Physical Examination Sufficient Work-up for Complaints of Breast Pain

Breast pain, or mastalgia, is a very common complaint; yet only 5% of patients with mastalgia have breast cancer. Clinicians, although aware of this low association, often order a variety of tests to alleviate patient worries. Study findings presented at the 2017 San Antonio Breast Cancer Symposium (SABCS 2017) demonstrated benefit and efficacy of extensive imaging and laboratory tests for mastalgia.

The study was conducted from June 2006 to February 2017 at the Breast Clinic of a safety net hospital in Phoenix, Arizona. A total of 1017 of 7202 (15%) patients presented with mastalgia, of which 15 (1%) were found to have breast cancer. Most were stage 0 or I. Breast cancer tumors were discovered in 1 patient by screening mammography, in 4 patients by physical examination, and in the remaining patients by mammography. Only one patient had cancer on the same side as her breast pain.

Approximately 85% of patients underwent breast imagining, including mammography, ultrasound, MRI, or CT scans; 32% underwent biopsy; and 68% had blood drawn for laboratory tests. Even more costly, 27% of patients were seen in the emergency department prior to visiting the Breast Clinic.

The researchers conclude that physical examination is sufficient in women with mastalgia not recommended to undergo screening per any national guidelines. “Diagnostic imaging (in the absence of findings on screening) and laboratory tests do not appear beneficial in patients with breast pain,” reported the researchers. “Continued education is necessary to avoid continued use of unnecessary medical resources.”

Reference

Komenaka IK, Cocco D, Hsu CH, et al. Breast pain: a very common complaint — what workup is cost effective? Poster presentation at: 2017 San Antonio Breast Cancer Symposium; December 6-9, 2017; San Antonio, TX. Abstract P4-12-12.