To image or not in noncyclic breast pain? A systematic review : Current Opinion in Obstetrics and Gynecology

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WOMEN'S HEALTH: Edited by Joseph Aquilina

To image or not in noncyclic breast pain? A systematic review

Martín-Díaz, Manuela; Maes-Carballo, Martaa,b; Khan, Khalid Saeedc; Bueno-Cavanillas, Aurorab,d,e

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Current Opinion in Obstetrics and Gynecology 29(6):p 404-412, December 2017. | DOI: 10.1097/GCO.0000000000000407


Purpose of review 

Investigation of noncyclic mastalgia in women without signs or risk factors for cancer is controversial. An initial imaging strategy can diagnose breast cancer early, potentially leading to better treatment and survival. However, cancer diagnosis is very uncommon in these cases, and this approach can be harmful, as false positives or suspicion results will lead to unneeded interventions and follow-up. The purpose of this review is to analyse the trade-offs between desirable and undesirable consequences of initial imaging tests against clinical follow-up.

Recent findings 

We found seven relevant studies, all observational, with some methodological limitations and very low-quality evidence. They showed low breast cancer prevalence (around 1–2%, increasing with age), high sensitivity to rule out disease but moderate specificity to rule it in using mammography and echography, and lacked evidence on follow-up and final outcomes.


There is a low prevalence of breast cancer in patients with painful breast with negative physical examination, and very little research to inform about the effect of performing or avoiding initial imaging test on outcomes of interest. With such limited evidence, only a weak recommendation to reinforce shared decision making about what should be done in the primary care setting can be made, with the backup of a specialized breast unit.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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