Mammography Pain and Missed Exams
An evidence-based response to Hologic patient education
Koning Health | White paper | October 2026
Executive position
Pain and fear of pain are documented barriers to mammography attendance. Patient education should acknowledge that evidence and help women obtain recommended care. Classifying an individual assessment of pain as false risks misleading patients about an experience that can influence whether they return for annual exams.
Koning Health challenges the framing of pain in Hologic’s public education campaign. The objection is specific: a subjective judgment about how much an examination hurts cannot be disproved by reassurance, comparisons with cosmetic procedures, or evidence that other women face different barriers. Imaging access and examination comfort both deserve attention.
What Hologic actually published
Hologic’s October 6, 2026 release reports that 37% of 1,000 surveyed U.S. women aged 35–75 had skipped or delayed a recommended mammogram. It highlights access, awareness and other obstacles, but reports no pain-specific findings. It does not state that pain is irrelevant. The release also promotes the company’s continuing myth-busting campaign. [1]
On that campaign page, the statement “Mammograms hurt way too much” is marked false. The explanation invokes women’s willingness to undergo fillers and waxing, then promotes comfort features and describes compression as “just a brief pinch.” [2] This framing is the focus of our criticism. Women’s willingness to undergo an unrelated procedure cannot establish the intensity or acceptability of their mammography pain.
Myth-busting becomes misleading when it treats a patient’s reported experience as a misconception to correct. That is an assessment of the communication, not an allegation that the underlying survey was fabricated or that its respondents’ access concerns are unimportant.
Evidence from women who missed exams
A 2025 BMC Public Health study analyzed 1,074 exam non-attenders in England. Fear of pain was reported by 27.2%, and previous painful experience by 25.9%, ranking third and fourth among individual barriers. After accounting for overlap, 415 respondents, approximately 39%, endorsed at least one pain-related barrier. [3]
These findings concern respondents who missed their exams, not merely patients reporting discomfort after an examination. The low response rate and possible self-selection limit generalizability. The two percentages must not be added together, and the combined figure must not be presented as a population estimate for all women. [3]
Evidence across studies and in the United States
Whelehan and colleagues’ 2013 systematic review included 20 studies of pain and repeat breast imaging. In the strongest studies asking non-returners why they had not attended again, 25%–46% cited pain. The authors concluded that painful mammography contributes to non-return. A separate association estimate was uncertain: relative risk 1.34, with a 95% confidence interval of 0.94–1.91. [4]
Hologic’s own commissioned U.S. research reinforces the concern. The Harris Poll surveyed 1,123 adult women in May 2025. Among women delaying breast imaging, 19% cited anticipated pain, compared with 23% citing lack of time. These are self-reported survey findings, not a clinical trial, but they directly connect pain concerns with delay. [5]
The studies differ in geography, recruitment, timing and exam history. Their percentages should not be pooled or treated as directly comparable. Taken together, they support a consistent practical conclusion: pain deserves explicit attention in efforts to improve attendance. They do not establish that pain is the leading cause for every population or that any particular technology will improve adherence.
Why the 2026 release cannot establish that pain matters less
The release describes an opt-in online panel, including a rural oversample, with demographic weighting. It does not provide the full questionnaire or a complete comparison of pain with other reported reasons for nonattendance. [1] Without those materials, readers cannot determine whether pain was measured, how it was worded, or where it ranked.
An omitted result is not a negative result. A list of highlighted findings does not establish an exhaustive ranking of barriers. Comparing a percentage among all respondents with a percentage among women who missed their exams would also require careful attention to denominators. Prominence in a press release is an editorial choice, not a statistical test of relative importance.
Even if another barrier is more prevalent in a particular sample, addressing pain can remain worthwhile. Imaging participation does not require choosing between transportation, affordability, reminders and comfort. A woman may face several obstacles, and solving one does not automatically resolve the others.
What the campaign should change
Koning Health calls on Hologic to revise the pain section so that it acknowledges variation in women’s experiences and removes the comparison with cosmetic treatments. Education should invite women to disclose previous pain and discuss concerns with their imaging team. Reassurance should be specific, realistic and responsive to the patient.
Product comfort claims should state the population studied, the comparator and the outcome measured. A reduction in discomfort does not establish a pain-free experience for every patient, and a comfort finding alone does not establish improved attendance. These principles apply equally to every breast imaging manufacturer, including Koning.
A more complete standard for patient education
Manufacturers and breast imaging programs should publish clear distinctions between anticipated pain, experienced pain, intended avoidance and actual missed appointments. When surveys compare barriers, reports should provide question wording, response options, subgroup denominators and relevant uncertainty. If pain was not assessed, that limitation should be explicit.
Patient education should support informed attendance while making room for difficult experiences. Telling a woman that breast imaging is important does not answer her concern about repeating a painful examination. The appropriate response is to listen, explain what can be adjusted and help her develop a plan with her clinician.
The defensible conclusion is that pain and fear of pain are substantial barriers for a meaningful subset of women. Calling a subjective pain threshold false oversimplifies the problem. Women deserve accurate information about breast imaging and a serious response to what makes attendance difficult.
Scope and disclosure
This paper is a focused evidence commentary, not a new systematic review or a head-to-head product evaluation. It concerns recommended and repeat mammography; the cited research does not uniformly assess annual screening. It does not advise women to skip screening or establish another modality as an equivalent screening substitute.
Koning Health develops breast imaging technology and has a commercial interest in this field. The recommendations here concern evidence reporting and patient communication. No claim about screening authorization, comparative diagnostic performance or improved attendance for a Koning product is made.
References
[1] Hologic. More Than One in Three U.S. Women Have Skipped or Delayed a Recommended Mammogram. October 6, 2026. Company release distributed by Business Wire; reviewed via its syndicated version.
[2] Hologic. Bust The Myth. Patient education campaign, pain section. Accessed October 9, 2026.
[3] Understanding barriers to breast screening: an online survey of non-attenders as part of a service evaluation in the breast screening programme in England. BMC Public Health. 2025.
[4] Whelehan P, Evans A, Wells M, MacGillivray S. The effect of mammography pain on repeat participation in breast cancer screening: a systematic review. The Breast. 2013;22(4):389–394.
[5] The Harris Poll. Why Too Many Women Still Skip Mammograms. Survey conducted for Hologic, May 20–22, 2025.
