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. 2024 Oct 30;13(4):e002882.
doi: 10.1136/bmjoq-2024-002882.

Community breast pain clinics can provide safe, quality care for women presenting with breast pain

Mark Sibbering  1 , Veronica Rogers  2 , Louise Merriman  3 , Iman Azmy  4 , Denise Stafford  2 , Kevin Clifton  4 , Jennifer Pickard  5 , Thilan Bartholomeuz  6 , John Robertson  2   7
Affiliations

Community breast pain clinics can provide safe, quality care for women presenting with breast pain

Mark Sibbering et al. BMJ Open Qual. .

Abstract

Introduction: Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data.

Results: 1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management.

Discussion: Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) 'extremely likely or likely' to recommend the service.

Conclusion: The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.

Keywords: Audit and feedback; Healthcare quality improvement; PRIMARY CARE; Pain; Patient safety.

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Conflict of interest statement

Competing interests: MS is a Breast Surgeon who has provided Breast Cancer Educational Services and attended Advisory Boards for Roche Products Ltd. TB is a GP with special interest in Cancer Services, Clinical Lead for Mid Nottinghamshire Placed Based Partnership. JR is a Breast Surgeon with an interest in early cancer detection and has consulted for AstraZeneca, Bayer, Carrick Therapeutics & Cullinan Oncology. He also has provided expert testimony for AstraZeneca. He holds shares in Oncimmune Holdings, FaHRAS Ltd and Carrick Therapeutics. JP is a GP who works as the cancer clinical lead for Derby and Derbyshire Integrated Care Board (DDICB). Further implementation of the Breast Pain Clinic Model beyond Derbyshire has been facilitated through a collaborative agreement between Roche Products Limited and HITS – Health Improvement Transformation Strategies Limited a Community Interest Company. Roche Products have provided funding to support implementation of clinics.

Figures

Figure 1
Figure 1. Patient pathway.
Figure 2
Figure 2. Word clouds.
See this image and copyright information in PMC

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