Should I order imaging to evaluate breast pain?

In a retrospective study, almost all diagnostic imaging for breast pain was negative.

Breast pain is common but the cause is not always clear, producing anxiety over the possibility of underlying malignancy. Although breast cancer is not associated with breast pain, many patients are referred for diagnostic imaging (usually with negative results). Researchers at MD Anderson Cancer Centre reported imaging findings for 799 patients who presented with breast pain at three community-based breast imaging centres in 2014.

The initial imaging modality was breast ultrasound for women younger than 30 and digital mammography (sometimes with tomosynthesis) for those aged ≥30 who had not had a mammogram within the last 6 months. Breast MRI was performed only when ordered by the referring physician. Most patients presented for diagnostic imaging; of these, 95% had negative findings and 5% had positive (but benign) findings.

Only one patient had an incidental breast cancer, which was contralateral and detected with tomosynthesis. The cost of breast imaging was $87,322 in women 40 or younger and $152,732 in older women.