Association of Breast Surgery: Position Statement on Breast Pain

Introduction

• Women with breast pain constitute up to 41% of attendees in the One Stop Clinic (OSC).
• The incidence of breast cancer in women with breast pain only symptoms (no lumps, nipple or skin symptoms) is 0.4%, as reported both in the largest consecutive series of women attending a symptomatic breast clinic, and in the most recent literature review.
• This figure is approximately half the detection rate in asymptomatic women screened by the national breast screening programme (9.2 per 1,000 women screened in 2021-22).

Better care for women with breast pain

• The Association of Breast Surgery (ABS) believes that women with breast pain require and deserve management by skilled clinicians, who can address the presenting complaint of breast pain and manage this appropriately.
• Time is also needed to give advice on the management of symptoms and address patient concerns, which is difficult in a pressured OSC. The OSC may not be the appropriate place to see patients with breast pain only, as it is a service designed to diagnose breast cancer.
• An alternative high quality, safe and effective pathway for women with breast pain only, outside of the OSC, would allow greater capacity for rapid review of women with red-flag symptoms (breast cancer incidence 5-6%) within the OSC.

Breast Services have found local solutions

A number of breast services have developed their own local solutions outside of OSCs, involving assessment of women with breast pain only, freeing up capacity within these clinics for women with true red-flag symptoms.

No innovation without evaluation

All units who have developed new assessment pathways for women referred with breast pain are reminded of their obligation to evaluate the new pathways to ensure safety, effectiveness and patient satisfaction.

Summary

• Women with breast pain may not be best served by current referral pathways, which can raise anxiety but fail to offer the opportunity to address underlying concerns and symptom management.
• ABS are working with NHS England and Breast Cancer charities to develop more appropriate pathways out-with the one stop clinic.
• New pathways should be evaluated assiduously with standard data collection
• ABS will continue to promote and facilitate collection of best evidence as part of the ASPIRE project

Link to full position statement