Incidental Breast Cancers Identified in the One-Stop Symptomatic Breast Clinic

Abstract

PurposeBreast cancers can be asymptomatic at an early stage and hence screening programmes play an important role in detecting breast cancers early. Even in those patients who present with breast symptoms, breast cancers may be present at a site remote to the site of symptoms. In this study, we aimed to assess the frequency, site and imaging modality used to identify these incidental cancers in the symptomatic one-stop breast clinic.MethodsAll patients who were seen in our breast clinic with breast symptoms over a two-year period were included in the study. We correlated the presenting symptoms of patients diagnosed with breast cancer with imaging (mammogram and ultrasound) findings. Incidental cancers were defined as "histologically confirmed breast cancers which were impalpable, remote to the site of symptoms and only identified on imaging."ResultsIn the study period, 281 women were diagnosed with breast cancer out of 4,400 patients seen at the one-stop breast clinic. Thirty six patients (12.8%) diagnosed with breast cancer had an incidental cancer which was only identified by imaging. The majority of contralateral, incidental cancers were identified by both mammography and ultrasound (US) and patients were all above 35 years.ConclusionWe suggest mammography of both breasts and US of the symptomatic breast in order to identify incidental cancers.

General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes

“…there were no clinics that accepted referrals where there was a general suspicion of cancer. The indications for referral included: seven studies on post-menopausal or abnormal vaginal bleeding (20)(21)(22)(23)(24)(25)(26), six studies on breast symptoms (14,15,(27)(28)(29)(30), three for lower gastrointestinal (GI) symptoms (16,31,32), three for elevated prostate specific antigen (PSA) (17,18,33), three for testicular symptoms (34)(35)(36), two for urological symptoms (37,38), two for dyspepsia (39,40), one for haematuria (19), one for unexplained lymphadenopathy (41), and one for neck lumps (6). When reported, one-stop clinics were held in a hospital setting.…”

“…Overdiagnosis of cancer is most commonly described in the context of screening but it is possible to diagnose cancer in patients with symptoms from another cause, especially when lower risk patients are tested (50). Based on the findings of this review, we are unable to comment on the risk of overdiagnosis in one-stop clinics: only one study reported patients diagnosed with asymptomatic breast cancer and most also had symptomatic breast cancer (29). Some authors considered the CR's for cancer and serious disease to be too low (30,39) whilst others concluded that testing more patients to reduce the risk of under-diagnosis was important (19,37).…”

“…Initial difficulties running one-stop clinics settled over time and clinicians were able to see as many patients as they had previously in the multi-stop clinic (15). As one-stop clinics produced similar diagnosis rates to multistop clinics or screening programmes, without increasing demands on resources or increasing diagnostic errors (15,29), it seems unlikely that one-stop clinics will place extra demands on the clinical teams who will treat the detected cancers but rather that they may ease demand if it can be shown that cancers are detected at an earlier, more treatable stage. This is a hypothesis that should be addressed in future research.…”

Adenomyoepithelioma: A Case Report of a Rare Breast Lump

“…While the majority of known cases present with symptomatic breast lumps, a minority may remain asymptomatic, with the tumor being incidentally detected during routine imaging or self-examination. In some instances, patients initially diagnosed with benign breast masses may later seek secondary opinions due to persistent symptoms or suspicion of misdiagnosis, as observed in our patient, possibly attributed to sampling errors or misinterpretation of imaging findings [ 10 ].…”

Commentary on: Incidental Breast Cancers Identified in a One-Stop Symptomatic Breast Clinic

“…In a recent study published in the Journal of Breast Cancer , Mehrotra et al [ 1 ] reported incidental breast cancers identified in a one-stop symptomatic breast clinic where patients receive the results of their radiological examinations and tissue sampling on the same day. Medical environments differ from country to country and from culture to culture.…”