Imaging may not always be necessary for women experiencing breast pain

Women regularly undergo imaging examinations because they are experiencing breast pain. If there are no other symptoms, however, imaging may not be necessary, according to new findings published in the Journal of Breast Imaging.

“We hypothesize that in a population of women undergoing breast imaging for the complaint of breast pain, the rate of cancer incidence will be no higher than that of women undergoing screening mammography,” wrote Anna I Holbrook, MD, department of radiology and imaging sciences at Emory University in Atlanta, and colleagues. “While cyclical breast pain (associated with the menstrual cycle) has been established as a benign entity, there is little in the literature that specifically describes pain associated with malignancy.”

The authors explored data from more than 400 patients who completed a breast pain history worksheet for a prior quality improvement project from Nov. 3, 2013, to July 28, 2016. Questions in the worksheet addressed the location of any pain, the size of the area of that pain and more. These answers were combined with more detailed patient information. The mean patient age was 50 years old.

For each patient, providers followed the American College of Radiology’s appropriateness criteria—targeted ultrasound for patients younger than 30 years old, bilateral diagnostic mammography with targeted ultrasound for patients 30 years old and older—for the screening and imaging of patients presenting with breast pain. One of seven breast imaging specialists interpreted each related examination.

Overall, there were a total of four cancers found at the site of breast pain, making up 1% of the study’s participating patients. All four cancers occurred in patients with coexisting palpable abnormalities and were detected after an initial imaging examination. In 22 cases (5.2% of participants), benign findings were detected at the site of breast pain.

When pain was the only symptom, the authors noted that no malignancies were found. The incidence rate of cancer for patients experiencing breast pain was 9.5 per 1,000 cases, which the authors said was “not statistically significantly different” from the rate associated with patients undergoing screening mammograms.

“In patients with isolated breast pain without a palpable abnormality, there were no cases of malignancy,” the authors wrote. “Only the presence of a palpable lump had a statistically significant correlation with the presence of cancer. This suggests that imaging for isolated breast pain, beyond adherence to screening recommendations, is not needed, and clinical management may suffice in cases where there is no other suspicious finding.”

Limitations for this study included the fact that it was retrospective and not every single patient filled out one of the breast pain history worksheets. Also, the study included a small number of cancers, which limited the amount of analysis the researchers were able to do.

“Future work could be done with a larger sample size to attempt to assess the type of pain and patient features associated with cancer,” the team concluded.