ArticleBreast care (Basel, Switzerland)2025
Revisiting the Need for Breast Imaging in Young Women with Clinically Significant Breast Pain and a Normal Physical Breast Examination.
Article in Breast care (Basel, Switzerland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Although breast pain as a sole symptom is very rarely associated with cancer, national guidelines recommend that all women with a complaint of breast pain have to be referred for ultrasound evaluation. This study sought to investigate the necessity of this practice. Methods: A retrospective study was conducted in consecutive women aged between 17 and 39 years, at average risk of breast cancer who presented at a major tertiary breast clinic with clinically significant breast pain (unilateral, unifocal, and noncyclic) in 2017-2023. Data on background, physical examination, imaging, and pathology were collected from the electronic medical records and analyzed by outcome. Results: The cohort included 814 women. Among the 574 women (70%) with a normal physical breast examination, ultrasound revealed normal findings or BI-RADS 1-2 lesions in 499 (87%), BI-RADS 3 lesions in 59 (10%), and BI-RADS 4 lesions in 16 (3%). Biopsies, performed in 30 BI-RADS 3 lesions and all BI-RADS 4 lesions, were benign. Half of the 337 patients with available follow-up data continued to attend the breast clinic (mean 3.5 ± 2.2 years). Among the 240 women (30%) with a palpable abnormality on breast examination, ultrasound revealed normal or benign BI-RADS 2 findings in 112 (47%), BI-RADS 3 lesions in 69 (29%), and BI-RADS 4-5 lesions in 59 (25%). Biopsies performed in BI-RADS 3 lesions (12%) were all benign. Biopsies, performed in all BI-RADS 4-5 lesions, yielded malignant pathology in 16 lesions (7%) (including IDC, DCIS, or angiosarcoma). The overall breast cancer risk was 2%. Ultrasound sensitivity was 94%, specificity 85%, and negative predictive value 99%. The negative predictive value for dedicated physical examination without imaging was 100%. The biopsy-proven positive predictive value was 0 in patients with a normal breast examination compared to 18% in patients with a palpable finding on breast examination ( Conclusion: A subset of women <40 years old with average breast cancer risk and breast pain, who would normally be referred for imaging, can be triaged by a dedicated physical examination. Limiting ultrasound evaluation to those with palpable findings will spare patients and the healthcare system unnecessary radiology and biopsy studies.
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