Lidocaine may mean gentler mammogram

July 22, 2008 3:33:11 PM PDT
Derinda Rapp, a 60-year-old woman from Emmett, Idaho, dreads one event each year more than almost anything else: her annual mammogram.

"I have very sensitive breasts that are good-sized and it's quite painful -- very painful, actually -- to have it put in 'the vise,'" Rapp explained. "On a scale from one to 10, the pain is a nine for me, and I usually have pain in my breasts for up to two days afterwards."

But two years ago, Rapp said she had the first mammogram of her life that was 100 percent pain-free.

The reason? Rapp was participating in a study out of St. Luke's Mountain States Tumor Institute in Boise, Idaho, that tested an over-the-counter anesthetic called lidocaine gel for reducing some of the breast pain and discomfort caused by mammograms.

Lidocaine gel is already used to help reduce pain in other minor procedures such as IV injections, but has never been offered as a pain reliever to women undergoing mammography.

The researchers studied 418 women who said that they expected pain and discomfort from their mammograms. Women involved received either a placebo gel or pre-mammogram over-the-counter painkillers such as Tylenol, either with or without the addition of lidocaine gel.

They found that while painkillers did not reduce any of the breast discomfort experienced by the study subjects, women who received the lidocaine gel said they experienced less pain and discomfort. In fact, researchers found that the use of lidocaine gel reduced pain and discomfort by about 20 percent in these women.

Rapp, who happened to be in the group of women receiving the lidocaine gel, said her only disappointment from participating in this study is that she wished she would have known to use lidocaine gel during her mammograms much earlier.

"It was the first mammogram in my life which gave me no pain at all. Not during it, not after it -- was wonderful," Rapp said. "I will absolutely get a tube of it for the next mammogram. Had I known it was that simple, I would have done it a long time ago."

Colleen Lambertz, study author and family nurse practitioner at St. Luke's Tumor Institute, said she hopes this study will encourage more women to go in for their regular mammograms.

"Certainly we hope that offering women this option will encourage them to go in for their regular mammograms," Lambertz said.

According to a study conducted by the National Cancer Institute (NCI) in May of 2007, the rate of women going in for a regular mammogram has been declining in recent years. Some doctors worry that this drop may be due in part to the fear and discomfort associated with the procedure.

The NCI currently recommends that all women aged 40 and older should get a mammogram every year. But the NCI study found that the percentage of women above the age of 40 who said they had a mammogram within the past two years slipped from 70 percent in 2000 to 66 percent in 2005.

Lambertz hopes that offering lidocaine gel as a pain relief option to this group of women might help in curbing this trend.

"So going along with the findings from the NCI study, we hope to reach that group of women," Lambertz said.

"Other studies have also found that a large portion of women are saying that mammography is a cause of huge pain and discomfort for them, but I don't think many people have taken this complaint very seriously," Lambertz added. "So in listening a little closer and hearing a little better we think that there has to be something we can do to help with that problem, and [lidocaine gel] could be it."

However, some experts believe the findings are extremely misleading.

Dr. Marie Savard, ABC News Medical Contributor, disagrees with the idea that most women avoid mammograms due to the pain and discomfort they cause.

"Women avoid mammograms primarily because they fear the results and not because they fear the pain," Savard said. "This concern is overstated, insulting to women, and in the 20-plus years of my practice I have never found this to be the reason a woman doesn't get screened."

Moreover, Savard believes offering women lidocaine gel as an incentive to get regular mammograms would have too little benefit to justify the cost of stocking up on the costly gel.

"Who pays for the added cost of the mammogram with lidocaine gel? Mammogram centers are already struggling to survive with reduced reimbursement. Better we put our money [and] our resources into seeing that every woman who needs digital mammogram and/or ultrasound has access," Savard explained. "Raising a woman's expectation that with lidocaine, [this] test will be painless seems silly and hardly the case."

But the researchers specifically studied over-the-counter brands of lidocaine gel to emphasize the possibility of women taking their pain into their own hands by purchasing and applying the gel themselves before their scheduled mammogram.

"Women can obtain [lidocaine gel] on their own, have it ready ahead of time, apply it an hour before their appointment and drive to doctor's office knowing and being confident that they've done something to take control of that discomfort," Lambertz said. "And we hope that these women would be more likely to undergo regular screening in the future by reducing that cycle of fear, anxiety and discomfort."

Dr. Jennifer Eng-Wong, a medical oncologist at Georgetown University's Lombardi Comprehensive Cancer Center, said she was not convinced by the findings that lidocaine gel offered a significant enough reduction in pain to warrant its use in all mammography clinics.

"In terms of how the study was designed, they only enrolled women who expected to have pain rather than an actual documentation of pain, and if you look at their discomfort scores they are all low and really in same range," Eng-Wong explained.

The researchers asked study subjects to score their pain from mammography on a scale from zero to 100, with 100 being the greatest level of pain.

"Regardless of intervention including placebo, people's scores were still in the lower range, between 23 and 36," Eng-Wong said. "I don't think that's a clinically meaningful reduction in pain. ... Everyone still had modest discomfort."

But Dr. Donna Shoupe, a professor of obstetrics and gynecology at the University of Southern California, said that regardless of how much pain relief the lidocaine gel actually provides, simply offering the gel to patients might have at least one benefit.

"I think it would show that the mammogram centers actually were trying to [make the procedure] hurt less, that they understood the issue, and that they cared," Shoupe explained.


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