title: Breast clinic referrals: can mastalgia be managed in primary care?
abstract: BACKGROUND
  Centralisation of breast cancer services in Ireland has resulted in a significant increase in the number of patients attending symptomatic breast units (SBU). A considerable proportion of patients referred to SBU present with non-suspicious symptoms and fall into a "low-risk" category for breast cancer. It has been proposed that consideration be given to a primary care-delivered service for these patients.
  
  
  OBJECTIVE
  To evaluate SBU attendances and correlate with diagnosis to identify a cohort of patients who may be suitable for management in the primary care setting.
  
  
  METHODS
  Data were collected from a prospectively maintained database on patients attending SBU at two tertiary referral centres (Beaumont Hospital and University College Hospital Galway) from January 2011 to 2012. Reasons for attendance, outcome of triple-assessment and incidence of malignancy were analysed.
  
  
  RESULTS
  14,325 patients underwent triple assessment at the SBU in this time period. 5,841 patients were referred with mastalgia, of whom 3,331 (57 %) reported mastalgia as the only symptom. The incidence of breast cancer in patients presenting with mastalgia alone was 1.2 %. All patients diagnosed with breast cancer in this cohort were over 35 years of age.
  
  
  CONCLUSIONS
  The incidence of breast cancer in patients referred to SBU with mastalgia as an isolated symptom is extremely low. Patients under 35 years of age, with mastalgia as an isolated symptom do not require breast imaging and have a sufficiently low risk of breast cancer that they may be suitable for management in the primary care setting.
authors.affiliation: Department of Breast and Endocrine Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland, doireann.joyce@gmail.com.
authors.forename: D P
authors.initials: DP
authors.lastname: Joyce
authors.forename: J
authors.initials: J
authors.lastname: Alamiri
authors.forename: A J
authors.initials: AJ
authors.lastname: Lowery
authors.forename: E
authors.initials: E
authors.lastname: Downey
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: R
authors.initials: R
authors.lastname: McLaughlin
authors.forename: A D K
authors.initials: AD
authors.lastname: Hill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007494:Ireland; D059373:Mastodynia / Q000209:etiology*; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation