Breast Injuries in Women's Rugby Union: A Comparison of Prospective and Retrospective Surveillance

Retrospective research has reported a high prevalence of breast injuries in women's rugby union (RU); however, most injuries are not reported to medical staff. This study compared the incidence and severity of breast injuries collected both prospectively and retrospectively over a comparable match exposure period. Prospective surveillance was conducted by clinicians (n = 14) using an online injury surveillance system across 140 RU players. Retrospective surveillance was conducted using an anonymous online survey completed by 370 RU players. Injury incidence was calculated per 1000 hours of match exposure. Severity was assessed using breast pain, bruising and swelling, ability to continue play, perceived effect on performance, and long-term breast changes. Three breast injuries were prospectively recorded over 1204 hours of competition (2.5 injuries/1000 hours). In contrast, 144 breast injuries were reported retrospectively over 5055 hours of competition (28.5 injuries/1000 hours). The retrospective injury rate was significantly higher than the prospective rate (IRR = 11.4, 95% CI: 3.15-41.73; p < 0.002). Ninety-six percent (n = 139) of retrospectively reported injuries had not been disclosed to medical staff. Injury severity was similar between surveillance methods, with bruising commonly reported, all players continuing to participate despite injury, and over half perceiving a negative effect on performance. Long-term breast changes were reported by 6% (n = 8) of players. The substantially lower incidence recorded prospectively suggests that breast injuries are underreported in women's RU. Improved reporting and surveillance strategies are required to better capture breast injuries and support female athlete health and performance.