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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. What is the problem?. Breast cancer - PowerPoint PPT Presentation
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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
ASO
U A
GM
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
ASO
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
ASO
U A
GM
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?
ASO
U A
GM
Fort Po
rtal, U
ganda
SELF TRANSILLUMINATION
ASO
U A
GM
Fort Po
rtal, U
ganda
ASO
U A
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
ASO
U A
GM
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
ASO
U A
GM
Fort Po
rtal, U
ganda
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%
ASO
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
ASO
U A
GM
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
ASO
U A
GM
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,
ASO
U A
GM
Fort Po
rtal, U
ganda
DISCUSSION
Sensitivity 63.2% LR 67-95%
Specificity 89.5%
Sensitivity 73.3 % 63-95% LR
Specificity 98.5%
BT MG
ASO
U A
GM
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
ASO
U A
GM
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
GM
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!!!
ASO
U A
GM
Fort Po
rtal, U
ganda
THE ENDtHaNk yOu fOr LiStEnInG