Research Finds Little Benefit of Breast Imaging for Women with Breast Pain.

For women who have breast pain but no sign of a lump or a mass during an exam, imaging may result in unnecessary follow-up care, according to a new study by researchers at the BU schools of Medicine and Public Health.

Breast pain accounts for between 45 percent and 70 percent of breast-related complaints in the primary-care setting, the authors said, but clinical guidelines have been somewhat unclear about how to address it. Very few women with breast pain alone have an underlying breast cancer, studies have shown.

The researchers reviewed medical records for 916 women who were referred to specialists for breast pain at Boston Medical Center between 2006 and 2009. Within three months of referral, 229 women had an imaging test, one-third of whom had no abnormality during a physical exam. Among those who were imaged, 78 percent had a normal test — but almost all returned for additional evaluation within a year. Six women in the study were diagnosed with cancer, but those women each had an abnormal physical exam before the imaging was conducted.

The results show that imaging tests can result in women getting caught in a loop of unnecessary care, said lead author Mary Beth Howard, a medical student at the BU School of Medicine. The additional ultrasounds and other studies beyond the regular screening mammogram had a potential negative side, including additional doctor visits, more mammograms and other tests and 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,” Howard said. “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.”

The findings appear on-line in Journal of General Internal Medicine. Besides Howard, authors include: Drs. Karen Freund and Tracy Battaglia of the Women’s Health Unit in the Department of Medicine at BUSM and BMC and the BUSPH Department of Epidemiology; and Dr. Marianne Prout, professor of epidemiology at BUSPH.

Funding for this study was provided by an Avon Foundation Safety Net Funding Initiative Grant and a Research in Health Disparities Training grant from the Susan G. Komen Foundation.

Submitted by: Lisa Chedekel

chedekel@bu.edu