title: The effect of imaging on the clinical management of breast pain.
abstract: BACKGROUND
  Breast pain is a common complaint to primary care and breast specialists. Literature recommends imaging to provide reassurance of benign etiology. The effect of imaging on reassurance and subsequent healthcare utilization has not been described.
  
  
  OBJECTIVE
  To determine if initial imaging for breast pain reduces subsequent utilization.
  
  
  METHODS
  Retrospective cohort study at a hospital-based breast health practice.
  
  
  METHODS
  Women referred for breast pain from 2006-2009.
  
  
  METHODS
  Imaging ordered at initial provider visit; clinical utilization, defined as the number of follow-up visits, diagnostic imaging studies, and biopsies completed within 12 months following initial visit.
  
  
  RESULTS
  Sixty-percent of women were age 40 or younger, 87% were from racial/ethnic minority groups. Twenty-five percent had imaging ordered at initial visit. Of those who received initial imaging, 75% had normal radiographic findings, yet 98% returned for additional evaluation. In adjusted analyses, women with initial imaging had increased clinical services utilization (OR 25.4, 95% CI: 16.7, 38.6). Women with normal clinical breast exams who received initial imaging exhibited increased odds for subsequent clinical services utilization (OR 23.8, 95% CI: 12.9, 44.0). Six cancers were diagnosed; imaging in the absence of clinical breast exam abnormalities did not result in any cancer identification.
  
  
  CONCLUSIONS
  Initial imaging for women with breast pain increased the odds of subsequent clinical utilization and did not increase reassurance in ruling out malignancy.
authors.affiliation: Women's Health Unit, Section of General Internal Medicine, Department of Medicine, and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA 02118, USA. mbhoward@bu.edu
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Howard
authors.forename: Tracy
authors.initials: T
authors.lastname: Battaglia
authors.forename: Marianne
authors.initials: M
authors.lastname: Prout
authors.forename: Karen
authors.initials: K
authors.lastname: Freund
mesh_terms: D000328:Adult; D001007:Anxiety; D001706:Biopsy / Q000706:statistics & numerical data; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000150:complications* / Q000175:diagnosis*; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000523:psychology; D012017:Referral and Consultation; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data