To image or not in noncyclic breast pain? A systematic review

Martín-Díaz, Manuel; Maes‐Carballo, Marta; Khan, Khalid S.; Bueno‐Cavanillas, Aurora

doi:10.1097/gco.0000000000000407

Cited by 6 publications

(3 citation statements)

References 51 publications

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“…Rates of breast cancer in women with mastalgia alone, in the absence of other breast symptoms, range from 0% to 0.4%. 17 – 19 These data are similar to cancer detection rates in asymptomatic women within the NHS breast screening programme 20 and suggest that any diagnosis of breast cancer accompanying the presence of mastalgia in a woman with no other breast symptoms is likely a coincidental occurrence.…”

Section: Discussionsupporting

confidence: 63%

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: Discussionsupporting

confidence: 63%

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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show abstract

“…Seventy per cent of women (85/121) were satisfied with their outcome, reporting lack of progression or resolution of symptoms. A recent systematic review concluded that primary care can be a good location for managing women with breast pain, including assessment of breast cancer risk, provided that healthcare professionals in primary care are supported with well-defined protocols and easy access to secondary care for clinical advice 10 . Such protocols have been adopted successfully for assessing cardiovascular risk in primary care 31 and more work is needed to develop and assess similar protocols for breast cancer risk assessment in women with breast pain alone.…”

Section: Discussionmentioning

confidence: 99%

“…These largely have been smaller retrospective cohorts, unclear on the separate analysis of women with breast pain alone or with associated other breast symptoms. A systematic review of the breast pain literature found the quality of evidence relating to breast pain diagnosis and management to be poor 10 . Seven of 8 studies in the past 10 years note rates of 0-0.4% 8 with the small numbers of malignancies seen being in women above 40 years 12 25 37 .…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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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Acupuncture for cyclic and noncyclic breast pain in women: A systematic review and meta-analysis of randomized controlled trials

Shi,

Chen,

Gao

et al. 2024

European Journal of Integrative Medicine

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To image or not in noncyclic breast pain? A systematic review

Cited by 6 publications

References 51 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

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

Acupuncture for cyclic and noncyclic breast pain in women: A systematic review and meta-analysis of randomized controlled trials

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