Beyond acquisition: rethinking value in mammography

We need to be honest about what defines success in mammography – and what does not.

Mammography sits at the intersection of technical precision and human vulnerability. As a profession, we have invested heavily in optimising positioning, refining compression and advancing image quality. Equipment continues to evolve through increasingly sophisticated design and the integration of artificial intelligence.

And yet, one uncomfortable truth remains: uptake has plateaued, inequalities persist and we are still losing individuals from screening programmes (NHS Digital, 2025; Breast Cancer Now, 2026).

If screening participation is the outcome we seek, then person-centred care is not an adjunct to practice – it is the intervention itself.

The wrong measure of success

Success in mammography is often defined at the point of image acquisition – a well-positioned, diagnostically robust image.

This is a limited view.

The more meaningful outcome lies further downstream: will this individual return? A technically optimal mammogram holds limited value if it ends the screening journey. This reflects a narrow interpretation of value, focused on immediate output rather than sustained engagement.

Emerging perspectives on value in healthcare highlight the need to move beyond this (Clarke, Mercer & MacKrell, 2024). The image itself holds a value, but this depends on the context in which it is produced and the interactions surrounding it. In mammography, this extends beyond technical execution to include experience, communication and trust.

Experience is not secondary

Around 70% of women attend breast screening in England, with participation dropping to approximately 55% in some areas, reflecting persistent inequalities (NHS Digital, 2025; Breast Cancer Now, 2026). This is often framed as an access issue.

However, evidence suggests otherwise.

A single mammography experience can determine whether an individual returns. For many, the decision is shaped less by clinical outcome and more by how the examination feels. Pain alone is cited by 25–46% of individuals who do not reattend (Whelehan et al., 2013), and emotional and experiential factors are known to significantly influence screening engagement and future behaviour (Huf et al., 2025).

People do not disengage because they fail to understand screening. They disengage because the experience is negative.

This challenges the assumption in imaging: that image quality and patient experience are separate domains.

They are not. They are interdependent.

Wellbeing is a technical variable

Wellbeing is often positioned as a ‘soft’ outcome. In mammography, it is anything but.

Individuals undergoing imaging frequently present with anxiety, muscle tension, increased heart rate and reduced concentration. These responses influence both perceived burden and future healthcare behaviour (Thompson et al., 2023).

Crucially, they also influence the examination itself:

• anxious individuals resist positioning
• tension alters compression experience
• fear reduces cooperation and likelihood of return

Wellbeing directly affects positioning accuracy, pressure distribution and image consistency. It is therefore a technical determinant as well as an experiential one.

Person-centred care requires recognising individuals as active participants in the imaging process, with attention to dignity, autonomy and shared understanding (Eden et al., 2024). A holistic approach further reinforces the need to integrate physical, psychological and environmental factors to optimise outcomes (Mercer, 2024).

Workforce wellbeing is a clinical issue

The wellbeing of the workforce is often discussed in operational terms, but its clinical impact is less explicitly acknowledged. Mammographers are working under sustained pressure: workforce shortages, increasing demand and constrained appointment times. These conditions contribute to fatigue, reduced concentration and emotional exhaustion.

Recent UK data indicate that 70% of radiographers experience burnout, with 68% reporting reduced wellbeing and around 30% demonstrating indicators of depressive symptoms (Elliott et al., 2026). These pressures are associated with reduced engagement, increased fatigue and concerns regarding concentration and risk of error.

This is not simply a workforce issue – it directly affects care delivery.

Wellbeing is inherently relational. A practitioner working under pressure may revert to task-focused communication and reduced adaptability. In contrast, a supported practitioner is more likely to demonstrate presence, empathy and responsiveness.

Person-centred care cannot be delivered consistently within systems that do not support those delivering it.

Design shapes experience and outcomes

If wellbeing matters, it must be designed into practice. This includes:

• environments that reduce anxiety
• workflows that allow time for meaningful interaction
• equipment that enables inclusive, flexible and ergonomic care

Mammography systems are not neutral; they actively shape both practitioner performance and client/patient experience. Evidence shows that imaging processes and system design influence operator capability and patient-centred outcomes (Thompson et al., 2023).

Features such as adjustable gantry positioning, sufficient working space and inclusive design enable adaptability. Gradual compression techniques and approaches that involve client/patient participation in compression application can reduce discomfort and increase perceived control. Within a holistic model, technical delivery, environment and human interaction are inseparable (Mercer, 2024) (Eden et al., 2024).

Equipment, therefore, becomes an active partner in care.

From task to relationship

Under pressure, mammography risks becoming transactional: position, compress, expose.

Efficient but incomplete.

Each individual presents with different physical and emotional needs, and positioning is influenced by comfort, trust and cooperation. A protocol-driven approach applied without adaptation risks reduced effectiveness and poorer experience.

In practice, interaction is not separate from technique – it is the technique.

Clients / patients remember how the examination felt. That experience determines whether they return. A person-centred approach requires:

• adapting techniques to the individual
• recognising emotional and physical cues
• enabling shared control
• understanding that compression is experienced, not simply applied

Person-centred care is not in conflict with efficiency – it underpins it.

The image is not the endpoint

Radiology has historically prioritised measurable outputs such as image quality and diagnostic accuracy. While essential, these alone do not define value.
Clarke, Mercer and MacKrell (2024) describe how individual value in healthcare is often “hidden in plain sight,” emerging from relational and contextual aspects of care. In this context, in mammography, the image contains a value at acquisition, but its overall value is shaped by the interaction between practitioner and individual, the experience of the examination and the conditions of care delivery.

It is co-created.

A technically perfect image obtained within a distressing encounter may reduce overall value if it discourages reattendance. Conversely, an encounter that prioritises wellbeing and communication supports both optimal imaging and sustained participation.

A call for a necessary shift

Mammography does not succeed at the point of image acquisition. It succeeds when individuals return.

Person-centred care – supported by practitioner wellbeing and enabled through effective system and equipment design is therefore not optional. It is fundamental.

Because ultimately:

• If the experience is wrong, people do not come back
• If people do not come back, screening fails

And if screening fails, the value of even the best image is never realised.

References

• Breast Cancer Now. (2026). Breast screening statistics and uptake in the UK.
• Clarke, A. P., Mercer, C. E., & MacKrell, P. A. (2024). Value hidden in plain sight–an allied health professional case study. In Contemporary Enterprise and Entrepreneurship in Context (pp. 120-131). Routledge.
• Eden JK, Hill CA, Mercer JE, Mercer C. (2024). Person centred care in breast imaging.
• Elliott J, Whybrow D, Bundy C. (2026). Burnout, wellbeing and work engagement in diagnostic radiographers working varied shift patterns in the United Kingdom: a national survey. Radiography.
• Huf S, et al. (2025). Barriers and facilitators to breast screening uptake: behavioural insights and evidence review.

• Mercer, C., Hogg, P., & Kelly, J. (Eds.). (2022). Digital mammography: A holistic approach. Springer Nature.
• NHS Digital. (2025). Breast Screening Programme, England 2023–24. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme/england—2023-24.

• Thompson MJ, et al. (2023). Patient centred outcomes of imaging tests: recommendations for patients, clinicians and researchers. BMJ Quality & Safety.
• Whelehan P, et al. (2013). Does mammographic pain influence attendance at screening? The Breast.

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