No association between breast pain and breast cancer, research finds

Women with breast pain alone should be reassured by health professionals that they have “no higher risk of breast cancer than asymptomatic women,” according to a study published in the British Journal of General Practice.

The news comes after the study found that just 0.4% of women with breast pain who were referred to a cancer diagnostic clinic actually had breast cancer. Despite this, women with breast pain currently constitute more than 20% of breast clinic attendees.

The researchers say that referrals for breast pain alone are therefore an “inefficient use of limited resources” and these findings should “prompt a review of health policy for the care of women with breast pain alone.”

Referrals for breast pain alone are not “cost-effective” and may cause delays

The researchers used real-time prospective electronic patient records of all consecutive women attending a large secondary breast diagnostic clinic between 1 April 2019 and 31 March 2020.

Of the 10,830 women on record, 1,972 (18%) were referred with breast pain, 6,708 (62%) with lumps, 480 (4%) with nipple symptoms, and 1,670 (15%) with ‘other’ symptoms.

Of the 1,972 women with breast pain, breast cancer incidence was 0.4% compared with ˆ¼5% in each of the three other clinical groups.

The researchers say the referrals for women with breast pain only are therefore not ‘cost-effective’, and may cause delay for women with higher-risk symptoms. As they explain:

“The total cost of breast clinic attendances for the 1,972 women referred with pain alone was £531,817, thus the cost per case of breast cancer identified in this group (n = 8) was £66,477. This is around 10-times the cost per case identified in the other presentation groups, which ranged from £6623 to £6944.

“Compared with reassurance in primary care, referral was more costly (net cost £262) and did not confer additional health benefits (net QALYs ˆ’0.012) that is referral to secondary care was dominated by reassurance from primary care physicians indicating that it was not likely to be cost-effective.”

More appropriate care pathways need to be implemented

They say now is the time to consider “more suitable pathways for those women requiring high-quality breast care advice but not a cancer diagnosis service.”

This could be through primary care assurance and advice as well as providing patients with online resources. Patients should also be provided with advice on how to alleviate their breast pain symptoms.

Since breast pain is often self-limiting and settles in a matter of weeks or months, the researchers suggest clinicians wait to refer patients to secondary care to allow for “spontaneous resolution”, averting “unnecessary medical intervention for many women without compromising care and enabling more effective use of finite resources.”

The study’s results should “reassure patients”

Dr Gary Howsam, Vice Chair of the Royal College of GPs, said the study’s results should “reassure patients” suffering with breast pain alone that it is unlikely to be a symptom of cancer.

He notes however that is “essential” that if patients are concerned or have symptoms of breast cancer, that they contact their GP to get checked out.

Symptoms can include a new lump, a change in size or shape of the breast, breast discharge and swelling and a lump or swelling in either of the armpits, which can all be experienced with and without breast pain.

“Medical research, such as this, is vital to improving the timeliness and accuracy of cancer diagnosis. As such, it’s important that this research is considered when clinical guidelines are developed or updated, so that GPs are confident they are making decisions about whether a referral is required, based on the latest evidence.

“Overall, GPs are doing a good job at identifying cancers and referring appropriately with around 75% of cancers being diagnosed after just one or two GP consultations – what would help further is better access to diagnostics in the community, and the appropriate staff and training to use them,” he said.