Abstract
Background
Centralisation of breast cancer services in Ireland has resulted in a significant increase in the number of patients attending symptomatic breast units (SBU). A considerable proportion of patients referred to SBU present with non-suspicious symptoms and fall into a “low-risk” category for breast cancer. It has been proposed that consideration be given to a primary care-delivered service for these patients.
Aim
To evaluate SBU attendances and correlate with diagnosis to identify a cohort of patients who may be suitable for management in the primary care setting.
Methods
Data were collected from a prospectively maintained database on patients attending SBU at two tertiary referral centres (Beaumont Hospital and University College Hospital Galway) from January 2011 to 2012. Reasons for attendance, outcome of triple-assessment and incidence of malignancy were analysed.
Results
14,325 patients underwent triple assessment at the SBU in this time period. 5,841 patients were referred with mastalgia, of whom 3,331 (57 %) reported mastalgia as the only symptom. The incidence of breast cancer in patients presenting with mastalgia alone was 1.2 %. All patients diagnosed with breast cancer in this cohort were over 35 years of age.
Conclusion
The incidence of breast cancer in patients referred to SBU with mastalgia as an isolated symptom is extremely low. Patients under 35 years of age, with mastalgia as an isolated symptom do not require breast imaging and have a sufficiently low risk of breast cancer that they may be suitable for management in the primary care setting.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Programme NCC, O’Rourke N (2012) Review of referral patterns and triage processes in symptomatic breast units. A hospital perspective. National Cancer Control Programme, Report No.: 9781906218492
A strategy for cancer control in Ireland (2006) National Cancer Forum-Department of Health and Children
Neary M, Lowery AJ, O’Conghaile A et al (2011) NCCP breast cancer referral guidelines—are breast cancer patients prioritised? Ir Med J 104(2):39–41
Barton MB, Elmore JG, Fletcher SW (1999) Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med 130(8):651–657
Newton P, Hannay DR, Laver R (1999) The presentation and management of female breast symptoms in general practice in Sheffield. Fam Pract 16(4):360–365
Ader DN, Browne MW (1997) Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol 177:126–132
Smith RL, Pruthi S, Fitzpatrick LA (2004) Evaluation and management of breast pain. Mayo Clin Proc 79(3):353–372
Preece PE, Baum M, Mansel RE et al (1982) Importance of mastalgia in operable breast cancer. Br Med J (Clin Res Ed) 284(6325):1299–1300
Smallwood JA, Kye DA, Taylor I (1986) Mastalgia: is this commonly associated with operable breast cancer? Ann R Coll Surg Engl 68:262–263
Fariselli G, Lepera P, Viganotti G et al (1988) Localized mastalgia as presenting symptom in breast cancer. Eur J Surg Oncol 14:213–215
Lumachi F, Ermani M, Brandes AA et al (2002) Breast complaints and risk of breast cancer: population-based study of 2,879 self- selected women and long-term follow-up. Biomed Pharmacother 56:88–92
Benson EA (1987) Mastalgia; is this commonly associated with operable breast cancer. Ann R Coll Surg Engl 69(2):87
Rosolowich V, Saettler E, Szuck B et al (2006) Mastalgia. J Obstet Gynaecol Can 28(1):49–71 (quiz 58–60, 72–74)
Conflict of interest
No ne.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Joyce, D.P., Alamiri, J., Lowery, A.J. et al. Breast clinic referrals: can mastalgia be managed in primary care?. Ir J Med Sci 183, 639–642 (2014). https://doi.org/10.1007/s11845-013-1066-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-013-1066-z