Imaging not necessary for patients with isolated breast pain
Imaging is not required for patients presenting with isolated breast pain and a normal clinical examination, according to new research published Thursday in Clinical Imaging.
Mastalgia, as it’s commonly referred to, is a frequent reason for referrals to breast clinics, reported by up to 70% of women at some point in their lives. However, when breast pain occurs in isolation with no lump nor nipple discharge, mammography rarely turns up cancer, previous studies have shown.
U.K. researchers aimed to better understand the cost and any benefit derived from mammography for mastalgia, analyzing NHS data spanning 5 years and almost 7,000 patients. They found very little value, with imaging for isolated breast pain producing a cancer detection in less than 1% of cases.
“This review supports the position that imaging is not required for patients presenting with isolated mastalgia and a normal clinical examination,” Dr. Dominique McGinlay, a radiology registrar with Queen Elizabeth University Hospital, Glasgow, and co-authors concluded.
The retrospective review included all mammograms performed for breast pain across a large health system between 2020 and 2024. Out of 6,670 scans incorporated, only 70 had final mammographic grading of BI-RADS 3 or above and proceeded for further assessment. A total of 69 patients underwent a biopsy, yielding 44 malignancies—38 invasive and 6 classified as Ductal carcinoma in situ (a noninvasive, stage 0 breast cancer).
This represented an overall cancer detection rate of 6 per 1,000 cases or 0.6%. Most infiltrating cancer was invasive ductal carcinoma (68%), grade 2 (51%), and strongly estrogen receptor-positive (72%). Cancer detection appeared to increase with age, reaching 1.4% in women over 70. The 0.6% detection rate is lower than the 0.7% reported in the U.K. National Breast Cancer Screening Program, the authors noted.
McGinlay and colleagues charge that avoiding low yield mastalgia imaging could reduce healthcare costs, with their findings supporting guideline changes for management of isolated breast pain. The authors also analyzed the cost and corresponding benefit from imaging for isolated breast pain. In the study group, unnecessary investigations were estimated to cost more than $954,000 (USD) over five years, based on typical NHS charges for a diagnostic mammogram and symptomatic breast clinic visit.
“When indirect and intangible costs—such as administrative processing, increased waiting times, and downstream investigations triggered by incidental findings—are considered, the true cost is likely to be substantially higher,” the authors wrote. “The low-yield imaging of isolated mastalgia contributes to diagnostic pathway congestion, straining radiology and breast clinic capacity and potentially prolonging waiting times for higher-risk patients. Across many U.K. breast services, demand is already exceeding imaging and clinical capacity, avoiding imaging in isolated mastalgia presents an opportunity for service transformation.”
Read more, including potential study limitations, in Clinical Imaging.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.