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I S B REAST TRANSILLUMINATION A VIABLE OPTION FOR BREAST CANCER SCREENING IN RESOURCE LIMITED SETTINGS ? Elobu Emmanuel, MD (Dar), MMed Surgery(MUK) FCS.

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Presentation on theme: "I S B REAST TRANSILLUMINATION A VIABLE OPTION FOR BREAST CANCER SCREENING IN RESOURCE LIMITED SETTINGS ? Elobu Emmanuel, MD (Dar), MMed Surgery(MUK) FCS."— Presentation transcript:

1 I S B REAST 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 ASOU AGM Fort Portal, Uganda

2 W HAT IS THE PROBLEM ? Breast cancer Common disease (Gakwaya et al) Rapidly rising incidence (Parkin et al) low overall survival- 56% (Gakwaya et al ASOU AGM Fort Portal, Uganda

3 P ROBLEM CONT D Prevention No effective primary prevention (Gakwaya et al) Secondary prevention is best hope (Prasad et al) No screening program ASOU AGM Fort Portal, Uganda

4 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 ASOU AGM Fort Portal, Uganda

5 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? ASOU AGM Fort Portal, Uganda

6 S ELF TRANSILLUMINATION ASOU AGM Fort Portal, Uganda

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8 S PECIFIC O BJECTIVE 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 ASOU AGM Fort Portal, Uganda

9 S PECIFIC O BJECTIVE 2 To describe the features of benign and malignant lumps as seen on breast transillumination among Ugandan women in Mulago hospital ASOU AGM Fort Portal, Uganda

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11 RESULTS ASOU AGM Fort Portal, Uganda

12 VariableMeasure95% CI Mean age42 years40-44 Range30-80 years Palpable Lumps size cm Average lump size3.8 cm P ARTICIPANT CHARACTERISTICS ASOU AGM Fort Portal, Uganda

13 C OMPARISON OF TRANSILLUMINATION TO MAMMOGRAPHY Breast TransilluminationMammography Total No. % Abnormal No % Normal No. % Positive Negative Total Prevalence from MG=63.2%, transillumination=45.3%. Sensitivity = 63.2%, PPV= 86.8% specificity = 89.5% NPV= 61.2% ASOU AGM Fort Portal, Uganda

14 D ISTRIBUTION OF THE FALSE NEGATIVE PICKED UP BY CBE AND MG ASOU AGM Fort Portal, Uganda

15 Transillumination characteristicHistologyTotal No. Malignant No % Benign No. % Irregular11(73.3)4(26.7)15 Regular23(56.1)18(43.9)41 Opaque11(36.7)19(63.3)30 Densely opaque23(88.5)3(11.5)26 Diffusely opaque3(75.0)1(25.0)4 C OMPARISON OF TRANSILLUMINATION CHARACTERISTICS TO H ISTOLOGY ASOU AGM Fort Portal, Uganda

16 DISTRIBUTION OF LUMP SIZES BY TECHNIQUE OF DETECTION, ASOU AGM Fort Portal, Uganda

17 DISCUSSION Sensitivity 63.2% LR 67-95% Specificity 89.5% Sensitivity 73.3 % 63-95% LR Specificity 98.5% BTMG ASOU AGM Fort Portal, Uganda

18 F ALSE 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 studyliterature ASOU AGM Fort Portal, Uganda

19 CASE FOR LOW COST SCREENING High burden of disease Rapidly rising incidence 77% present in stage III & IV Peak age years Survival stage Mammography Expensive Inequitably distributed Excludes women less than 30 yrs ASOU AGM Fort Portal, Uganda

20 B OLD 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 ASOU AGM Fort Portal, Uganda

21 LIMITATIONS Hospital based study on symptomatic women Learning curve for breast transillumination Age limit of 30 years ASOU AGM Fort Portal, Uganda

22 R ECOMMENDATIONS 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!!! ASOU AGM Fort Portal, Uganda

23 THE END tHaNk yOu fOr LiStEnInG ASOU AGM Fort Portal, Uganda


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