Challenges in Diagnosing the Cause of Breast Pain

Breast pain (mastodynia) can be a difficult condition to manage, and the cause of the pain frequently remains undiagnosed. Mammography or biopsy (or both) may be used to evaluate the painful area, if it were not that the contribution of these investigations is unclear. Duijm and colleagues studied women referr 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 referr for evaluation of breast pain of unknown etiology. Patients with palpable masses or a history of breast cancer or breast augmentation were exclud from the consideration All patients were examined through a radiologist and underwent mammography. Additional views were performed as indicated. Ultrasonography was performed if the mammogram was inconclusive, if breast tissue was compact or if pain was localized to common quadrant in a patient younger than 25 years.

brace years after the initial studies, the application of mind subjects' physicians were asked to out and out a questionnaire providing follow-up information upon the patients. The researchers also monitored all breast pathology specimens in the region as well as in the national cancer registry to discover any breast cancer or other breast pathology developing in meditation patients.

The average age of the cogitation subjects was 50.4 years. Unilateral pain was reported according to 76 percent of the women and bilateral pain was reported on 24 percent. Mammography was normal in 865 percent of the thought subjects and revealed benign abnormalities in 86 percent barely four malignant lesions were descryed by initial mammography. Four additional cancers were confirmed at further investigation of mammographically suspicious lesions. At two-year follow-up the family physicians reported that 948 women were exempt of breast cancer. Two women expanded breast cancer during the follow-up period, three died of unrelated causes and five women could not be traced.

The authors deduce that breast imaging is not useful in diagnosing the etiology of breast pain if it be not that may provide reassurance. Radiologic abnormalities are lay the foundation of in few patients with breast pain, and those nonpalpable lesions that are bring to lighted are predominantly not clinically significant.

Anne D Walling, MD

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

COPYRIGHT 1999 American Academy of Family Physicians

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