The Effect of Imaging on the Clinical Management of Breast Pain
- First Online:
- 199 Downloads
Breast pain is a common complaint to primary care and breast specialists. Literature recommends imaging to provide reassurance of benign etiology. The effect of imaging on reassurance and subsequent healthcare utilization has not been described.
To determine if initial imaging for breast pain reduces subsequent utilization.
Retrospective cohort study at a hospital-based breast health practice.
Women referred for breast pain from 2006–2009.
Imaging ordered at initial provider visit; clinical utilization, defined as the number of follow-up visits, diagnostic imaging studies, and biopsies completed within 12 months following initial visit.
Sixty-percent of women were age 40 or younger, 87% were from racial/ethnic minority groups. Twenty-five percent had imaging ordered at initial visit. Of those who received initial imaging, 75% had normal radiographic findings, yet 98% returned for additional evaluation. In adjusted analyses, women with initial imaging had increased clinical services utilization (OR 25.4, 95% CI: 16.7, 38.6). 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). Six cancers were diagnosed; 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 reassurance in ruling out malignancy.
KEY WORDSbreast pain mammography breast cancer
- 2.Ganschow P, Norlock F, Jacobs E, Marcus E. Breast health and vommon nreast problems: a practical approach. Philadelphia: American College of Physicians; 2004.Google Scholar
- 15.Klimberg V. Etiology and management of breast pain. In: Harris J, Lippman M, Morrow M, Hellman S, eds. Diseases of the Breast, vol. 99-106. Philadelphia: Lippincott-Raven; 1996.Google Scholar
- 21.Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Canc Inst J Natl Canc Inst. 2002;94(5):334–57.Google Scholar
- 27.Screening for breast cancer: U.S. Preventive Services Task Force Recommendations. Ann Intern Med. 2009;151(10):I–44.Google Scholar
- 29.Balsa AI, Seiler N, McGuire TG, Bloche MG. Clinical uncertainty and healthcare disparities. Am J Law Med. 2003;29(207).Google Scholar
- 30.Lutfey KE, Link CL, Grant RW, Marceau LD, McKinlay JB. Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes. Health policy (Amsterdam, Netherlands). 2009;89(3):279–87.CrossRefGoogle Scholar
- 31.Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Canc Inst J Natl Canc Inst. 1989;81(24):1879–86.Google Scholar