BACKGROUND AND PURPOSE:

• Breast pain may be a symptom of breast cancer
• However, radiographic studies have indicated only a 0-1.2% incidence of breast cancer in association with breast pain
• US Data regarding the cancer incidence of patients entering a breast imaging center for evaluation of breast pain is not available
• Kushwaha et al. (American Journal of Roentgenology, 2018) analyzed the incidence of breast pain, and the incidence of breast cancer in women with breast pain, and compared these data who women who present as part of the general screening population
  • The authors also performed a cost-benefit analysis

METHODS:

• Three different community breast imaging centers were included in the study
• Participants
  • All female patients presenting with breast pain (2014)
• Demographic characteristics and imaging findings were recorded
• Digital mammography was used on all women
  • Digital tomosynthesis was done at the request of the physician or patient
  • MRI performed by order of the physician as necessary
  • Ultrasound, when performed, was whole-breast of the breast and axilla

RESULTS:

• 799 patients were included
• Total 85,841 imaging exams were performed
  • 1.4% (1,196 studies) were done for breast pain
• Pain was
  • Diffuse in 30% | Focal in 30% | Localized in 40%
• A benign sonographic correlate was detected in the pain area in 5% of patients (39/799)
• No cancers were found in the symptomatic breast
  • One patient had a single cancer detected in the contralateral asymptomatic breast
• When compared to concurrent cancer detection rate in the screening population (5.5 cases/1000 examinations)
  • Breast pain was not associated with breast cancer (p = 0.027)
• Cost analysis
  • Patients <40 years (316/799)
    • 454 workup studies for breast pain
    • 1 biopsy
    • All findings were benign
    • Cost of these studies was $87,322
  • Patients ≥40 years or older (483/799)
    • 745 workup studies for breast pain
    • 6 biopsies
    • Cost of $152,732

CONCLUSION:

• Breast pain was not helpful as a screening symptom/indication for breast cancer and consequent breast cancer screening cost significant money for imaging centers
• The authors recommend the following work-up for breast pain alone (no mass) “should include an annual screening mammogram for women 40 years or older and reassurance for female patients younger than 40 years.”

Learn More – Primary Sources:

Overutilization of Health Care Resources for Breast Pain

Related ObG Topics:

Mammography Guidelines for Average-Risk Women

BI-RADS: Standardizing Breast Imaging and Reporting 

Breast Cancer Screening using MRI vs Mammography – How Do They Compare?