This referral for breast pain can lead to imaging overuse, wrote a team lead by Dr. Anne Kushwaha from MD Anderson Cancer Center in Houston.
Kushwaha and colleagues sought to analyze the incidence of women with breast pain who underwent imaging and were then diagnosed with cancer. They reviewed demographic characteristics and imaging findings for 799 women who presented with breast pain at three community breast imaging centers between January and December 2014.
Most of the women (99%) arrived for a diagnostic evaluation, and 95% of these women had negative findings, although one patient was found to have cancer in the contralateral asymptomatic breast. Among the study participants, 30% had diffuse breast pain, 30% had focal pain, and 40% had pain that was not localized.
Women younger than 40 years (316 of 799 participants) underwent 454 workup studies for breast pain; these studies included ultrasound, mammography, MRI, and digital breast tomosynthesis and cost $87,322. All findings were benign in this group, the researchers noted. Those patients 40 years or older (483 of 799) underwent 745 imaging studies at a cost of $152,732.
When the researchers compared correlations between breast pain and the presence of cancer in the study participants with the concurrent cancer detection rate in the screening population (5.5 cases per 1,000 examinations performed), they found that breast pain was not a sign of breast cancer (p = 0.027).
So why do women with breast pain undergo imaging? Perhaps to assuage their anxiety, the group noted. But this doesn't necessarily work.
"[A recent study found that of] the patients with pain, 25% underwent imaging, and findings for 75% of this group were normal; however 98% of those who underwent imaging returned for additional evaluation," the researchers wrote. "Imaging of these patients led to an increase in health service use and may not have provided patient reassurance in ruling out malignancy."
It's better to counsel women who present with breast pain to undergo regular mammography screening, they concluded.
"Our recommendations for value-based healthcare for women presenting solely with breast pain should include an annual screening mammogram for women 40 years or older and reassurance [without imaging] for female patients younger than 40 years," Kushwaha and colleagues wrote.
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