{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T01:52:42Z","timestamp":1781488362567,"version":"3.54.1"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Standard mechanical compression applied during screening mammography is a primary barrier that reduces patient compliance. Current guidelines attempt to standardize compression based solely on the one-dimensional \u201cbreast thickness\u201d measured by the device. This study aimed to investigate the effects of three-axis anatomical breast dimensions, applied compression force, menstrual cycle phases, and BI-RADS breast density patterns on pain scores during mammography within a comprehensive biomechanical model. Methods: This retrospective cohort study included 443 female patients who underwent routine screening or diagnostic mammography. Patients with a history of breast implants, lactation, or prior breast surgery that could alter tissue biomechanics were excluded. Maximum pain scores (1\u201310 on a Visual Analog Scale [VAS]) were recorded. Transverse, anteroposterior, and superoinferior breast biometric measurements for each patient were calculated using advanced radiological workstations. Data were analyzed using One-Way ANOVA and Multiple Linear Regression (OLS) models. Results: The mean age of the participants was 49.7 \u00b1 9.4 years, the mean applied compression force was 62.4 \u00b1 10.3 N, and the mean pain score was 2.03 \u00b1 2.12 (range: 1\u201310). The multiple linear regression analysis was statistically significant overall (F = 2.516, p = 0.015). Having a BI-RADS Type D (extremely dense) breast pattern was identified as the strongest independent factor associated with an increased pain score (p = 0.082, coefficient = 1.219). Age showed a trend toward a negative effect on pain (p = 0.072), while compression force showed a trend toward a positive effect (p = 0.067). Conversely, breast thickness (p = 0.231) and the three-dimensional mean breast size index (p = 0.568) demonstrated no independent predictive power. The menstrual cycle phase did not reach independent significance in the multivariate regression model (p = 0.117); however, non-parametric univariate analysis revealed a significant difference in pain across hormonal groups (Kruskal\u2013Wallis H = 10.04, p = 0.039), with actively menstruating and luteal-phase women reporting higher pain than menopausal women. Conclusions: The pain experienced during mammography depends on the internal fibroglandular architecture (elasticity and stiffness) of the tissue rather than its external volumetric dimensions. Notably, neither device-measured breast thickness nor manually calculated three-dimensional breast dimensions independently predicted pain, challenging the widespread assumption that breast size drives mammographic discomfort. \u201cOne-size-fits-all\u201d or thickness-based compression strategies should be abandoned in routine practice. Instead, \u201cpersonalized compression\u201d protocols that prioritize patient comfort without compromising image quality should be developed, particularly for younger patients and those with BI-RADS Type D, and to a lesser extent Type C, density patterns.<\/jats:p>","DOI":"10.3390\/diagnostics16121819","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:44:58Z","timestamp":1781484298000},"page":"1819","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomechanical and Parenchymal Determinants of Pain Perception During Mammography: Three-Dimensional Biometric Measurements and the Need for Personalized Compression"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0958-6581","authenticated-orcid":false,"given":"Abdulkadir","family":"Eren","sequence":"first","affiliation":[{"name":"Department of Radiology, Istanbul Medipol University Mega University Hospital, Istanbul 34214, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8667-1125","authenticated-orcid":false,"given":"Emrah","family":"Karatay","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul 34668, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irmak Durur","family":"Subasi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Institute of Senology, Acibadem Atakent University Hospital, Acibadem MAA University, Istanbul 34303, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1819\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T01:06:16Z","timestamp":1781485576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16121819"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16121819","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}