No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic

Dave, Rajiv; Bromley, Hannah L.; Taxiarchi, Paraskevi; Chatterjee, Sumohan; Barnes, Nicola; Hutchison, Gillian; Bishop, Paul; Hamilton, William; Kirwan, Cliona C.; Gandhi, Ashu

doi:10.3399/bjgp.2021.0475

Cited by 11 publications

(5 citation statements)

References 35 publications

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“…The rate of cancer detection was low (0.6%) in breast pain patients, which is comparable with previously published data. 9 , 12 , 13 All malignancies were diagnosed through mammography and this could well be considered opportunistic breast screening. Use of mammography in women with breast pain and an absence of any other breast symptoms is controversial.…”

Section: Discussionmentioning

confidence: 99%

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Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service

Ellis,

Robinson,

Foster

et al. 2024

annals

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Introduction There has been an almost 100% increase in referrals to breast cancer diagnostic clinics in the past decade. Breaching of the two-week cancer referral target is now commonplace, potentially delaying diagnoses of breast malignancy in many women. Almost one in five of these referrals are women with mastalgia, not a symptom linked to breast cancer. The objective of the study was the safe introduction of an advanced nurse practitioner-led telephone service for women with mastalgia to improve the service for women and create capacity for those with “red flag” breast symptoms. Methods Referrals to clinic were triaged, women with mastalgia only were directed to a telephone-based assessment clinic and symptoms evaluated using a multidisciplinary created proforma. Results Within 23 months, 1,427 women were assessed in the breast pain telephone assessment clinic: 863 (61%) were aged over 40 and 564 (39%) aged under 40. A total of 1,238 underwent telephone assessment. Reassurance and discharge only was needed for 365 (26%). The aetiology of pain was identified as musculoskeletal in 1,104/1,238 (89%) of patients, with only 39/1,238 (3.2%) identified as having true breast pain. Additional symptoms were mentioned by 264 women (18%) during the consultation; all immediately redirected back to a diagnostic clinic. Mammography was undertaken in 609 women (43%). Seven women (0.6%) were diagnosed with a breast malignancy. Patient survey indicated that 93% of patients were satisfied with the care received and 97% said they would recommend the service to a family member or friend. Conclusions Although face-to-face assessments for breast pain remain the standard practice in many breast units, data indicating the safety of a telephone assessment clinic, along with high levels of patient satisfaction, question whether services can be delivered differently.

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Section: Discussionmentioning

confidence: 99%

“… 6 , 7 However, mastalgia as a solitary symptom is very unlikely to be linked with a breast malignancy, 8 and a recent comprehensive large prospective study of almost 11,000 symptomatic breast clinic referrals suggested a breast cancer incidence of 0.4% in women with a solitary symptom of mastalgia. 9 …”

Section: Introductionmentioning

confidence: 99%

Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service

Ellis,

Robinson,

Foster

et al. 2024

annals

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“…We would like to address the common misconception of breast pain as a potential symptom of BCa. A recent study of almost 11,000 referrals of women to the breast diagnostic clinic, showed no association of breast pain and BCa [ 42 ]. Referrals based on breast pain alone were quoted as “ inefficient ” with “ no health benefit ” but “ increased costs ” [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study of almost 11,000 referrals of women to the breast diagnostic clinic, showed no association of breast pain and BCa [ 42 ]. Referrals based on breast pain alone were quoted as “ inefficient ” with “ no health benefit ” but “ increased costs ” [ 42 ]. This information is hardly groundbreaking; breast pain, in the absence of other BCa symptoms, is not an indication for referral to the BCa unit [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Awareness regarding breast cancer amongst women in Pakistan: A systematic review and meta-analysis

Abdul Rehman,

Tahir,

Ghulam Hussain

et al. 2024

PLoS ONE

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Background Breast cancer (BCa) is the most common cause of cancer death in Pakistan. In 2019, Pakistan saw the highest global BCa-associated death rate. But do Pakistani women know about the various aspects of BCa? And how prevalent are BCa screening methods amongst Pakistani females? These questions formed the basis for our study. Methods We conducted this review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. On September 1, 2023, we searched PubMed, Embase, Scopus, and Google Scholar, and performed a citation search to search for eligible studies published in 2010 or after, using the following terms: “breast cancer” and “Pakistan”. Observational studies that evaluated BCa awareness and/or practice amongst Pakistani females who were not associated with medicine were eligible. We used the National Institutes of Health quality assessment tool to assess the risk of bias. We conducted a proportion meta-analysis to calculate pooled prevalences for variables. Results Responses from 9766 Pakistani women across 18 included studies showed alarmingly low levels of BCa knowledge: risk factors, 42.7% (95% CI: 34.1%-51.4%); symptoms, 41.8% (95% CI: 26.2%-57.5%); diagnostic modalities, 36.3% (95% CI: 23.1%-49.4%); treatments, 46.6% (95% CI: 13.5%-79.8%). Prevalence of breast self-examination (BSE) and ever having undergone a clinical breast exam (CBE) was 28.7% (95% CI: 17.9%-39.6%) and 15.3% (95 CI: 11.2%-19.4%), respectively. BCa knowledge was significantly associated with better educational status, age, and socioeconomic status. Conclusion On average, only two in five Pakistani women are aware of one or more risk factors, symptoms, or diagnostic modalities. Approximately one in two women know about possible BCa treatment. Less than one in three women practice regular BSE, and less than one in five women have ever undergone a CBE.

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“…However, a small proportion of women had breast pain, which was recorded as an isolated feature in over half of Black women with that feature. These women may form the bulk of those experiencing greater pre-referral consultations and longer times to diagnosis [ 10 , 11 ], since isolated breast pain is less predictive of cancer [ 31 , 34 , 35 ], with no current UK recommendation for urgent investigation. Breast pain has been linked to a greater risk of advanced-stage breast cancer [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study

Martins

Ukoumunne

Lyratzopoulos

et al. 2023

Cancers

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We investigated ethnic differences in the presenting features recorded in primary care before cancer diagnosis. Methods: English population-based cancer-registry-linked primary care data were analysed. We identified the coded features of six cancers (breast, lung, prostate, colorectal, oesophagogastric, and myeloma) in the year pre-diagnosis. Logistic regression models investigated ethnic differences in first-incident cancer features, adjusted for age, sex, smoking status, deprivation, and comorbidity. Results: Of 130,944 patients, 92% were White. In total, 188,487 incident features were recorded in the year pre-diagnosis, with 48% (89,531) as sole features. Compared with White patients, Asian and Black patients with breast, colorectal, and prostate cancer were more likely than White patients to have multiple features; the opposite was seen for the Black and Other ethnic groups with lung or prostate cancer. The proportion with relevant recorded features was broadly similar by ethnicity, with notable cancer-specific exceptions. Asian and Black patients were more likely to have low-risk features (e.g., cough, upper abdominal pain) recorded. Non-White patients were less likely to have alarm features. Conclusion: The degree to which these differences reflect disease, patient or healthcare factors is unclear. Further research examining the predictive value of cancer features in ethnic minority groups and their association with cancer outcomes is needed.

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No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic

Cited by 11 publications

References 35 publications

Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service

Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service

Awareness regarding breast cancer amongst women in Pakistan: A systematic review and meta-analysis

Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study

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