Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) have found that women with breast pain who receive imaging (mammograms, MRIs or ultrasounds) as part of breast pain evaluation, undergo follow-up diagnostic testing, but do not gain benefit from these additional studies. These findings currently appear on-line in Journal of General Internal Medicine.
Breast pain is a common breast health complaint, but very few women with breast pain alone have an underlying breast cancer. The guidelines for management of women with breast pain are not clear, though past studies have suggested that other tests beyond the routine screening mammogram can provide reassurance for women with breast pain.
The researchers analyzed a group of 916 women who were referred from 2006-2009 for breast pain at Boston Medical Center. They compared the clinical management of women who received imaging to evaluate breast pain to women who did not. Six cancers were identified: all these women either had a lump on exam, or had a routine screening mammogram find a cancer in the other breast. For women who had a completely normal breast examination, the addition of an ultrasound, MRI or mammogram did not help the patient or the doctor in their decisions. The additional ultrasounds and other studies beyond the regular screening mammogram did have a potential negative side, including additional doctor visits, more mammograms and other tests as well as more biopsies.
"While some have suggested that doing further testing in women with breast pain will help to reassure the patient, we did not find this to be the case," explained lead author Mary Beth Howard, MS, an MD candidate, BUSM Class of 2015. Howard authored this study under the mentorship of Drs. Karen Freund, Tracy Battaglia and Marianne Prout of the Women's Health Unit in the Department of Medicine at BUSM and BMC.
"More tests are not always a good thing. They can lead to still further tests or even biopsies which themselves have some risk. They can sometimes increase anxiety without providing any benefit to the patient," she added.
According to the researchers, if the goal is to improve health care quality, it is important to determine if imaging in women with breast pain is a valuable diagnostic tool. "We hope this study is a first step in providing better direction for managing women with breast pain, and hopefully emphasizing that additional imaging studies are not indicated in women unless there is a focal breast complaint, such as a mass or lump," said Howard.
Funding for this study was made possible by an Avon Foundation Safety Net Funding Initiative Grant and a Research in Health Disparities Training grant from the Susan G. Komen Foundation.
- Mary Beth Howard, Tracy Battaglia, Marianne Prout, Karen Freund. The Effect of Imaging on the Clinical Management of Breast Pain. Journal of General Internal Medicine, 2012; DOI: 10.1007/s11606-011-1982-4
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