Mammography for mastalgia - Worth the pain and the price? A large centre retrospective review and cost-benefit analysis.

UNLABELLED: Aim To determine the cancer detection rate (CDR) of mammography in women presenting with isolated mastalgia and a normal clinical breast examination. METHODS: A retrospective review was conducted of all mammograms performed for "pain," "breast pain" or "mastalgia" across a large health board over 5 years from 1 January 2020 to 31 December 2024. Cases with additional symptoms or clinical findings graded E2 benign or above were excluded. Imaging, histopathology, patient demographics and patient outcomes were analysed. RESULTS: Of 9795 mammograms performed, 6670 met inclusion criteria. Among these,70 mammograms had final mammographic grading of M3 or above and proceeded to further assessment. 69 patients underwent biopsy, yielding 44 malignancies (38 invasive and 6 DCIS), representing an overall CDR of 6 per 1000 (0.6%). Most invasive cancers were invasive ductal carcinoma (68%), grade 2 (51%), and strongly ERpositive (72%). CONCLUSION: The diagnostic yield of mammography in detecting invasive malignancy in women presenting solely with mastalgia and a normal examination was 0.6%, comparable to but slightly lower than the UK National Breast Screening Programme Cancer Detection Rate (0.7%) and comparable to similar studies. This review supports the position that imaging is not required for patients presenting with isolated mastalgia and a normal clinical examination.