Overutilization of Health Care Resources for Breast Pain

Kushwaha, Anne C.; Shin, Kyung-Min; Kalambo, Megan; Legha, Ravinder; Gerlach, Karen E.; Kapoor, Megha; Yang, Wei Tse

doi:10.2214/ajr.17.18879

Cited by 35 publications

(18 citation statements)

References 17 publications

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“…Inevitably, performing imaging investigations in this cohort of women will result in "false positive" findings; the discovery of benign lesions that would never have caused any symptoms. These are seen in around 5% of women with breast pain alone 27 and when discovered instigate further intervention. In our cohort, 77 women (4%) suffered the prolonged anxiety of awaiting further investigations and (eventually benign) results, with others reporting similar rates 27 .…”

Section: Discussionmentioning

confidence: 99%

“…These are seen in around 5% of women with breast pain alone 27 and when discovered instigate further intervention. In our cohort, 77 women (4%) suffered the prolonged anxiety of awaiting further investigations and (eventually benign) results, with others reporting similar rates 27 .…”

Section: Discussionmentioning

confidence: 99%

“…One previous retrospective American study examined health economic costs of evaluating 799 women with breast pain within three breast imaging centres 27 . It is not clear whether their analysis may be applicable within the UK NHS context.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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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

et al. 2021

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Background Women with breast pain constitute upto 20% of breast clinic attendees. Aim: To investigate breast cancer incidence in women presenting with breast pain and establish health economics of referring women with breast pain to secondary care. Design & Setting: Prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months. Methods: Women were categorised by presentation into 4 distinct clinical groups and cancer incidence investigated. Results: Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms,1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in 8 (0.7%). In 1972 women with breast pain, breast cancer incidence was 0.4% compared with ~5% in each of the three other clinical groups. Using ‘breast lump’ as reference, odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval 0.02–0.09; P<0.001). Compared to reassurance in primary-care, referral was more costly (net cost £262) without additional health benefits (net Quality Adjusted Life Year (QALY) loss -0.012) Greatest impact on the incremental cost effectiveness ratio (ICER) was when QALY loss due to referral associated anxiety was excluded. Primary-care reassurance no longer dominated, but the ICER remained greater (£45,528/QALY) than typical UK National Health Service cost-effectiveness thresholds. Conclusions: This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

et al. 2021

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“…Eliminating the number of low yield follow‐up studies would decrease cost. Kushwaha et al found a single complete breast ultrasound (CPT code 76641) costs $150.59 26 . With three follow‐up studies typically performed for a BI‐RADS 3 assessment, the healthcare cost may potentially deter patients from completing their full 24‐month surveillance.…”

Section: Discussionmentioning

confidence: 99%

ACR BI‐RADS Category 3 Lesions in Women Younger Than 30: Follow‐up Outcomes and Factors Associated With Biopsy

Merchant

Omar

Hayes

et al. 2021

J of Ultrasound Medicine

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Objective-Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years.Methods-We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed.Results-Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up.Conclusions-BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months.

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“…In patients with potentially resectable PDAC, MR with diffusion weighted sequences (DWI) significantly improved the diagnostic performance in the characterization of focal liver lesions, especially if small (≤1 cm), as compared with CT. In particular, MR after CT plays a role on liver staging [ 17 ] ( Table 2 ).…”

Section: Methodsmentioning

confidence: 99%

Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology (AIOM)

Silvestris

Brunetti

Bittoni

et al. 2020

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in women (7%) and the sixth in men (5%) in Italy, with a life expectancy of around 5% at 5 years. From 2010, the Italian Association of Medical Oncology (AIOM) developed national guidelines for several cancers. In this report, we report a summary of clinical recommendations of diagnosis, treatment and follow-up of PDAC, which may guide physicians in their current practice. A panel of AIOM experts in upper gastrointestinal cancer malignancies discussed the available scientific evidence supporting the clinical recommendations.

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Overutilization of Health Care Resources for Breast Pain

Cited by 35 publications

References 17 publications

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

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

ACR BI‐RADS Category 3 Lesions in Women Younger Than 30: Follow‐up Outcomes and Factors Associated With Biopsy

Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology (AIOM)

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