Consultations for breast disease in general practice and hospital referral patterns

Roberts, M M; Elton, R. A.; Robinson, Susan E.; French, Kate Rollert

doi:10.1002/bjs.1800741121

Cited by 43 publications

(20 citation statements)

References 4 publications

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“…It is estimated that a GP will see between six and 34 new patients with symptomatic breast problems every year, but only one case of breast cancer. [3][4][5][6][7] Early diagnosis of breast cancer benefits patients in terms of improved chance of survival; timely and appropriate assessment and referral is a critical step in terms of improved early diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Identifying suspected breast cancer: development and validation of a clinical prediction rule

McCowan¹,

Donnan²,

Dewar³

et al. 2011

Br J Gen Pract

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BackgroundAn evidence-based approach is needed to identify women with breast symptoms who are most likely to have breast cancer so that timely and appropriate referral can take place. AimTo report the development and validation of a clinical prediction rule for the diagnosis of breast cancer. Design and settingCohort study with two prospective groups of women: those presenting to a symptomatic breast clinic (derivation cohort) and a separate cohort presenting to 11 general practices (validation cohort) in Tayside, Scotland. MethodRegression analysis was used to derive a clinical prediction rule from presenting symptoms, personal and family history, and clinical findings. Validation consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. ResultsIn the derivation cohort of 802 patients, 59 (7%) were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] = 1.07 to 1.13); presence of a discrete lump (AOR 15.20, 95% CI = 4.88 to 47.34); breast thickening (AOR 7.64, 95% CI = 2.23 to 26.11); lymphadenopathy (AOR 3.63, 95% CI = 1.33 to 9.92); and lump ≥2 cm (AOR 5.41, 95% CI = 2.36 to 12.38). All eight patients with skin tethering had breast cancer. The regression model had good predictive power, identifying all five breast cancers in the validation cohort of 97 patients in the top two deciles of risk. ConclusionThe clinical prediction rule discriminates between patients at high risk of breast cancer from those at low risk, and can be implemented as an evidence-based recommendation to enhance appropriate referral from general practice to a symptomatic breast clinic. Ongoing validation in further populations is required.Keywords breast cancer; diagnosis; primary care. methodological standards. Conventionally, clinical prediction rules go through three distinct stages before full implementation in a clinical setting:1. Development of the clinical prediction rule, establishing the independent and combined effect of explanatory variables that can include symptoms, signs, or diagnostic tests.2. Narrow and broad validation: the explanatory variables or clinical predictors in the derivation clinical prediction rule set are assessed in separate populations.3. Impact analysis of the clinical prediction rule, assessed by means of a randomised controlled trial: the impact of applying the clinical prediction rule in a clinical setting is measured either by patient outcome, health-professional behaviour, resource use, or any combination of these outcomes. 21The aim of this study was to develop and validate a clinical prediction rule in women presenting with breast symptoms, so that a more evidence-based approach to referral -which would include urgent referral under the 2-week rule -could be implemented as part of clinical-practice guidance. METHOD Study design and participantsThe study comprised two cohorts of p...

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Section: Introductionmentioning

confidence: 99%

Identifying suspected breast cancer: development and validation of a clinical prediction rule

McCowan¹,

Donnan²,

Dewar³

et al. 2011

Br J Gen Pract

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“…It represents the most common breast symptom reported to general practitioners and is a frequent reason for consultation. Cyclical mastalgia is the most common type of mastalgia, with a reported prevalence of up to one third of all of women of reproductive age [1]- [4]. Though its etiology is unknown, cyclical mastalgia is associated with hormones-especially estrogen-and the menstrual cycle, arising as a result of the breast tissue proliferation coinciding with ovulation, and thus is diagnosed only in women of reproductive age [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical Assessment of Treatment Outcomes Following <i>Borago officinalis</i> Extract Therapy in Patients Presenting with Cyclical Mastalgia

Gama¹,

Lasmar²,

Gama³

et al. 2015

IJCM

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In order to evaluate the safety and efficacy of Borago officinalis (900 mg borage oil capsules) in the treatment of patients presenting with cyclic mastalgia, 91 subjects were included in the study. Efficacy assessments were performed based on data obtained prior to the start of treatment (Pretreatment), and after each menstrual cycle (Assessment 2-following 45 days of treatment; and Assessment 3-at the end of the 90-day treatment period). Primary efficacy measures considered the results of the Mastalgia Questionnaire, including a 100 mm visual analog pain scale assessing mean, most intense mastalgia severity, and impact on work, sleep, and sexual activity. Safety and tolerability measures included any changes in vital signs and physical exam in relation to pretreatment, any changes in clinical laboratory exams in relation to pretreatment, and the occurrence of adverse events after the first dose of study medication. The VAS scores of the mean mastalgia and most severe mastalgia both showed statistically significant (p < 0.0001) reductions from Pretreatment to Assessment 3. Mean mastalgia scores improved among 92.3% of the treated patients, while most severe mastalgia scores improved among 93.4% of patients. There were sta-* Corresponding author. C. R. B. Gama et al. 364tistically significant improvements in the assessments of mastalgia impact on work (χ 2 = 28.24; gl = 4; p < 0.0001), sleep (χ 2 = 14.29; gl = 4; p = 0.0006), and sexual activity (χ 2 = 16.11; gl = 4; p = 0.0029) during the treatment period. The results of this study indicate a significant improvement in the mastalgia of the treated patients together with an improvement in the quality of life parameters evaluated. In terms of safety, the tolerability of the treatment was good, with the presence of some adverse events, all of which had been previously described with use of the Borago officinalis extract. No serious side effects were reported, and the events that did occur were transitory. Based on the results of this study, we concluded that the Borago officinalis extract was safe and effective in the treatment of cyclic mastalgia among the treated patients.

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“…Mastalgia or breast pain is a very common condition in female 1 and constitutes one of the most common breast disorders experienced by women [2][3][4] . Mastalgia is a frequent symptom for which women seek medical attention and can causes significant patient anxiety 5 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasonic evaluation of milk duct dilatation in mastalgia in Erbil, Iraq

Akreyi

2013

ZJMS

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Background and objective:As the etiology of mastalgia is poorly understood this study applied ultrasonography to mastalgia patients with the aim of analyzing the significance of milk duct dilatation in patients with mastalgia. Methods: This cross-sectional study involved 170 women with the mean age of 31 years presenting with breast pain who were referred to the Radiology Department of the Maternity and Rizgari Teaching Hospitals from October 2008 to September 2009. The breasts of each woman were examined by ultrasound scan with special attention was focused on the milk ducts. The presence and the width of the ducts were documented. Each woman was asked for pain intensity and breast pain intensity evaluated as mild, moderate and severe. Results: The mean±SD diameter of duct was 3.99±1.37 mm. The mean diameter of the duct was higher among the younger age group of <25 years than older age groups (4.28 vs 3.95 and 3.87), among married than singles (3.99 vs 3.90) and among those having cyclic pain compared to those having non-cyclic pain (4.0 vs 3.95). However, these differences were not statistically significant. The mean diameter of the duct was significantly higher among those having bilateral pain than those having unilateral pain (4.47 for bilateral vs 4.02 for left side and 3.61 for right side) and among those having severe pain compared to those having moderate or mild pain (4.91 vs 3.40 and 3.28). Conclusion:The study results show that duct ectasia is a major factor in determining the severity of mastalgia with no significance difference between cyclical and non-cyclical mastalgia.

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Consultations for breast disease in general practice and hospital referral patterns

Cited by 43 publications

References 4 publications

Identifying suspected breast cancer: development and validation of a clinical prediction rule

Identifying suspected breast cancer: development and validation of a clinical prediction rule

Clinical Assessment of Treatment Outcomes Following <i>Borago officinalis</i> Extract Therapy in Patients Presenting with Cyclical Mastalgia

Ultrasonic evaluation of milk duct dilatation in mastalgia in Erbil, Iraq

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Consultations for breast disease in general practice and hospital referral patterns

Cited by 43 publications

References 4 publications

Identifying suspected breast cancer: development and validation of a clinical prediction rule

Identifying suspected breast cancer: development and validation of a clinical prediction rule

Clinical Assessment of Treatment Outcomes Following &lt;i&gt;Borago officinalis&lt;/i&gt; Extract Therapy in Patients Presenting with Cyclical Mastalgia

Ultrasonic evaluation of milk duct dilatation in mastalgia in Erbil, Iraq

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Clinical Assessment of Treatment Outcomes Following <i>Borago officinalis</i> Extract Therapy in Patients Presenting with Cyclical Mastalgia