Breast pain indicates possibility of cancer, study finds

In the controversy surrounding using breast pain as a reason for diagnostic imaging, researchers find cancers may manifest in the absence of other signs or symptoms. During a study presented Thursday at the RSNA meeting, researchers found eight of 500 women seeking breast exams for breast pain were diagnosed with breast cancer.

Breast pain is one of the most common reasons prompting a breast exam, according to Dr. Lauren Stein, from the University of Michigan, who presented the study. The reported prevalence of breast cancer in women presenting with breast pain ranges from 0% to 7%. But the literature about imaging women with breast pain is limited, hence there is some controversy regarding diagnostic imaging for breast pain.

Stein and colleagues conducted a retrospective study of 500 consecutive women referred to breast imaging for isolated breast pain. All cancer cases were reviewed to establish geographic correlation of the cancer and the site of pain. Cancers diagnosed within six months of imaging were considered acute and those diagnosed more than six months after imaging were considered subsequent.

Of the eight cancers, three were acute and five were subsequent. Diagnostic mammography was a true positive in all acute cases. The incidence of acute cancer was 0.6%; all three patients reported focal breast pain and all three cancers were in the same geographic location as the pain.

Of the subsequent cancers, four were detected by mammographic screening and one had a palpable finding with a positive mammogram.

The eight cancers were invasive ductal carcinoma (five), invasive lobular carcinoma (one), and ductal carcinoma in situ (two).

The sensitivity of two-view mammography for the detection of cancer in patients with pain was 66.7% and the negative predictive value was 99.8%.

The sensitivity of greater than two-view mammography for the detection of cancer in patients with pain was 100% and the negative predictive value was 100%.