Little benefit in imaging tests for women with breast pain

by Bruce Sylvester – Women with breast pain who undergo extra-routine mammograms, MRIs or ultrasounds as part of breast pain evaluation derive no diagnostic or therapeutic benefit, researchers report.

“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,” said lead author Mary Beth Howard, MS and MD candidate at Boston University School of Medicine in Boston, Massachusetts.

These findings currently appeared on-line on March 7 in Journal of General Internal Medicine.

As background, the authors noted that the guidelines for management of women with breast pain have not been clear, and some studies have suggested that tests beyond routine screening mammogram might provide reassurance for women with breast pain.

The investigators retrospectively analyzed data from 916 women who were referred from 2006-2009 for breast pain to the Boston Medical Center.

They compared the clinical management of women had received extra-routine imaging (beyond regular mammogram) to women who had not received such imaging.

All of the women in whom six cancers were identified had either a palpable lump in the painful breast or a routine screening mammogram disclosed cancer in their other breast.

For women with breast pain who had a completely normal breast examination, the addition of an ultrasound, MRI or more mammograms did not disclose new information.

The authors noted that additional ultrasounds and other evaluations beyond a regular screening mammogram had a potential negative side. “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,” Howard said.

“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,” Howard added.

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.