be the size of the head of a pin, and in order to detect it the breast must be compressed. However, your breast is only compressed for a fraction of a second.

There are plenty of tests that don't require compression. One is ultrasound. But ultrasound is not a screening tool because it cannot find the very early stage of breast cancer, which is what we call microcalcification. Microcalcifications are seen inconsistently on ultrasound. I love ultrasound; it's a fabulous tool in the breast, but we can't use it as a screening tool. MRI, interestingly, is performed lying down on your stomach with the breast immobilized. Now we've come to realize we can do the MRI if the breast is compressed, so we're back to compression.