Abstract:Breast pain represents an area of overutilization of health care resources. For female patients who present with pure breast pain, breast imaging centers should consider the following imaging protocols and education for referring physicians: an annual screening mammogram should be recommended for women 40 years or older, and reassurance without imaging should be offered to patients younger than 40 years.
“…Inevitably, performing imaging investigations in this cohort of women will result in "false positive" findings; the discovery of benign lesions that would never have caused any symptoms. These are seen in around 5% of women with breast pain alone 27 and when discovered instigate further intervention. In our cohort, 77 women (4%) suffered the prolonged anxiety of awaiting further investigations and (eventually benign) results, with others reporting similar rates 27 .…”
Section: Discussionmentioning
confidence: 99%
“…These are seen in around 5% of women with breast pain alone 27 and when discovered instigate further intervention. In our cohort, 77 women (4%) suffered the prolonged anxiety of awaiting further investigations and (eventually benign) results, with others reporting similar rates 27 .…”
Section: Discussionmentioning
confidence: 99%
“…One previous retrospective American study examined health economic costs of evaluating 799 women with breast pain within three breast imaging centres 27 . It is not clear whether their analysis may be applicable within the UK NHS context.…”
Section: Comparison With Existing Literaturementioning
Background Women with breast pain constitute upto 20% of breast clinic attendees. Aim: To investigate breast cancer incidence in women presenting with breast pain and establish health economics of referring women with breast pain to secondary care. Design & Setting: Prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months. Methods: Women were categorised by presentation into 4 distinct clinical groups and cancer incidence investigated. Results: Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms,1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in 8 (0.7%). In 1972 women with breast pain, breast cancer incidence was 0.4% compared with ~5% in each of the three other clinical groups. Using ‘breast lump’ as reference, odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval 0.02–0.09; P<0.001). Compared to reassurance in primary-care, referral was more costly (net cost £262) without additional health benefits (net Quality Adjusted Life Year (QALY) loss -0.012) Greatest impact on the incremental cost effectiveness ratio (ICER) was when QALY loss due to referral associated anxiety was excluded. Primary-care reassurance no longer dominated, but the ICER remained greater (£45,528/QALY) than typical UK National Health Service cost-effectiveness thresholds. Conclusions: This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.
“…Inevitably, performing imaging investigations in this cohort of women will result in "false positive" findings; the discovery of benign lesions that would never have caused any symptoms. These are seen in around 5% of women with breast pain alone 27 and when discovered instigate further intervention. In our cohort, 77 women (4%) suffered the prolonged anxiety of awaiting further investigations and (eventually benign) results, with others reporting similar rates 27 .…”
Section: Discussionmentioning
confidence: 99%
“…These are seen in around 5% of women with breast pain alone 27 and when discovered instigate further intervention. In our cohort, 77 women (4%) suffered the prolonged anxiety of awaiting further investigations and (eventually benign) results, with others reporting similar rates 27 .…”
Section: Discussionmentioning
confidence: 99%
“…One previous retrospective American study examined health economic costs of evaluating 799 women with breast pain within three breast imaging centres 27 . It is not clear whether their analysis may be applicable within the UK NHS context.…”
Section: Comparison With Existing Literaturementioning
Background Women with breast pain constitute upto 20% of breast clinic attendees. Aim: To investigate breast cancer incidence in women presenting with breast pain and establish health economics of referring women with breast pain to secondary care. Design & Setting: Prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months. Methods: Women were categorised by presentation into 4 distinct clinical groups and cancer incidence investigated. Results: Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms,1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in 8 (0.7%). In 1972 women with breast pain, breast cancer incidence was 0.4% compared with ~5% in each of the three other clinical groups. Using ‘breast lump’ as reference, odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval 0.02–0.09; P<0.001). Compared to reassurance in primary-care, referral was more costly (net cost £262) without additional health benefits (net Quality Adjusted Life Year (QALY) loss -0.012) Greatest impact on the incremental cost effectiveness ratio (ICER) was when QALY loss due to referral associated anxiety was excluded. Primary-care reassurance no longer dominated, but the ICER remained greater (£45,528/QALY) than typical UK National Health Service cost-effectiveness thresholds. Conclusions: This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.
“…Eliminating the number of low yield follow‐up studies would decrease cost. Kushwaha et al found a single complete breast ultrasound (CPT code 76641) costs $150.59 26 . With three follow‐up studies typically performed for a BI‐RADS 3 assessment, the healthcare cost may potentially deter patients from completing their full 24‐month surveillance.…”
Objective-Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years.Methods-We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed.Results-Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up.Conclusions-BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months.
“…In patients with potentially resectable PDAC, MR with diffusion weighted sequences (DWI) significantly improved the diagnostic performance in the characterization of focal liver lesions, especially if small (≤1 cm), as compared with CT. In particular, MR after CT plays a role on liver staging [ 17 ] ( Table 2 ).…”
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in women (7%) and the sixth in men (5%) in Italy, with a life expectancy of around 5% at 5 years. From 2010, the Italian Association of Medical Oncology (AIOM) developed national guidelines for several cancers. In this report, we report a summary of clinical recommendations of diagnosis, treatment and follow-up of PDAC, which may guide physicians in their current practice. A panel of AIOM experts in upper gastrointestinal cancer malignancies discussed the available scientific evidence supporting the clinical recommendations.
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