GPs can feel ‘reassured’ that they do not need to refer women with breast pain alone for cancer investigation, researchers have said.
A large study, carried out by researchers from Manchester University NHS Foundation Trust, University of Manchester and the University of Exeter, found ‘no association’ between breast pain and breast cancer.
It concluded that referral of women only suffering from breast pain is ‘not cost-effective and may cause delay for women with higher-risk symptoms’.
And researchers said the results should ‘prompt a review of health policy for the care of women with breast pain alone’.
The analysis, of 10,830 symptomatic women referred to a breast cancer diagnostic clinic over a year, found that only 0.4% of the women with symptoms of breast pain actually had breast cancer.
The paper, published in the British Journal of General Practice (BJGP), said: ‘Of the 1,972 women with breast pain, breast cancer incidence was 0.4% compared with ~5% in each of the three other clinical groups.
There has been almost a 100% increase in referrals over the past 10 years, the researchers noted, with recent audits showing that women referred with breast pain account for more than 20% of attendees to breast outpatient services.
The researchers commented: ‘Breast pain is common and is not a presenting symptom of breast cancer. Women and GP should be reassured of this finding, there is no need for routine referral of women with breast pain to a cancer diagnostic clinic.’
Exeter GP and professor of primary care diagnostics at the University of Exeter Professor Willie Hamilton told Pulse the study suggests there is ‘little to be gained by putting these women through all the testing for cancer’ but that it ‘does not mean’ referral is ‘necessarily wrong’.
He said: ‘If the woman is fearful their mastalgia augurs cancer, GPs have now a solid basis for reassurance (assuming there’s no accompanying high-risk features). Referral may still be helpful as mastalgia can be a ghastly complaint, and specialist input may help.’
Professor Hamilton said this ‘suggests the optimum specialist pathway is a clinic for mastalgia, quite separate from the cancer pathway.’
East London GP and researcher at King’s College London Dr Thomas Round told Pulse GPs may want to use advice and guidance, as well as patient contact to go through self-examination and ‘safety net for worrying clinical features like breast lumps, which would require an urgent referral’.
And RCGP vice chair Dr Gary Howsam said the study results should ‘reassure patients suffering solely with breast pain, that it is unlikely to be a sign of cancer’.
He said: ‘Medical research, such as this, is vital to improving the timeliness and accuracy of cancer diagnosis.
‘As such, it’s important that this research is considered when clinical guidelines are developed or updated, so that GPs are confident they are making decisions about whether a referral is required, based on the latest evidence.
‘Overall, GPs are doing a good job at identifying cancers and referring appropriately with around 75% of cancers being diagnosed after just one or two GP consultations – what would help further is better access to diagnostics in the community, and the appropriate staff and training to use them.’
It comes as a trust recently reported 40-day indicative waits for urgent breast cancer referrals.
And the Government suggested patients who think they may have cancer could self-refer for investigation without the need for a GP referral.
NICE guidance for breast cancer diagnosis
1.4 Breast cancer
1.4.1 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:
aged 30 and over and have an unexplained breast lump with or without pain or
aged 50 and over with any of the following symptoms in one nipple only:
other changes of concern. 
1.4.2Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:
with skin changes that suggest breast cancer or
aged 30 and over with an unexplained lump in the axilla. 
1.4.3Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain. See also recommendations 1.16.2 and 1.16.3 for information about seeking specialist advice. 
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
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