ASO

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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

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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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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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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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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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SELF TRANSILLUMINATION

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ASO

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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

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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

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rtal, U

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ASO

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ganda

RESULTS

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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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Fort Po

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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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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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<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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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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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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Fort Po

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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

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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

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Fort Po

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ganda

LIMITATIONS

Hospital based study on symptomatic women

Learning curve for breast transillumination

Age limit of 30 years

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Fort Po

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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

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Fort Po

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THE ENDtHaNk yOu fOr LiStEnInG