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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
Dave, R. V. Bromley, H. Taxiarchi, V. P. Camacho, E. Chatterjee, S. Barnes, N. Hutchison, G. Bishop, P. Hamilton, W. Kirwan, Cliona C
Dave, R. V.
Bromley, H.
Taxiarchi, V. P.
Camacho, E.
Chatterjee, S.
Barnes, N.
Hutchison, G.
Bishop, P.
Hamilton, W.
Kirwan, Cliona C
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Abstract
Background: Women with breast pain constitute >20% of breast clinic attendees.
Aim: To investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care.
Design and setting: A prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months.
Method: Women were categorised by presentation into four 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 eight (0.7%). Of the 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, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09, P<0.001). Compared with reassurance in primary care, referral was more costly (net cost £262) without additional health benefits (net quality-adjusted life-year [QALY] loss -0.012). The greatest impact on the incremental cost-effectiveness ratio (ICER) was when QALY loss because of 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.
Conclusion: 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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2022
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Dave RV, Bromley H, Taxiarchi VP, Camacho E, Chatterjee S, Barnes N, et al. No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic. Vol. 72, British Journal of General Practice. Royal College of General Practitioners; 2021. p. e234–43.