The purpose of this study was to evaluate the use of a radiolucent cushioning pad during routine screening mammography to determine the degree of reduction in discomfort, any correlation of that reduction with various clinical factors, and the pad's impact on image quality, compression force, and radiation dose. A total of 512 patients presenting for routine screening mammography were evaluated. The radiolucent cushioning pads (MammoPad, Biolucent Inc., Aliso Viejo, CA) were placed on the bucky and compression paddle of the mammographic equipment (M-IV, Lorad Corp., Danbury, CT). For each patient, the radiolucent pads were used for imaging one breast while the opposite breast, which served as a control, was imaged without the pads. In all patients, the breast was positioned and compressed in standard fashion, using routine craniocaudal (CC) and mediolateral oblique (MLO) views. Patients completed a questionnaire before and after the mammogram. A visual analog scale (VAS) was used to record anticipated discomfort as well as the discomfort experienced during compression with and without the pads. Age, hormone replacement status, prior experience with mammography, compression force, and breast composition were recorded, as were dose parameters (mAs and kVp), from which midglandular dose values were calculated. On the side where the pads were used to cushion the breast, 73.5% (371/505) of women experienced a significant decrease in discomfort. Of those who benefited, there was a 47% decrease in discomfort. On the pad side, compression force was increased an average of 14%, and there was a 4% decrease in dose for the CC view and no increase in dose for the MLO view. When comparing benefit versus nonbenefit groups, a significant reduction in discomfort did not correlate with any of the clinical factors evaluated, with the exception of experienced discomfort reported after the mammogram. Use of the MammoPad radiolucent cushion on the bucky and compression paddle was an effective means of reducing discomfort during compression for a majority (73.5%) of our patients undergoing screening mammography. Image quality and the ability to detect all pertinent anatomy were maintained.