1. No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic.
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Dave, Rajiv V, Bromley, Hannah, Taxiarchi, Vicky P, Camacho, Elizabeth, Chatterjee, Sumohan, Barnes, Nicola, Hutchison, Gillian, Bishop, Paul, Hamilton, William, Kirwan, Cliona C, and Gandhi, Ashu
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BREAST cancer ,CANCER pain ,COHORT analysis ,LONGITUDINAL method ,MEDICAL economics ,BREAST tumor diagnosis ,NATIONAL health services ,COST benefit analysis ,IMPACT of Event Scale ,BREAST tumors ,QUALITY-adjusted life years - Abstract
Background: Women with breast pain constitute >20% of breast clinic attendees.Aim: To investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care.Design and Setting: A prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months.Method: Women were categorised by presentation into four distinct clinical groups and cancer incidence investigated.Results: Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms, 1670 (15%) with 'other' symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in eight (0.7%). Of the 1972 women with breast pain, breast cancer incidence was 0.4% compared with ∼5% in each of the three other clinical groups. Using 'breast lump' as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09, P<0.001). Compared with reassurance in primary care, referral was more costly (net cost £262) without additional health benefits (net quality-adjusted life-year [QALY] loss -0.012). The greatest impact on the incremental cost-effectiveness ratio (ICER) was when QALY loss because of referral-associated anxiety was excluded. Primary care reassurance no longer dominated, but the ICER remained greater (£45 528/QALY) than typical UK National Health Service cost-effectiveness thresholds.Conclusion: This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden. [ABSTRACT FROM AUTHOR]- Published
- 2022
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