Abstract Background Breast-related symptoms are common in primary care and frequently prompt imaging or referral. While a palpable breast lump is strongly associated with breast cancer, isolated mastalgia is generally considered low risk. Most evidence comes from secondary care, limiting applicability to general practice. Aim To estimate the likelihood of breast cancer associated with breast-related symptoms in primary care and to evaluate current GP management of women with isolated mastalgia. Design and setting Retrospective cohort study using electronic health records from a Dutch primary care research network. Methods We included women aged ≥ 30 years presenting with breast-related symptoms or diagnosed with breast cancer between 2014 and 2021. Multivariable logistic regression assessed associations between symptoms and breast cancer. Mastalgia was classified as either isolated (without any other breast-related symptoms) or in combination with other symptoms. In women with isolated mastalgia, GP-initiated imaging and referrals were recorded and evaluated. Results We included 2073 episodes from 1752 women (median age: 45.0 years, range 30–100 years); 189 episodes (9.1%) resulted in breast cancer. Presentation with a breast lump (OR 10.57, 95%-CI 4.89–22.84), skin or nipple retraction (OR 5.54, 95%-CI 2.28–13.48), and increasing age (OR 1.07 per year, 95%-CI 1.05–1.08) were independently associated with breast cancer. Mastalgia was associated with lower odds (OR 0.56, 95%-CI 0.34–0.92). Mastalgia was reported in 26 episodes that ultimately resulted in a breast cancer episode, but no cases occurred among women with isolated mastalgia (0 of 588 episodes). Despite this, 39.6% of women with isolated mastalgia underwent breast imaging, nearly half within three months. Conclusion In primary care, breast cancer is strongly associated with a palpable lump, skin or nipple retraction, and increasing age. Isolated mastalgia was not associated with breast cancer. However, mastalgia occurring in combination with other breast-related symptoms may indicate a higher risk. Imaging and referral may often be safely deferred in women presenting with short-duration isolated mastalgia.
Ieperen et al. (Fri,) studied this question.