Every year millions of mammograms are performed worldwide, representing the primary examination for the early diagnosis of breast cancer. Despite continuous advances in medicine and technology, an aspect of mammography has not changed in over fifty years: the breast is still compressed on the detector because this allows to reduce the thickness of the breast thus improving the quality of the diagnostic image and reducing the dose of radiation necessary to obtain a clear image. Many women perceive as painful this compression, including women who have been treated for breast cancer.

Pain can discourage asymptomatic women to present themselves periodically to screening mammography, while an increasing number of women in follow-up after conservative surgery have to withstand the pain caused by mammography.

Some studies mention various factors that are responsible for pain when performing mammography: breast sensitivity, anxiety level, expected pain and staff attitude. Some studies have also identified breast density, breast volume and menstrual phase as other influencing factors, although not all studies support these hypothesis. The technical characteristics of the equipment can greatly affect annoyance, sense of oppression, pain. The technological proposals to reduce the discomfort of the patients concern various items: flexible compressors, self-compression devices under the supervision of the technician who performs the positioning and the minimum initial compression, environmental factors such as equipment noise reduction, chromatic, sound and sensory effects (eg: aromatic diffusers).

The aim of our study is to evaluate the effectiveness of the self-compression compared to the standard one, in reducing annoyance, a sense of oppression and pain, and to evaluate the difference of the average glandular dose given to the woman for each projection.

Self-compression may help reaching better compression tolerating the discomfort and pain induced thus allowing to achieve a lower thickness, a lower glandular dose and a better image.

Inclusion Criteria:

• Women in follow-up after surgery
• Symptomatic women undergoing mammography
• Early diagnosis in asymptomatic women outside the organized screening program (these women are predominantly aged 40-44 / 75-85)
• Women with familiar risk

Exclusion Criteria:

• Augmentation prostheses
• Women in screening with active invitation
• Physical impossibility to use the self-compression command
• Inability to provide consent

The differences in average glandular dose between the two groups will be compared with a student test if the distributions can be assimilated to a normal one and with non-parametric test in case of non-normality of the distributions.

If the average glandular dose is not lower in the study group (superiority test) and / or the proportion of women with suboptimal compression (<10daN) and> = in the experimental group, the image quality measured with a qualitative subjective scale of the radiologist with a non-parametric test (superiority test).

For secondary endpoints, the results will be compared between the two arms with student tests for the medium with normal distribution, non-parametric tests for non-normal distributions, while for the proportions a chi-square test will be performed.

Each patient is identified in the study by a Subject Number (Subject No.), that is assigned when the patient is registered for mammography and is retained as the primary identifier for the patient throughout his/her entire participation in the trial.

The allocation to experimental or control arm ill be open to patients and the research staff.

The Image quality evaluations of Radiologists and the Radiographers are performed blindly.