Can a 'Direct to Mammogram' Clinic Provide a Safe Pathway for Patients with Mastalgia?
Association of Breast Surgery ePoster Library. Ayyar S. 05/15/17; 166314; P136
Ms. Shruti Ayyar
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Abstract
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Introduction: As presented at the ABS Conference 2016, demand is outstripping capacity in breast one-stop clinics (Bramley, 2016). A “direct to mammogram” clinic has been proposed at the Royal Bolton Hospital for patients older than 40 years with mastalgia only. A pilot study was performed to compare cancer detection rates in this population to that of the screening population (8.5/1000, NHSBSP Audit 2015) to validate the safety of the proposal.
Methods: Patients referred in a 4-week period to Bolton Breast Unit with mastalgia as the primary symptom were prospectively identified from GP referral letters and further data was collected from clinic notes.
Results: 108 patients were referred with mastalgia as a primary symptom (40% of referrals). 49 patients (18%) were at least 40 years old and referred with mastalgia only. Mammogram, ultrasound, and core biopsy were performed in 46, 21, and 6 cases respectively – with outcomes graded as below.
No patients were found to have breast cancer in this sample; however, 25% of referrals did not show concordance between the findings of the GP and the breast specialist. 16% of patients who were referred with mastalgia only were found to have other symptoms/signs in breast clinic.
Conclusion: In a 4-week period, the cancer detection rate was 0% in all patients over 40 referred with mastalgia only; however, there was discordance between GP and specialist findings. This discordance has raised concerns about the safety of the proposed 'direct to mammogram' referral pathway and a larger study would be required before considering any change to practice.
Methods: Patients referred in a 4-week period to Bolton Breast Unit with mastalgia as the primary symptom were prospectively identified from GP referral letters and further data was collected from clinic notes.
Results: 108 patients were referred with mastalgia as a primary symptom (40% of referrals). 49 patients (18%) were at least 40 years old and referred with mastalgia only. Mammogram, ultrasound, and core biopsy were performed in 46, 21, and 6 cases respectively – with outcomes graded as below.
No patients were found to have breast cancer in this sample; however, 25% of referrals did not show concordance between the findings of the GP and the breast specialist. 16% of patients who were referred with mastalgia only were found to have other symptoms/signs in breast clinic.
Conclusion: In a 4-week period, the cancer detection rate was 0% in all patients over 40 referred with mastalgia only; however, there was discordance between GP and specialist findings. This discordance has raised concerns about the safety of the proposed 'direct to mammogram' referral pathway and a larger study would be required before considering any change to practice.
Introduction: As presented at the ABS Conference 2016, demand is outstripping capacity in breast one-stop clinics (Bramley, 2016). A “direct to mammogram” clinic has been proposed at the Royal Bolton Hospital for patients older than 40 years with mastalgia only. A pilot study was performed to compare cancer detection rates in this population to that of the screening population (8.5/1000, NHSBSP Audit 2015) to validate the safety of the proposal.
Methods: Patients referred in a 4-week period to Bolton Breast Unit with mastalgia as the primary symptom were prospectively identified from GP referral letters and further data was collected from clinic notes.
Results: 108 patients were referred with mastalgia as a primary symptom (40% of referrals). 49 patients (18%) were at least 40 years old and referred with mastalgia only. Mammogram, ultrasound, and core biopsy were performed in 46, 21, and 6 cases respectively – with outcomes graded as below.
No patients were found to have breast cancer in this sample; however, 25% of referrals did not show concordance between the findings of the GP and the breast specialist. 16% of patients who were referred with mastalgia only were found to have other symptoms/signs in breast clinic.
Conclusion: In a 4-week period, the cancer detection rate was 0% in all patients over 40 referred with mastalgia only; however, there was discordance between GP and specialist findings. This discordance has raised concerns about the safety of the proposed 'direct to mammogram' referral pathway and a larger study would be required before considering any change to practice.
Methods: Patients referred in a 4-week period to Bolton Breast Unit with mastalgia as the primary symptom were prospectively identified from GP referral letters and further data was collected from clinic notes.
Results: 108 patients were referred with mastalgia as a primary symptom (40% of referrals). 49 patients (18%) were at least 40 years old and referred with mastalgia only. Mammogram, ultrasound, and core biopsy were performed in 46, 21, and 6 cases respectively – with outcomes graded as below.
No patients were found to have breast cancer in this sample; however, 25% of referrals did not show concordance between the findings of the GP and the breast specialist. 16% of patients who were referred with mastalgia only were found to have other symptoms/signs in breast clinic.
Conclusion: In a 4-week period, the cancer detection rate was 0% in all patients over 40 referred with mastalgia only; however, there was discordance between GP and specialist findings. This discordance has raised concerns about the safety of the proposed 'direct to mammogram' referral pathway and a larger study would be required before considering any change to practice.
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