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Mammographic Screening for Breast Cancer in a Resource Restricted Environment

Justus Apffelstaedt

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Introduction: Despite mammographic screening not being policy screening mammograms are done at public sites as part of clinical practice. We here report the results of these at tertiary hospital in the Western Cape Methods: All mammograms performed between 2003 and 2012 at a tertiary hospital were analyzed for basic demographics, clinical data, indication and outcome as per BIRADS. Screening mammography was offered to patients above 40 years of age and read by experienced breast surgeons. Patients with BIRADS 3 and 4 lesions were recalled for short-term follow-up, further imaging or tissue acquisition. Patients with BIRADS 5 lesions were recalled for tissue acquisition. Further imaging, method of tissue acquisition, histology results and use of neo-adjuvant therapy were also recorded. Results: Of 16105 mammograms, 3774 (23.4%) were done for screening purposes. The median age was 54 years. Of 407 mammograms (10.8% of screening mammograms) reported BIRADS 3-5, 187 (46% of recalled women) went on to have further imaging only; tissue was acquired in 175 patients (43% of recalled women) for a biopsy rate of 4.6% of the total series. The malignancy rate of tissue acquisition was 25%. Forty-three breast cancers were diagnosed (11.4/1000 examinations). Of the cancers, 9 (31%) were ductal carcinoma in situ. Of 20 invasive cancers, 9 (45%) were less than 10mm in size. Of the invasive cancers, 40% were node-positive. Conclusions: In the public sector, a significant number of mammograms are done for screening purposes. The cancer diagnosis rate indicates a high breast cancer load in an urbanized population.

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