Patient Preference and Adherence in Mammography Screening: A Narrative Review.

OBJECTIVE

To examine how mammography-related pain, anxiety, compression experience, perceived control, and patient-centered interventions influence patient preference and screening adherence.

METHODS

A structured literature search of PubMed, CINAHL, PsycINFO, Scopus, and the Cochrane Library was conducted for peer-reviewed English- and Chinese-language studies published between January 2000 and October 2025. Eligible studies examined mammography-related pain, anxiety, compression experience, perceived control, patient-assisted compression, psychosocial interventions, patient preference, patient experience, or screening adherence.

KEY FINDINGS: Mammography-related pain is multifactorial and is influenced by compression force and pressure, breast morphology, positioning, prior negative experiences, and anxiety-mediated pain sensitization. Pressure-standardized compression may reduce severe pain, particularly among women with smaller breast volumes, while patient-assisted compression may increase patients' perceived ability to influence the compression process and improve tolerance without compromising diagnostic image quality. Psychosocial interventions, including structured education, patient-centered communication, and music-based interventions, may reduce anxiety and improve satisfaction by interrupting the anxiety-pain feedback loop. Qualitative evidence further suggests that patient-centered communication tailored to diverse ethnic backgrounds may help reduce anxiety and pain during mammography.

CONCLUSION

Technical and psychosocial dimensions of the mammography experience may influence patient preference and screening tolerance; however, evidence directly linking these factors to future screening re-attendance remains limited. A multimodal, patient-centered strategy combining optimized compression, patient participation in the compression process, clear communication, and low-resource psychosocial support may improve screening tolerance, but whether these improvements translate into actual repeat screening participation requires further investigation.

IMPLICATIONS FOR PRACTICE: Screening programs should consider integrating pain assessment, patient education, patient-centered communication tailored to diverse ethnic backgrounds, and patient-assisted or pressure-guided compression where feasible to enhance patient-centered mammography care.