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Challenges in Diagnosing the Cause of Breast Pain

Am Fam Physician. 1999 Apr 1;59(7):1944-1951.

Breast pain (mastodynia) can be a difficult condition to manage, and the cause of the pain often remains undiagnosed. Mammography or biopsy (or both) may be used to evaluate the painful area, but the contribution of these investigations is unclear. Duijm and colleagues studied women referred to a Dutch teaching hospital for investigation of breast pain to establish the usefulness of mammography and biopsy in the assessment of breast pain.

A total of 987 women were referred for evaluation of breast pain of unknown etiology. Patients with palpable masses or a history of breast cancer or breast augmentation were excluded from the study. All patients were examined by a radiologist and underwent mammography. Additional views were performed as indicated. Ultrasonography was performed if the mammogram was inconclusive, if breast tissue was dense or if pain was localized to one quadrant in a patient younger than 25 years.

Two years after the initial studies, the study subjects' physicians were asked to complete a questionnaire providing follow-up information on the patients. The researchers also monitored all breast pathology specimens in the region as well as in the national cancer registry to detect any breast cancer or other breast pathology developing in study patients.

The average age of the study subjects was 50.4 years. Unilateral pain was reported by 76 percent of the women, and bilateral pain was reported by 24 percent. Mammography was normal in 86.5 percent of the study subjects and revealed benign abnormalities in 8.6 percent. Only four malignant lesions were detected by initial mammography. Four additional cancers were confirmed by further investigation of mammographically suspicious lesions. At two-year follow-up, the family physicians reported that 948 women were free of breast cancer. Two women developed breast cancer during the follow-up period, three died of unrelated causes and five women could not be traced.

The authors conclude that breast imaging is not useful in diagnosing the etiology of breast pain but may provide reassurance. Radiologic abnormalities are found in few patients with breast pain, and those nonpalpable lesions that are detected are predominantly not clinically significant.

Duijm LE, et al. Value of breast imaging in women with painful breasts: observational follow-up study. BMJ. December 1998;317:1492–5.


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