Is Breast transillumination a viable option for breast cancer screening in resource limited settings...
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Elobu Emmanuel, MD (Dar), MMed Surgery(MUK) FCS (ECSA) trainee, Registrar PowerPoint PPT Presentation


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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

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Elobu Emmanuel, MD (Dar), MMed Surgery(MUK) FCS (ECSA) trainee, Registrar

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Elobu emmanuel md dar mmed surgery muk fcs ecsa trainee registrar

Is Breast transillumination a viable option for breast cancer screening in resource limited settings?

ASOU AGM Fort Portal, Uganda

Elobu Emmanuel,

MD (Dar), MMed Surgery(MUK)

FCS (ECSA) trainee,

Registrar

Colorectal Surgery Unit

Mulago Hopsital


What is the problem

What 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


Problem cont d

Problem 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


Elobu emmanuel md dar mmed surgery muk fcs ecsa trainee registrar

  • 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


Elobu emmanuel md dar mmed surgery muk fcs ecsa trainee registrar

  • 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


Self transillumination

Self transillumination

ASOU AGM Fort Portal, Uganda


Elobu emmanuel md dar mmed surgery muk fcs ecsa trainee registrar

ASOU AGM Fort Portal, Uganda


Specific objective 1

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

ASOU AGM Fort Portal, Uganda


Specific objective 2

Specific Objective 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


Elobu emmanuel md dar mmed surgery muk fcs ecsa trainee registrar

ASOU AGM Fort Portal, Uganda


Results

results

ASOU AGM Fort Portal, Uganda


Participant characteristics

Participant characteristics

ASOU AGM Fort Portal, Uganda


Comparison of transillumination to mammography

Prevalence from MG=63.2%, transillumination=45.3%.

Sensitivity = 63.2%, PPV= 86.8%

specificity = 89.5% NPV= 61.2%

Comparison of transillumination to mammography

ASOU AGM Fort Portal, Uganda


Distribution of the false negative picked up by cbe and mg

Distribution of the false negative picked up by CBE and MG

ASOU AGM Fort Portal, Uganda


Comparison of transillumination characteristics to histology

Comparison of transillumination characteristics to Histology

ASOU AGM Fort Portal, Uganda


Distribution of lump sizes by technique of detection

distribution of lump sizes by technique of detection,

ASOU AGM Fort Portal, Uganda


Discussion

discussion

BT

MG

  • Sensitivity 63.2%

    • LR 67-95%

  • Specificity 89.5%

  • Sensitivity 73.3 %

    • 63-95% LR

  • Specificity 98.5%

ASOU AGM Fort Portal, Uganda


False negative 36 8

False negative-36.8%

Our study

literature

  • 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

ASOU AGM Fort Portal, Uganda


Case for low cost screening

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

ASOU AGM Fort Portal, Uganda


Bold suggestion

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

ASOU AGM Fort Portal, Uganda


Limitations

limitations

  • Hospital based study on symptomatic women

  • Learning curve for breast transillumination

  • Age limit of 30 years

ASOU AGM Fort Portal, Uganda


Recommendations and prospects

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!!!

ASOU AGM Fort Portal, Uganda


Elobu emmanuel md dar mmed surgery muk fcs ecsa trainee registrar

THE END

tHaNkyOufOrLiStEnInG

ASOU AGM Fort Portal, Uganda


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