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Research ArticleOriginal Research

Mastalgia is Not An Indication for Mammogram

Ian K. Komenaka, Jesse Nodora, Maria Elena Martinez, Chiu-Hsieh Hsu, Tina Wong, Anushi Shah and Daniel M. Caruso
The Journal of the American Board of Family Medicine September 2022, jabfm.2022.AP.210476; DOI: https://doi.org/10.3122/jabfm.2022.AP.210476
Ian K. Komenaka
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
MD
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Jesse Nodora
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
DrPH
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Maria Elena Martinez
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
PhD
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Chiu-Hsieh Hsu
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
PhD
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Tina Wong
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
MD, PhD
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Anushi Shah
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
MD
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Daniel M. Caruso
From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
MD
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  • Article
  • Figures & Data
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Article Figures & Data

Tables

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    Table 1.

    Patient Sociodemographic Information From 2006–2020

    Breast Pain Patients (n = 2820)All Other Patients (n = 6140)P Value
    Mean age, years (SD)40.7 (11.8)44.9 (13.2)<0.0001
    Postmenopausal523 (19%)2149 (35%)<0.0001
    Race/ethnicity
     Non-Hispanic White307 (11%)1182 (19%)
     African American186 (7%)599 (10%)
     Hispanic2231 (79%)4077 (66%)<0.0001
     Other96 (3%)282 (5%)
    Language, English1042 (37%)2897 (47%)<0.0001
    Education, years (SD)10.1 (3.7)10.6 (3.8)<0.0001
     6 or less617 (22%)1176 (19%)
     7 – 11867 (31%)1572 (26%)
     High school/equivalent716 (25%)1551 (26%)
     Some college383 (14%)1151 (19%)
     College degree224 (8%)611 (10%)
    Missing1379
    Adequate Health Literacy14% (283/2024)18% (877/4866)0.0006
    Height (m)1.58 (0.079)1.60 (0.077)
    Weight (kg)74.3 (18.1)76.1 (19.3)
    Body mass index in kg/m2 (SD)29.5 (6.62)29.9 (8.08)0.03
    Marital status – married1196 (42%)2432 (40%)0.0006
     Domestic partner246 (9%)466 (7%)
    Employment, employed1008 (36%)2133 (35%)0.39
    Insurance status
     Commercial141 (5%)386 (6%)
     Medicare70 (2%)252 (4%)
     AHCCCS (Medicaid)699 (25%)1773 (29%)
     None1910 (68%)3729 (61%)<0.0001
    Monthly income $ (SD)1208.03 (1116.00)1211.92 (1245.34)0.66
    Family history of breast cancer in first degree relative244 (9%)748 (12%)<0.0001
    Undergoing breast screening (40 years+)23% (343/1500)22% (967/4331)0.97
     Age 40 to 49 years25% (232/927)
     Age 50 years+19% (111/573)
    • Abbreviations: SD, standard deviation; AHCCCS, Arizona Health Care Cost Containment System.

    • View popup
    Table 2.

    Recall Rate, Positive Predictive Value, and Cancer Detection Rate of Breast Imaging for Complaint of Breast Pain

    AgeRecall RatePositive Predictive Value2 (PPV2)Positive Predictive Value3 (PPV3)Cancer Detection Rate (per 1000 examinations)
    BCSC National Benchmark1310.6%25.4%31%4.7
    Current Study
    Under 40 years88%0.2% (1/590)0.2% (1/580)0.9
    40 to 49 years87%2.3% (9/391)2.5% (9/362)10
    Over 50 years94%4% (8/202)4.5% (8/178)14
    P Value (vs BCSC)*<0.0001<0.0001<0.00010.13
    • ↵* Derived from Pearson Chi-Squared test.

    • Abbreviation: BCSC, Breast Cancer Surveillance Consortium.

    • View popup
    Table 3.

    Patients’ Location of Breast Pain and Location of Breast Cancer

    PatientAgePainCancer LocationCancerER/PRErbB2 (Her2neu)LNStage
    145LeftRight mammogramDCIS81/58NANA0
    247BilateralRight mammogramIDC90/8001IIA
    341BilateralRight massIDC95/8000I
    446BilateralLeft mammogramIDC91/532+, 1.30I
    540BilateralRight massILC100/9000I
    644BilateralLeft mammogramIDC95/9000I
    748BilateralLeft massIDC95/702+, 6.40IIA
    860BilateralRight mammogramDCIS97/80NANA0
    950BilateralLeft mammogramIDC95/952+, 1.10I
    1037BilateralLeft mammogramIDC100/1002+, 1.23IIA
    1137BilateralRight massIDC90/802+, 3.82IIA
    1265LeftLeft mammogramIDC90/601+0I
    1352LeftRight mammogramILC100/991+0I
    1445LeftRight massIDC0/000IIIA
    1559LeftRight massIDC95/90002
    1642LeftRight mammogramDCIS95/0NA00
    1764LeftLeft mammogramDCIS90/80NANA0
    1863LeftRight mammogramILC95/000I
    1952RightLeft mammogramDCIS95/100NANA0
    2049RightRight mammogramIDC60/603+7IIIA
    Mean49.3
    • View popup
    Table 4.

    Risk of Breast Cancer by Age (SEER Data Normal Risk Women14)

    Risk of Breast Cancer
    AgeSEER (Normal Risk Women)Current StudyP Value*
    30–39 years0.49%0.16% (n = 1280)0.10
    40–49 years1.55%1.11% (n = 950)0.29
    50 + years2.40%1.45% (n = 590)0.15
    • ↵* Derived from Pearson chi-squared test (vs SEER).

    • Abbreviation: SEER, The Surveillance, Epidemiology, and End Results.

    • View popup
    Table 5.

    Studies of Breast Pain/Mastalgia

    AuthorYearSpecialtyLocationPatients (n)Mean Age (Years)Mean Follow up (months)Breast Cancer Cases (%)
    Current study2020SurgeryAZ, USA2820406120 (0.7%)
    Owen et al182019RadiologyMO, USA94446447 (0.7%)
    Mema et al222019RadiologyNY, USA37446NR0 (0%)
    Fonseca et al242019RadiologyCanada95350NR8 (0.8%)
    Altintas et al152018RadiologyTurkey129443NR10 (0.8%)
    Cho et al172017RadiologyNC, USA41353240 (0%)
    Chetlen et al192017RadiologyPA, USA236NRNR1 (0.4%)
    Noroozian et al252015RadiologyMI, USA617495111 (1.8%)
    Joyce et al12014SurgeryIreland3331NRNR40 (1.2%)
    Leddy et al212013RadiologySC, USA25748123 (1%)
    Howard et al272012Internal MedicineMA, USA91639NR2 (0.2%)*
    Masroor et al262009RadiologyPakistan20744180 (0%)
    Duijm et al201998RadiologyNetherlands98749484 (0.4%)
    Total13,349106 (0.8%)
    • ↵* Study reported 6 patients (0.6%) with breast cancer, however, 4 patients presented with a palpable mass and pain.

    • Abbreviation: NR, not reported.

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The Journal of the American Board of Family     Medicine: 38 (1)
The Journal of the American Board of Family Medicine
Vol. 38, Issue 1
January-February 2025
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Mastalgia is Not An Indication for Mammogram
Ian K. Komenaka, Jesse Nodora, Maria Elena Martinez, Chiu-Hsieh Hsu, Tina Wong, Anushi Shah, Daniel M. Caruso
The Journal of the American Board of Family Medicine Sep 2022, jabfm.2022.AP.210476; DOI: 10.3122/jabfm.2022.AP.210476

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Mastalgia is Not An Indication for Mammogram
Ian K. Komenaka, Jesse Nodora, Maria Elena Martinez, Chiu-Hsieh Hsu, Tina Wong, Anushi Shah, Daniel M. Caruso
The Journal of the American Board of Family Medicine Sep 2022, jabfm.2022.AP.210476; DOI: 10.3122/jabfm.2022.AP.210476
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Keywords

  • Breast Cancer
  • Evidence-Based Medicine
  • Health Literacy
  • Low-Value Care
  • Mastalgia
  • Radiology
  • Retrospective Studies

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