Is mammogram indicated in patients presenting with breast pain alone in the presence of a normal clinical examination?

Patients with breast pain are commonly seen in one-stop breast clinics. Breast pain alone, however, is rarely associated with an underlying malignancy. The Royal College of Radiologists do not recommend routine mammography or ultrasound when examination is normal. We analysed the outcomes of referrals to breast clinic over 1 year.

A retrospective analysis of 1,673 patients attending the breast clinic over a 12-month period. Patients were subcategorised into those presenting with breast pain alone, and in whom mammo-grams were performed. The results of clinical and radiological examination were correlated.

There were 359 (21.5%) patients who presented with breast pain alone. Of these, 251 patients were aged ≥35 years with normal examinations; 230 of these patients (91.6%) had mammograms, 220 (96%) of which were normal. One out of 251 (0.4%) patients who attended with breast pain had microcalcifications on mammography, which was later confirmed as ductal carcinoma in situ. This patient was aged 52 years. She had not previously attended for screening mammography and was classed as low risk.

The incidence of breast cancer at age 50 to 52 years in the NHS Breast Screening Programme is 4 per 1,000 women screened. This is far less in younger age groups. Our study demonstrates that the pick-up rate of breast cancer from mammograms in breast pain alone is low. The case we have identified is likely to be an incidental finding. We continue to screen women with breast pain over the age of 35 years. Should we continue to perform opportunistic screening or should we tailor our screening with age/risk?