{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:04:30Z","timestamp":1787313870737,"version":"build-2736575974"},"reference-count":41,"publisher":"Royal College of General Practitioners","issue":"717","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Women with breast pain constitute &gt;20% of breast clinic attendees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>A prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Women were categorised by presentation into four distinct clinical groups and cancer incidence investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms, 1670 (15%) with \u2018other\u2019 symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in eight (0.7%). Of the 1972 women with breast pain, breast cancer incidence was 0.4% compared with \u223c5% in each of the three other clinical groups. Using \u2018breast lump\u2019 as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Compared with reassurance in primary care, referral was more costly (net cost \u00a3262) without additional health benefits (net quality-adjusted life-year [QALY] loss \u22120.012). The greatest impact on the incremental cost-effectiveness ratio (ICER) was when QALY loss because of referral-associated anxiety was excluded. Primary care reassurance no longer dominated, but the ICER remained greater (\u00a345 528\/QALY) than typical UK National Health Service cost-effectiveness thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3399\/bjgp.2021.0475","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T14:20:13Z","timestamp":1639405213000},"page":"e234-e243","source":"Crossref","is-referenced-by-count":18,"title":["No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic"],"prefix":"10.3399","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6827-8090","authenticated-orcid":false,"given":"Rajiv V","family":"Dave","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Bromley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky P","family":"Taxiarchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Camacho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumohan","family":"Chatterjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-7209","authenticated-orcid":false,"given":"Nicola","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Hutchison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bishop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-1373","authenticated-orcid":false,"given":"William","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1725-4790","authenticated-orcid":false,"given":"Cliona C","family":"Kirwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7264-6201","authenticated-orcid":false,"given":"Ashu","family":"Gandhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2021,12,13]]},"reference":[{"key":"2022033117302326000_72.717.e234.1","unstructured":"NHS England Hospital Episode Statistics for Admitted Patient Care and Outpatient Data. https:\/\/bit.ly\/3uyldnL (accessed 15 Feb 2022)."},{"key":"2022033117302326000_72.717.e234.2","unstructured":"UK Office for National Statistics (2019) Cancer Registration Statistics. www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/datasets\/cancerregistrationstatisticscancerregistrationstatisticsengland (accessed 15 Feb 2022)."},{"issue":"4","key":"2022033117302326000_72.717.e234.3","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s11845-013-1066-z","article-title":"Breast clinic referrals: can mastalgia be managed in primary care?","volume":"183","author":"Joyce","year":"2014","journal-title":"Ir J Med Sci"},{"issue":"6","key":"2022033117302326000_72.717.e234.4","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.ejso.2018.02.048","article-title":"Relieving the pain of the new referral clinic (abstract)","volume":"44","author":"Sawyers","year":"2018","journal-title":"Eur J Surg Oncol"},{"key":"2022033117302326000_72.717.e234.5","unstructured":"National Institute for Health & Care Excellence (2015) Suspected cancer: recognition and referral NICE Guideline NG12, (updated 21 Jan 2021); www.nice.org.uk\/guidance\/ng12. 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