Mastalgia and breast cancer risk

Mastalgia and breast cancer

Approximately 60 to 70 % of women experience some degree of breast pain at some stages of their lives, and in 10 to 20 % of cases, it is severe (1)

Women with breast pain constitute upto 20% of breast clinic attendees (2)

A prospective study investigated the association between breast pain and breast cancer (2):

• 10,830 women seen in the 12 months of whom 1972 (18%) were referred with breast pain.
• 6708 (62%) with lumps, 480 (4%) with nipple symptoms,1670 (15%) with "other" symptoms"
  • "..In 1972 women with breast pain, breast cancer incidence was 0.4% compared with about 5% in each of the three other clinical groups..."
  • study authors suggest study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources
    
    
  • important features of this study are:
    • i) It is Prospective - most of the literature involves retrospective audits and while retrospective audits can be very informative and valuable there is the potential that they are more likely to have missing data or have potential biases (ie what data was or wasn’t collected into the database) compared to prospective audits that are set up to collect specific data to address specific questions and this reduces the chance of bias
    • ii) Consecutive - all patients presenting to the unit are included which again reduces another potential bias - ie selection bias.
    • iii) 12 months - it provides a good sample and should account for variations that might occur in referral patterns or rate at certain times of the year (eg over summer vacation or Christmas vacation times)

Cook et al state (3):

• breast pain with no palpable pathology is a significant resource demand to symptomatic breast clinics in the UK
• incidence of breast cancer in a painful breast with no other symptom is rare
• "..make a suggestion that breast pain, portrayed as a concerning symptom associated with breast cancer is removed from all public health literature .."

Further evidence of the low incidence of breast cancer in patients presenting with mastalgia alone was shown in a study in Ireland (4):

• 3,331 reported mastalgia as the only symptom
  • 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
  • "..figure of 1.2% is high - higher than the figure for the national screening programme which is just over 0.8% for the prevalence round and 0.5% for incidence rounds. Even patients who have had breast cancer the annual incidence is about 1.2% so this paper is saying patients with pain only have an incidence of breast cancer that is similar to the annual incidence of women who have had a previous breast cancer...Certainly in the abstract there is no indication that patients with a prior history of breast cancer have been excluded .." (5)

Concluding remarks

• "in summary, the evidence is that the incidence of breast cancer in a population of women of all ages (ie over 16 yrs) attending symptomatic breast clinics is ~0.4% (4: 1000) which is below the NHS BSP (breast cancer screening programme) detection level..." (5)

Resources:

For the GatewayC Fast Facts Video relating to Breast Pain and Breast Cancer then click here

• this content has been produced by GatewayC and commissioned by Sandwell and West Birmingham NHS Trust. If you would like to learn more about breast examination, please watch this video.
• GatewayC is an online cancer education platform for healthcare professionals across England. To register for your FREE account click here.

Reference:

• Kataria K, Dhar A, Srivastava A, Kumar S, Goyal A. A systematic review of current understanding and management of mastalgia. Indian J Surg. 2014;76(3):217-222. doi:10.1007/s12262-013-0813-8
• Rajiv D et al. No Association Between Breast Pain and Breast Cancer. A Prospective Cohort Study of 10,830 Symptomatic Women Presenting to a Breast Cancer Diagnostic Clinic.British Journal of General Practice 13 December 2021; BJGP.2021.0475. DOI: 10.3399/BJGP.2021.0475
• Cook N, Batt J, Fowler C. Symptomatic Breast Cancers and Why Breast Pain May not Always Need Clinical Review. Eur J Breast Health. 2020;16(4):267-269. Published 2020 Jul 29. doi:10.5152/ejbh.2020.5730
• Joyce DP et al. Breast clinic referrals: can mastalgia be managed in primary care? Ir J Med Sci. 2014 Dec;183(4):639-42
• Commentary - John FR Robertson, Professor of Surgery,Director of Centre of Excellence for Autoimmunity in Cancer, University of Nottingham (January 28th 2022)