• Ian K Komenaka, Jesse Nodora, Maria Elena Martinez, Chiu-Hsieh Hsu, Tina Wong, Anushi Shah, and 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) Komenaka@hotmail.com.
• J Am Board Fam Med. 2022 Sep 12.

Mastalgia is a common breast complaint that is worrisome to patients. This study was performed to determine if mastalgia is a sign of breast cancer and to evaluate the benefit of its work up. MethodsRetrospective review of prospectively collected data on 8960 consecutive patients at a safety net institution from June 1, 2006 to December 31, 2020. Data on patient reported mastalgia and diagnosis of breast cancer were collected. Results8960 patients had a mean age of 45 years. The population was predominantly underinsured, 70% Hispanic, and 16% had adequate health literacy. Approximately 31% (2820 of 8960) of patients presented with a complaint of breast pain. Of 2820 patients with breast pain, 20 (0.7%) were found to have breast cancer. The average age of patients with breast cancer was 49 years. Physical examination identified a mass in 6 patients and only 3 patients had pain limited to the side of the cancer (10 bilateral, 7 contralateral). Of 1280 patients who were under age 40 years, 88% underwent breast imaging. The Cancer Detection Rate (CDR) was 0.9 per 1000 examinations. For 950 patients age 40 to 49 years and 590 patients age 50 years and older, 98% and 99% underwent breast imaging, respectively. The CDR was 10 per 1000 examinations for age 40 to 49 and 14 per 1000 examinations for age 50 years and older. ConclusionsMastalgia is rarely associated with breast cancer. In the absence of other findings, imaging of patients less than age 40 is not recommended. Any workup beyond routine screening mammography in age-appropriate patients, to identify the "cause" of breast pain, does not seem warranted.© Copyright by the American Board of Family Medicine.

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