RT Journal Article SR Electronic T1 No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic JF British Journal of General Practice JO Br J Gen Pract FD British Journal of General Practice SP e234 OP e243 DO 10.3399/BJGP.2021.0475 VO 72 IS 717 A1 Rajiv V Dave A1 Hannah Bromley A1 Vicky P Taxiarchi A1 Elizabeth Camacho A1 Sumohan Chatterjee A1 Nicola Barnes A1 Gillian Hutchison A1 Paul Bishop A1 William Hamilton A1 Cliona C Kirwan A1 Ashu Gandhi YR 2022 UL http://bjgp.org/content/72/717/e234.abstract AB Background Women with breast pain constitute >20% of breast clinic attendees.Aim To investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care.Design and setting A prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months.Method Women were categorised by presentation into four distinct clinical groups and cancer incidence investigated.Results Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms, 1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in eight (0.7%). Of the 1972 women with breast pain, breast cancer incidence was 0.4% compared with ∼5% in each of the three other clinical groups. Using ‘breast lump’ as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09, P<0.001). Compared with reassurance in primary care, referral was more costly (net cost £262) without additional health benefits (net quality-adjusted life-year [QALY] loss −0.012). The greatest impact on the incremental cost-effectiveness ratio (ICER) was when QALY loss because of referral-associated anxiety was excluded. Primary care reassurance no longer dominated, but the ICER remained greater (£45 528/QALY) than typical UK National Health Service cost-effectiveness thresholds.Conclusion This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.