Diagnostic mammograms not superior to screening for women with breast pain
A screen first approach for women who present to appointments with breast pain decreases healthcare spending without the risk of missing cancer.
Routing patients to screening mammograms rather than diagnostic exams also often prevents them from having to undergo additional procedures, thus reducing the use of unnecessary clinical resources and saving organizations tens of thousands of dollars annually, according to a new analysis in Clinical Imaging.
“Although breast pain is exceedingly common, the rate of breast cancer for women undergoing diagnostic breast imaging solely for breast pain is comparable to or less than the screening population. No abnormalities are typically found at the site of pain, and imaging findings that are identified are typically benign,” corresponding author of the paper Nina Capiro, with the Department of Radiological Sciences at the David Geffen School of Medicine, UCLA, and colleagues explained. “Even in patients presenting with breast pain who are found to have breast cancer, it is unclear if the cancer results in breast pain, or if the breast pain led to evaluation that identified an asymptomatic breast cancer.”
For the analysis, researchers examined the cases of 100 consecutive women older than 40 and without a history of breast cancer who presented to their physicians with complaints of breast pain. Each was sent for a diagnostic mammogram and breast ultrasound between January and April 2022. Department resource allocation and the costs associated were calculated based on the participants’ subsequent exams.
Women were considered screening eligible if they had completed a mammogram at least 12 months prior to presenting with breast pain. Of the 100 women included, 68% were screening eligible when they were sent for their diagnostic mammogram. Using a screen first approach, 47 of those who were eligible would have had negative screening mammograms, which would have kept 47 diagnostic appointments open for others.
“Given the high demand for breast imaging, this increase in appointment availability could impact patient wait times and decrease diagnostic delays,” the group suggested.
The workflow in the study resulted in 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds and 10 image-guided biopsies, costing $42,872.41. A screen first approach would have nearly halved the amount of diagnostic mammograms and ultrasounds, reduced follow-up ultrasounds by one-third and cost approximately $9,000 less.
The financial figures likely would have been higher on an individual level, the group noted, highlighting coverage of screening mammograms that is mandated by the Affordable Care Act. Diagnostic mammograms are not guaranteed the same coverage, likely resulting in additional out-of-pocket costs for some patients.
Two cancers were identified within the group, though the authors noted that they would have been visible on the patients’ screening mammograms.
Rather than sending screening-eligible women with breast pain for diagnostic imaging, the authors suggested instead that providers use the appointment to educate patients on screening recommendations.
“When a patient reports having clinically insignificant breast pain, providers can use the opportunity to reassure the patient that breast pain is rarely a sign of breast cancer and to encourage the patient to undergo routine screening mammography.”
Learn more about the analysis here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.