Breast Complaints, Biopsies, and Cancer Correlated with Age in 10,000 Consecutive New Surgical Referrals

Abstract:   The incidence of breast cancer in symptomatic women as correlated with the type of complaint and patient age is important for the development of guidelines for patient referral and breast biopsy. The goal of this article is to demonstrate those situations that are most likely to yield a cancer diagnosis and to emphasize the benignity of the majority of breast complaints. It is suggested that the information will be useful to those who develop guidelines for the management of breast complaints. Data on 10,000 consecutive new surgical referrals for breast complaints were reviewed with attention to age, type of complaint, the occurrence of breast biopsy, and the finding of breast cancer. The majority of patients (68%) were less than 50 years old. Only 4% of patients less than 50 years old were found to have breast cancer and 17% of patients ≥50 years old had breast cancer. Only 9% of all of the patients had breast cancer. Nine percent of patients with a chief complaint of discharge ≥50 years old and 8% of patients ≥70 years old with pain as their complaint had breast cancer. Patients with breast symptoms presenting to a surgeon are not usually found to have breast cancer. There is a need for more useful guidelines related to the indications for patient referral and breast biopsies, as well as a need to inform the public that only a minority of complaints result in a cancer diagnosis. Complaints of nipple discharge or pain in older patients require careful evaluation.