Skip to main content

Advertisement

SpringerLink
Log in

The Effect of Imaging on the Clinical Management of Breast Pain

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Breast pain is a common complaint to primary care and breast specialists. Literature recommends imaging to provide reassurance of benign etiology. The effect of imaging on reassurance and subsequent healthcare utilization has not been described.

OBJECTIVE

To determine if initial imaging for breast pain reduces subsequent utilization.

DESIGN

Retrospective cohort study at a hospital-based breast health practice.

PATIENTS

Women referred for breast pain from 2006–2009.

MAIN MEASURES

Imaging ordered at initial provider visit; clinical utilization, defined as the number of follow-up visits, diagnostic imaging studies, and biopsies completed within 12 months following initial visit.

KEY RESULTS

Sixty-percent of women were age 40 or younger, 87% were from racial/ethnic minority groups. Twenty-five percent had imaging ordered at initial visit. Of those who received initial imaging, 75% had normal radiographic findings, yet 98% returned for additional evaluation. In adjusted analyses, women with initial imaging had increased clinical services utilization (OR 25.4, 95% CI: 16.7, 38.6). Women with normal clinical breast exams who received initial imaging exhibited increased odds for subsequent clinical services utilization (OR 23.8, 95% CI: 12.9, 44.0). Six cancers were diagnosed; imaging in the absence of clinical breast exam abnormalities did not result in any cancer identification.

CONCLUSIONS

Initial imaging for women with breast pain increased the odds of subsequent clinical utilization and did not increase reassurance in ruling out malignancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Millet AV, Dirbas FM. Clinical Management of Breast Pain: A Review. Obstet Gynecol Surv. 2002;57(7):451–61.

    Article  PubMed  Google Scholar 

  2. Ganschow P, Norlock F, Jacobs E, Marcus E. Breast health and vommon nreast problems: a practical approach. Philadelphia: American College of Physicians; 2004.

  3. BeLieu R. Mastodynia. Obstetrics and gynecology clinics of North America. 1994;21(3):461–77.

    PubMed  CAS  Google Scholar 

  4. Ader D, Browne M. Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol. 1997;177:126–32.

    Article  PubMed  CAS  Google Scholar 

  5. Leinster SJ, Whitehouse GH, Walsh PV. Cyclical mastalgia: Clinical and mammographic observations in a screened population. Br J Surg. 1987;74(3):220–2.

    Article  PubMed  CAS  Google Scholar 

  6. Barton MB, Elmore JG, Fletcher SW. Breast Symptoms among Women Enrolled in a Health Maintenance Organization: Frequency, Evaluation, and Outcome. Ann Intern Med. 1999;130(8):651–7.

    PubMed  CAS  Google Scholar 

  7. Lumachi F, Ermani M, Brandes AA, et al. Breast complaints and risk of breast cancer. Population-based study of 2,879 self-selected women and long-term follow-up. Biomed Pharmacother. 2002;56(2):88–92.

    Article  PubMed  CAS  Google Scholar 

  8. Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and Management of Breast Pain. Mayo Clin Proc. 2004;79(3):353–72.

    Article  PubMed  Google Scholar 

  9. Duijm LEM, Guit GL, Hendriks JHCL, Zaat JOM, Mali WPTM. Value of breast imaging in women with painful breasts: observational follow up study. Br Med J. 1998;317(7171):1492–5.

    Article  CAS  Google Scholar 

  10. Preece P, Baum M, Mansel R, et al. Importance of mastalgia in operable breast cancer. Br Med J (Clinical Research Edition). 1982;284(6325):1299–300.

    Article  CAS  Google Scholar 

  11. Tumyan L, Hoyt AC, Bassett LW. Negative predictive value of sonography and mammography in patients with focal breast pain. Breast J. 2005;11(5):333–7.

    Article  PubMed  Google Scholar 

  12. Morrow M. The evaluation of common breast problems. Am Fam Physician. 2000;61(8):2371–8.

    PubMed  CAS  Google Scholar 

  13. Ader DN, Shriver CD. Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample. J Am Coll Surg. 1997;185(5):466–70.

    PubMed  CAS  Google Scholar 

  14. Brand IR, Sapherson DA, Brown TS. Breast imaging in women under 35 with symptomatic breast disease. The British Journal of Radiology. 1993;66(785):394–7.

    Article  PubMed  CAS  Google Scholar 

  15. Klimberg V. Etiology and management of breast pain. In: Harris J, Lippman M, Morrow M, Hellman S, eds. Diseases of the Breast, vol. 99-106. Philadelphia: Lippincott-Raven; 1996.

    Google Scholar 

  16. Stone MD, Norton S, Mendez JE, Hirsch E. Positive impact of a breast-health triaging system on breast-care access and physician satisfaction. Am J Surg. 2007;194(4):482–7.

    Article  PubMed  Google Scholar 

  17. Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States. Cancer. 2003;97(6):1528–40.

    Article  PubMed  Google Scholar 

  18. Chang S, Kerlikowske K, Napoles-Springer A, Posner S, Sickles E, PerezStable E. Racial differences in timeliness of follow-up after abnormal screening mammography. Cancer. 1996;78(7):1395–402.

    Article  PubMed  CAS  Google Scholar 

  19. Gwyn K, Bondy ML, Cohen DS, Lund MJ, Liff JM, Flagg EW, et al. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer. 2004;100(8):1595–604.

    Article  PubMed  Google Scholar 

  20. Gross CP, Smith BD, Wolf E, Andersen M. Racial disparities in cancer therapy. Cancer. 2008;112(4):900–8.

    Article  PubMed  Google Scholar 

  21. Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Canc Inst J Natl Canc Inst. 2002;94(5):334–57.

    Google Scholar 

  22. Kerin M, O'Hanlon D, Khalid A, Kent P, McCarthy P, Given H. Mammographic assessment of the symptomatic nonsuspicious breast. Am J Surg. 1997;173(3):181–4.

    Article  PubMed  CAS  Google Scholar 

  23. Hendee WR, Becker GJ, Borgstede JP, et al. Addressing overutilization in medical imaging. Radiology. 2010;257(1):240–5.

    Article  PubMed  Google Scholar 

  24. Levin DC, Rao VM. Turf wars in radiology: Other causes of overutilization and what can be done about it. J Am Coll Radiol. 2004;1(5):317–21.

    Article  PubMed  Google Scholar 

  25. McDonald IG, Daly J, Jelinek VM, Panetta F, Gutman JM. Opening Pandora's box: the unpredictability of reassurance by a normal test result. Br Med J. 1996;313(7053):329–32.

    Article  CAS  Google Scholar 

  26. Fitzpatrick R. Telling patients there is nothing wrong. Br Med J. 1996;313(7053):311–2.

    Article  CAS  Google Scholar 

  27. Screening for breast cancer: U.S. Preventive Services Task Force Recommendations. Ann Intern Med. 2009;151(10):I–44.

    Google Scholar 

  28. Lutfey KE, Link CL, Marceau LD, et al. Diagnostic certainty as a source of medical practice variation in coronary heart disease: results from a cross-national experiment of clinical decision making. Med Decis Making. 2009;29(5):606–18.

    Article  PubMed  Google Scholar 

  29. Balsa AI, Seiler N, McGuire TG, Bloche MG. Clinical uncertainty and healthcare disparities. Am J Law Med. 2003;29(207).

  30. Lutfey KE, Link CL, Grant RW, Marceau LD, McKinlay JB. Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes. Health policy (Amsterdam, Netherlands). 2009;89(3):279–87.

    Article  Google Scholar 

  31. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Canc Inst J Natl Canc Inst. 1989;81(24):1879–86.

    CAS  Google Scholar 

Download references

Contributors

The authors thank Timothy C. Heeren, PhD, Boston University School of Public Health, for his input on statistical analyses and data presentation. No compensation was received.

Funding/Support

This publication was made possible by grant 05-2011-023 from the Avon Foundation Safety Net Funding Initiative Grant and grant KG101421 from the Susan G. Komen Foundation.

Role of the Sponsors

The funding organizations were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Women’s Health Unit, Section of General Internal Medicine, Department of Medicine, and Women’s Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA, 02118, USA

    Mary Beth Howard MS, Tracy Battaglia MD MPH & Karen Freund MD MPH

  2. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Tracy Battaglia MD MPH, Marianne Prout MD MPH & Karen Freund MD MPH

Authors
  1. Mary Beth Howard MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tracy Battaglia MD MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marianne Prout MD MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karen Freund MD MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary Beth Howard MS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Howard, M.B., Battaglia, T., Prout, M. et al. The Effect of Imaging on the Clinical Management of Breast Pain. J GEN INTERN MED 27, 817–824 (2012). https://doi.org/10.1007/s11606-011-1982-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-011-1982-4

KEY WORDS

Search

Navigation