Imaging for breast pain: A useful paradigm to promote breast cancer screening and reduce unnecessary breast imaging

Abstract

Objective

Identify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection.

Methods

We retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule.

Results

68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach.

Discussion

Identifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.