Abstract
Breast pain is a common complaint to both primary care and breast specialists. Current literature recommends imaging for women with breast pain to provide reassurance of benign etiology. The current study sought to determine if imaging is a valuable tool in providing reassurance for women with breast pain, through measuring the association between initial imaging in the evaluation of women with breast pain and subsequent clinical services utilization
From 2006–2009, 916 women were referred to an urban, Safety Net, diagnostic breast health practice for breast pain. We compared the subsequent clinical utilization of women who had imaging ordered at their initial visit to women who did not have imaging ordered. Clinical utilization was defined as the number of follow-up visits, diagnostic imaging studies, and biopsies completed within the 12 months following the initial provider visit. The study population was stratified based on the presence or absence of clinical breast exam findings.
Sixty-percent of women referred for breast pain were age 40 or younger, 87% were from racial/ethnic minority groups, 45% were non-English speaking, and 73% had public or no health insurance. Twenty five percent of women had imaging ordered at initial provider visit for breast pain. Minority and non-English speaking women were less likely to receive initial imaging. Of those who received initial imaging, 75% had radiographic findings which required no additional follow-up, yet 98% returned for additional evaluation. In adjusted analyses, women with imaging ordered at initial provider visit had increased clinical services utilization (OR 25.4, 95% CI: 16.7, 38.6). When the study population was stratified by clinical breast exam results, the risk-adjusted association between initial imaging and subsequent clinical services utilization remained. 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) than women who did not initial imaging. Six cancers were diagnosed in the study population; yet imaging in the absence of clinical breast exam abnormalities did not result in any cancer identification.
Initial imaging for women with breast pain increased the odds of subsequent clinical utilization and did not increase diagnostic certainty in ruling out malignancy.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B87.
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