Imaging for breast pain increases procedures but not cancer detection

Treating women with breast pain by performing imaging increased the odds of further tests and visits, a study found.

To determine if initial imaging for breast pain reduces subsequent clinical utilization, researchers conducted a retrospective cohort study at one hospital-based breast health practice, following women referred for breast pain from 2006 to 2009. Results appeared online Jan. 31 at the Journal of General Internal Medicine.

Initial imaging was defined as a physician-ordered diagnostic mammogram, ultrasound, or magnetic resonance imaging (MRI) within three months of the visit; screening mammograms were excluded. Clinical services utilization included additional imaging tests, biopsies or another visit to a breast specialist.

Breast pain accounted for 32% of new patient referrals seen by internal medicine breast providers. The mean age was 39±13 years, and 60% of the women were less than 40 years old. In the study, 25% of women were referred for diagnostic imaging at first visit.

The results found that 98% of women who received imaging initially had additional clinical services utilization, versus 26% of women who did not receive imaging (P<0.0001). After adjustment for clinical breast exam results, age, family history and clinician, women who received initial imaging had 25 times higher odds of using subsequent clinical services (95% CI, 16.7 to 38.6).

Women with normal clinical breast exams who received initial imaging had 23.8 (95% CI, 12.9 to 44.0) times the odds of further clinical utilization than women who did not receive initial imaging, after controlling for age, family history and clinician. They had 10.4 (95% CI, 5.5 to 19.2) times the odds of receiving additional imaging, 3.7 (95% CI, 1.1 to 12.2) times the odds of receiving a biopsy, and 2.3 (95% CI, 1.4, 3.9) times the odds of having additional visits.

The authors concluded, “While initial imaging in women with breast pain has been recommended for reassurance purposes, there is significant increased subsequent utilization in women who receive initial imaging, without increased diagnostic yield.”