Abstract P4-12-12: Breast pain: A very common complaint - What workup is cost effective?
Authors: Komenaka IK , Cocco D , Hsu C-H , Davis J , Nodora J , Martinez ME 
Published: February 2018

Abstract
Background: Mastalgia, without other signs or symptoms, is a very common complaint, yet occurs in only approximately 5% of patients with breast cancer. Most clinicians are aware of this lack of association with cancer. Mastalgia, however, remains worrisome to many women, and when seen in the office, clinicians tend to give in to the fear of patients and order various tests. Trusted surgical textbooks recommend that women 30 years and older with mastalgia undergo mammography and ultrasound, in addition to a physical examination, and other necessary workup. The current study was performed to evaluate the benefit and efficacy of working up patients with mastalgia.
Methods: The safety net hospital in Phoenix, Arizona serves a patient base which is 34.5% non-English speaking. The majority of these patients are uninsured or underinsured. A total of 7202 consecutive patients were seen at least once at the Breast Clinic from June 1, 2006 to February 28, 2017. Sociodemographic variables were collected on all patients. All patients who presented with a complaint of breast pain were evaluated to determine the efficacy of their workup. Additionally, all patients who complained of a breast mass but were found to have pain with no mass were evaluated in a similar fashion.
Results: More than 1 of 7, 15% of patients (1017 of 7202) presented with a complaint of breast pain. In addition, 702 patient who complained of a breast “mass” really were found to have only breast pain. Of the 1719 patients with breast pain, 15 (&lt;1%) were found to have breast cancer. The average age of patients found to have cancer was 49 years. None of the patients found to have cancer were at increased risk according to Gail Model risk estimates (mean 5 yr risk 0.7% (range 0.2 – 1.4%). Only 1 patient (6%) were undergoing screening mammography. Physical examination identified a mass in 4 patients and the remaining cancers were found by mammogram. Of the 15 patients found to have breast cancer, most (13 of 15) were stage 0 or stage 1. Also only 1 patient had pain only on the side of the cancer.
A total of 880 patients were under the age of 40 years. Only 1 breast cancer patient was under age 40.
524 patients were between 40-49 years and 8 were found to have breast cancer.
The remaining 315 patients were 50 years or older and 6 were found to have breast cancer.
Most patients underwent workup for their breast pain with 85% undergoing breast imaging (mammogram, ultrasound, or MRI, and even 2 CT scans), 32% undergoing a biopsy, and 68% having blood drawn for laboratory tests. To add to the costs, 27% of patients were seen in the Emergency Department prior to their visit at the Breast Clinic.
Conclusions: Mastalgia is a very common complaint in patients seen in outpatient clinics. In patients not recommended to undergo screening based on any National guideline (Age &lt; 40 years), any workup beyond physical examination does not appear to be cost effective. In patients at least 40 years mammography should be performed if the patient has not been participating in routine screening. Diagnostic imaging (in the absence of findings on screening) and laboratory tests do not appear beneficial in patients with breast pain. Continued education is necessary to avoid continued use of unnecessary medical resources.
Citation Format: Komenaka IK, Cocco D, Hsu C-H, Davis J, Nodora J, Martinez ME. Breast pain: A very common complaint - What workup is cost effective? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-12.