'No association between breast pain and breast cancer'
Tuesday February 22nd 2022
Referring women with breast pain to a diagnostic clinic is an inefficient use of limited resources because there is no association between breast pain and cancer, researchers report today.
The study, led by researchers at Wythenshawe Hospital, Manchester, UK, wanted to investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring them to secondary care.
They carried out a prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months and the results are published in today’s edition of British Journal of General Practice.
Audits have already established that women with breast pain constitute more than 20% of breast clinic attendees.
In this study, breast cancer incidence was prospectively assessed in women with breast pain alone as part of a cohort of 10,830 women presenting to a breast cancer diagnostic clinic, and the clinical utility of routine imaging assessment in women being referred with breast pain alone was reviewed.
An economic analysis to estimate and compare the costs of outcomes associated with referral compared with reassurance for women with breast pain alone was conducted.
Out of the total number of women assessed, 1,972 (18%) were referred with breast pain, 6,708 (62%) with lumps, 480 (4%) with nipple symptoms, and 1,670 (15%) with other symptoms.
Mammography identified cancer in eight (0.7%) out of 1,112 women with breast pain. Of the 1,972 women with breast pain, breast cancer incidence was 0.4% compared with under 5% in each of the three other clinical groups.
When the team used “breast lump” as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05, with a 95% confidence interval = 0.02 to 0.09, P<0.001.
Compared with reassurance in primary care, referral was more costly, at a net cost of £262, without additional health benefits.
The authors conclude that providing alternative management pathways for women with breast pain could improve capacity and reduce financial burden, adding that commissioners should work with breast care providers and the Association of Breast Surgery to develop these pathways.
They say their conclusions should prompt a review of health policy for the care of women with breast pain alone.
Dr Gary Howsam, vice chair of the Royal College of GPs, said the study findings should reassure patients suffering solely with breast pain, but said anyone with any potential symptoms of breast cancer should contact their GP.
“Medical research, such as this, is vital to improving the timeliness and accuracy of cancer diagnosis,” he said.
“As such, it’s important that this research is considered when clinical guidelines are developed or updated, so that GPs are confident they are making decisions about whether a referral is required, based on the latest evidence.”
He added that GPs are doing a good job at identifying cancers and referring appropriately, with about 75% of cancers being diagnosed after one or two GP consultations.
Dave RV, Bromley H, Taxiarchi VP et al. No association between breast pain and breast cancer: a prospective cohort study of 10?830 symptomatic women presenting to a breast cancer diagnostic clinic. British Journal of General Practice 22 February 2022
Tags: Cancer | Pain Relief | UK News | Women's Health & Gynaecology
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