# Psychological Factors Influencing Pain Perception and Experience in Women Undergoing Mammography: Protocol for a Systematic Review

## TL;DR

This paper outlines a systematic review protocol to explore how psychological factors like anxiety and fear influence pain during mammography in women.

## Contribution

This is the first systematic review to comprehensively investigate psychological factors affecting pain perception during mammography.

## Key findings

- Psychological factors such as anxiety and fear influence pain perception during mammography.
- The review will synthesize evidence to inform interventions that improve screening experiences and participation.
- Findings will be disseminated through peer-reviewed publication to guide clinical practice.

## Abstract

Breast cancer is the most frequently diagnosed cancer among women worldwide and a leading cause of cancer-related mortality. Mammographic screening significantly improves the early detection and survival rates. However, the pain and discomfort experienced during mammography, primarily due to breast compression, can serve as major deterrents to participation in routine screening programs. Psychological factors such as anxiety, fear, and pain catastrophizing have been shown to influence pain perception and experience during mammography. These factors may affect women’s decisions to participate in or avoid screening, undermining public health efforts for early detection.

This study aims to synthesize the scientific literature on the psychological factors influencing pain perception and experience in women undergoing mammography.

This systematic review protocol is in accordance with the 2015 PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guidelines. Eligible studies will include randomized controlled trials and observational designs that examine psychological factors—such as anxiety, catastrophizing, and related constructs—in relation to pain perception and experience among women undergoing screening or diagnostic mammography. The primary outcome is women’s perception and experience of pain during mammography, and the role of psychological factors may influence it, while secondary outcomes include pain intensity and pain-related distress, measured with validated pain scales or self-reported questionnaires. There will be no restriction on publication year, but only peer-reviewed, full-text articles in English will be included. Gray literature will be excluded. A systematic search will be conducted in PubMed, Scopus, and PsycINFO using database-specific strategies with keywords and Boolean operators; reference lists of included studies will also be screened. Study selection and data extraction will be performed independently by two reviewers. Risk of bias will be assessed using the Joanna Briggs Institute critical appraisal tools. Data will be synthesized narratively, with thematic grouping of psychological factors and tabulation of study characteristics. Due to anticipated heterogeneity across populations, study designs, and outcome measures, a meta-analysis will not be feasible; instead, greater interpretive weight will be given to findings from studies judged to have a lower risk of bias.

The database search has been completed in September 2025. Data extraction and organization into summary tables are scheduled to be finished by December 2025, followed by a narrative synthesis of findings. The systematic review manuscript is planned for submission to a peer-reviewed journal in January 2026.

This protocol outlines the first systematic review to comprehensively investigate women’s perception and experience of pain during mammography and the psychological factors, such as anxiety, depression, fear, and coping strategies, that may influence it. The review aims to generate evidence-based insights that will inform clinical practice and guide the development of targeted interventions designed to reduce discomfort, improve screening experiences, and increase participation in breast cancer screening programs. The authors also plan to disseminate the findings through publication in a peer-reviewed journal.