Long-term clinical outcomes in women with breast pain in the absence of additional clinical findings: mammography remains indicated

Abstract

The purpose of the study was to determine the long-term clinical outcomes of women with breast pain in the absence of additional symptoms or signs (isolated breast pain), and the utility of mammography in their work-up. IRB approved, HIPAA compliant study retrospectively reviewed 1,386 patients referred for breast imaging with ICD-9 code for breast pain between 1/1/2006 and 12/31/2007. Of these, 617 consecutive women (mean age, 49 years) with isolated breast pain, mammogram, and follow-up (mean, 51 months) constituted the study group. Clinical data, mammographic and sonographic BI-RADS assessments, and geographic relationship between the site of cancer and pain were evaluated. The frequency of malignancies and of specific benign outcomes, both at and subsequent to the time of presentation, was determined. Breast cancer and specific benign outcomes were diagnosed in the painful breast of 11/617 (1.8 %) and 63/617 (10.2 %) women, respectively. Majority of the cancers (9/11, 81.8 %) were diagnosed subsequent (5-52 months) to initial imaging evaluation, whereas the majority of benign outcomes (52/63, 82.5 %) were diagnosed at initial presentation. Diagnostic mammography at initial presentation had a negative predictive value of 99.8 % (95 % CI 99.1 %, 100 %), specificity of 98.5 % (95 % CI 97.2 %, 99.3 %), and sensitivity of 66.7 % (95 % CI 11.6 %, 94.5 %). Three cancers were subsequently diagnosed in the contralateral (non-painful) breast. Eleven of 14 (78.6 %) cancers were in the symptomatic breast, of which 9 (81.8 %) geographically corresponded to the same area of focal pain. Thus, infrequently, breast cancer may clinically present as or be preceded by isolated breast pain and diagnostic mammography is useful for assessment.

No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic

“…Based on our clinic data and previous reports 25 , it was assumed that women presenting with pain only and diagnosed with breast cancer had early-stage disease, received treatment and then, after 52 weeks, returned to general population levels of health utility. As a worst-case scenario, for women with cancer not referred to breast clinic, it was assumed that they had equivalent health utility to women with early-stage cancer for 52 weeks, and then late-stage cancer for 52 weeks, after which they died.…”

“…Seven of 8 studies in the past 10 years note rates of 0-0.4% 8 with the small numbers of malignancies seen being in women above 40 years 12 25 37 . Some suggest that symptoms of non-cyclical focal breast pain may be associated with higher incidence of breast malignancy 25 than other presentations of breast pain. However, this is inconsistent and not been noted by others [36][37][38][39] .…”

Transforming the 2-week wait (2WW) pathway: management of breast pain in primary care

“…These publications included patients across nine decades of life (range 12-92 years of age) presenting with breast pain only. [10][11][12][13][14][15][16][17][18][19][20][21] Six thousand two hundred and fiftyseven patients were identified with breast pain only across 13 studies. Twenty-nine cancers were identified in this group (0.46%), or equivalent to 4.6 per 1000 patients.…”

Current Management and Treatment Options for Breast Pain

“…4 Breast cancer does not generally cause cyclic breast pain, and studies have not identified a causative relationship between symptoms and breast cancer risk. 5 Noncyclic Breast Pain Noncyclic breast pain tends to be more focal than cyclic breast pain and is often limited to a specific quadrant of the breast, although the pain may be diffuse. In contrast to patients with cyclic breast pain, patients with noncyclic pain are typically older, with the age of onset in the 40s to 50s.…”