i s b reast transillumination a viable option for breast cancer screening in resource limited...
TRANSCRIPT
ASO
U A
GM
Fort Po
rtal, U
ganda
IS BREAST TRANSILLUMINATION A VIABLE OPTION FOR BREAST CANCER SCREENING IN RESOURCE LIMITED SETTINGS?
Elobu Emmanuel,
MD (Dar), MMed Surgery(MUK)
FCS (ECSA) trainee,
Registrar
Colorectal Surgery Unit
Mulago Hopsital
ASO
U A
GM
Fort Po
rtal, U
ganda
WHAT IS THE PROBLEM?
Breast cancer Common
disease(Gakwaya et al)
Rapidly rising incidence(Parkin et al)
low overall survival-56%(Gakwaya et al
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U A
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Fort Po
rtal, U
ganda
PROBLEM CONT’D
Prevention No effective primary
prevention(Gakwaya et al)
Secondary prevention is best hope(Prasad et al)
No screening program
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U A
GM
Fort Po
rtal, U
ganda
Mammography Internationally
accepted effective screening tool(Brittenden,
Nelson)
Not feasible for poor resource country like Uganda(Gakwaya et al)
Age limit (> 30 y) High Cost Inequitable
distribution
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U A
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Fort Po
rtal, U
ganda
Breast transillumination is Safer (IR vs. Xray) Cheaper ($150) easier to use(self
exam) minimal running
costs No age limit
How does it perform in comparison with MG?
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U A
GM
Fort Po
rtal, U
ganda
SELF TRANSILLUMINATION
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GM
Fort Po
rtal, U
ganda
ASO
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GM
Fort Po
rtal, U
ganda
SPECIFIC OBJECTIVE 1
To determine the sensitivity, specificity and predictive values of breast transillumination compared to mammography in the evaluation of breast lumps among Ugandan women at Mulago hospital
ASO
U A
GM
Fort Po
rtal, U
ganda
SPECIFIC OBJECTIVE 2
To describe the features of benign and malignant lumps as seen on breast transillumination among Ugandan women in Mulago hospital
ASO
U A
GM
Fort Po
rtal, U
ganda
ASO
U A
GM
Fort Po
rtal, U
ganda
RESULTS
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Fort Po
rtal, U
ganda
Variable Measure 95% CI
Mean age 42 years 40-44
Range 30-80 years
Palpable Lumps size 0.5-10 cm
Average lump size 3.8 cm
PARTICIPANT CHARACTERISTICS
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COMPARISON OF TRANSILLUMINATION TO MAMMOGRAPHY
Breast Transillumination Mammography Total
No. %
Abnormal
No %
Normal
No. %
Positive 79 63.2 8 10.5 91 86.8
Negative 46 36.8 68 89.5 110 61.2
Total 125 37.8 76 62.2 201
Prevalence from MG=63.2%, transillumination=45.3%. Sensitivity = 63.2%, PPV= 86.8% specificity = 89.5% NPV= 61.2%
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U A
GM
Fort Po
rtal, U
ganda
DISTRIBUTION OF THE FALSE NEGATIVE PICKED UP BY CBE AND MG
<1 1 2 3 4 non lump lesions
0
5
10
15
20
25
30
CBE
CBE
CBE
MG
MG
MG
MG
MG
size (cm)
frequency
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Fort Po
rtal, U
ganda
Transillumination characteristic
Histology Total No.
MalignantNo %
BenignNo. %
Irregular 11 (73.3) 4 (26.7) 15
Regular 23 (56.1) 18 (43.9) 41
Opaque 11 (36.7) 19 (63.3) 30
Densely opaque 23 (88.5) 3 (11.5) 26
Diffusely opaque 3 (75.0) 1 (25.0) 4
COMPARISON OF TRANSILLUMINATION CHARACTERISTICS TO HISTOLOGY
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U A
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Fort Po
rtal, U
ganda
<2 2--5 >50
10
20
30
40
50
60
70
80
90
CBE
CBE
CBE
BT
BT
BT
MG
MG
MG
lump size (cm)
Frequency
DISTRIBUTION OF LUMP SIZES BY TECHNIQUE OF DETECTION,
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Fort Po
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DISCUSSION
Sensitivity 63.2% LR 67-95%
Specificity 89.5%
Sensitivity 73.3 % 63-95% LR
Specificity 98.5%
BT MG
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U A
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Fort Po
rtal, U
ganda
FALSE NEGATIVE-36.8%
Average size 1.5 cm (range 0.5-4cm)
61.2% BIRADS II
50% close to chest wall
Relatively small/thin breasts
Lumps close to chest-SICKLER
Lumps in relatively small breasts CUTLER
Our study literature
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U A
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Fort Po
rtal, U
ganda
CASE FOR LOW COST SCREENING
High burden of disease Rapidly rising incidence 77% present in stage III & IV Peak age 30-39 years Survival stage
Mammography Expensive Inequitably distributed Excludes women less than 30 yrs
ASO
U A
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Fort Po
rtal, U
ganda
BOLD SUGGESTION
Preliminary data shows that BT is possibly comparable to Mammography
Let us rethink breast cancer screening and diagnosis
Get breast transillumiantion off the dusty shelves
ASO
U A
GM
Fort Po
rtal, U
ganda
LIMITATIONS
Hospital based study on symptomatic women
Learning curve for breast transillumination
Age limit of 30 years
ASO
U A
GM
Fort Po
rtal, U
ganda
RECOMMENDATIONS AND PROSPECTS
Large scale population based evaluation as a screening tool
Evaluate Sensitivity in asymptomatic population Intra/inter-observer variability Acceptability
Grand Challenge Canada application Please vote!!!
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U A
GM
Fort Po
rtal, U
ganda
THE ENDtHaNk yOu fOr LiStEnInG