Breast Pain Overview
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Our next topic is breast pain.
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And again, there's an ACR appropriateness
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criteria to correlate with this.
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So another expert panel giving us
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advice on how to image breast pain.
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The basics are that diagnostic imaging,
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really is not indicated for diffuse,
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bilateral, or cyclical pain.
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Imaging is indicated for focal,
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unilateral, and non-cyclical breast pain.
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This is a very common complaint.
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Most people with breast pain have
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normal imaging, and the imaging
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can be very useful for reassurance.
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We can find a reason for pain,
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such as a cyst or an abscess, but often the
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exam is normal, and the chance of cancer
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is very low, estimated at 0 to 3%.
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So the ACR appropriateness criteria recommend
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that for patients under age 30, we would do breast
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ultrasound, mammogram only if needed, and then
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for age 30 to 39, that intermediate age group.
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Ultrasound or mammogram both get
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the same appropriateness rating,
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so either one could be performed first.
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And then for age 40 and up, diagnostic mammogram
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is recommended, followed by ultrasound.
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Our protocol is just slightly different
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in that for patients age 30 and up,
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we're going to start with a mammogram first.
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So we took that age 30 to 39-year-old
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age group and decided that we would.
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do a mammogram in all of those patients.
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So for age under 30, we'll start
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with ultrasound, age 30 and up,
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mammogram first, and then ultrasound.
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And we do bilateral CC and MLO views.
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If the patient has had a screening
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mammogram within the last six months,
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we don't repeat the mammogram.
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We go straight to ultrasound.
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If it's been more than six months,
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we'll go ahead and repeat a unilateral mammogram.
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And for mammography, we'll mark the
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site of pain with a skin marker,
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and in this case, we use a square.
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Breast pain has a number of different
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causes, some of which we really can't image.
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It can be hormonal, it can be related
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to cysts or multiple cysts, it could
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be nerve-related or musculoskeletal.
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The etiology could be completely unknown,
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and very rarely, as I mentioned before,
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it can be associated with breast cancer.
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I think in over 20 years of breast imaging,
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I've seen about three cases where a
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patient presented with focal breast pain.
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And when we image that area, we found
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a mass, and subsequent biopsy showed a
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breast cancer, but it's pretty unusual.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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