Performance data of screening mammography at a dedicated breast health centre

Mammographic screening has become part of routine health care. We present a first analysis of screening mammography in a dedicated breast health centre in Africa. All mammography performed between 2003 and August 2003 was entered into a prospective database. Mammography was performed exclusively by certified mammographers and double read by experienced readers. Outcomes were classified in a simplified classification system based on BIRADS. In 40-49 year old women, 3192 mammograms led to a recall rate of 4.7%, a biopsy rate of 1.9% and a cancer diagnosis rate of 3.8 per 1000 examinations; for women 50 years and older, these figures were 4446, 5.4%, 2.6% and 9.7 per 1000. Of cancers detected, 31% were in-situ and of invasive cancers, 81% were node-negative. These figures established by a dedicated, surgeon-led team fall within the range expected in organized screening programs in resource-rich environments and provide a first benchmark for screening mammography in Africa

Conservative management of breast cancer in the elderly in a developing country

<p>Abstract</p> <p>Background</p> <p>The cost effective treatment of cancer in developing countries remains challenging. In the elderly with possible limited life expectancy, the health expenditure associated with standard treatment regimes should be carefully considered. We present the results of conservative management of breast cancer in the aged in a resource-limited environment.</p> <p>Methods</p> <p>Patients aged 70 or older with early breast cancer were treated with tumour excision or simple mastectomy and adjuvant tamoxifen. The records of patients presenting to the Breast Unit between January 1990 and December 2004 were retrieved and demographic, clinical, pathological and oncological data were reviewed. Survival statistics were calculated using the life table method.</p> <p>Results</p> <p>A total of 483 patients above 70 years of age were identified. One hundred and eighty eight patients were managed according to the conservative protocol. Forty-one had a simple mastectomy and 147 tumour excision. Their mean age was 77.3 years. The mean follow-up is 62 months. Thirty-one patients (16.4%) were not compliant with tamoxifen use. TNM staging was 0 in 4 patients, I in 42 patients, II in 116 patients and III in 26 patients. There was no 30-day mortality. The cumulative incidence of local recurrence was 3.3% at 5 and 10 years. The cumulative incidence of regional recurrence was 3.3% at 5 years and 4.5% at 10 years. The cumulative incidence of distant recurrence was 6.2% at 5 years and 12.2% at 10 years. The cumulative overall, disease specific and disease free survival at 10 years was 59%, 88% and 81% respectively.</p> <p>Conclusion</p> <p>Limited surgery and tamoxifen provide excellent control of breast cancer in the elderly in a resource restricted environment. Radiotherapy and axillary dissection and can be safely omitted thereby reducing health care resource utilization.</p

Mammographic screening for breast cancer in a resource-restricted environment

Background. Mammographic screening is carried out at public sector hospitals as part of clinical practice.Objective. We report the experience of such screening at Tygerberg Academic Hospital (TBAH), a tertiary referral hospital in the Western Cape Province, South Africa.Methods. All mammograms performed between 2003 and 2012 at TBAH were analysed regarding patient demographics, clinical data, indication and outcome according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). Screening mammography was offered to patients &gt;40 years of age and mammograms were 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 16 105 mammograms, 3 774 (23.4%) were carried out for screening purposes. The median age of patients undergoing screening was 54 years. Of 407 women with mammograms that were reported as BIRADS 3 - 5 (10.8% of screening mammograms), 187 (46% of recalled women) went on to have further imaging only. Tissue was acquired in 175 patients (43% of recalled women), comprising a biopsy rate of 4.6% of the total series. The malignancy rate in cases in which tissue acquisition was done was 25%. Forty-three breast cancers were diagnosed (11.4/1 000 examinations). Of the cancers, nine (31%) were ductal carcinomas in situ. Of 20 invasive cancers, nine (45%) were &lt;10 mm in size. Of the invasive cancers, 40% were node-positive.Conclusions. The cancer diagnosis rate indicates a high breast cancer load in an urbanised population.

Mammography reporting at Tygerberg Hospital, Cape Town, South Africa

CITATION: Pitcher, R. et al. 2014. Mammography reporting at Tygerberg Hospital, Cape Town, South Africa. South African Medical Journal, 104:7, 456-457, doi:10.7196/SAMJ.8455.The original publication is available at http://www.samj.org.zaIn their recent article, Apffelstaedt et al.[1] analysed 16 105 mammograms performed at Tygerberg Hospital (TBH), Cape Town, South Africa (SA), between 2003 and 2012. The summary reported that ‘mammograms were read by experienced breast surgeons’, while the discussion stated: ‘A further noteworthy fact is that this TBH series was based exclusively on mammography interpretation by surgeons with a special interest in breast health.’ The suggestion that mammograms were exclusively interpreted by breast surgeons does not reflect the mammography workflow at our institution.http://www.samj.org.za/index.php/samj/article/view/8455Publisher's versio

Not all is rosy with PinkDrive

The original publication is available at http://www.samj.org.zaThe Breast Interest Group of Southern Africa would like to respond to a recent article in the SAMJ regarding the activities of PinkDrive in the Western Cape and KwaZulu-Natal.Publishers' Versio

Mammographic screening for breast cancer in a resource-restricted environment

CITATION: Apffelstaedt, J. P., Dalmayer, L. & Baatjes, K. 2014. Mammographic screening for breast cancer in a resource-restricted environment. South African Medical Journal, 104(4):294-296, doi:10.7196/SAMJ.7246.The original publication is available at http://www.samj.org.zaBackground. Mammographic screening is carried out at public sector hospitals as part of clinical practice. Objective. We report the experience of such screening at Tygerberg Academic Hospital (TBAH), a tertiary referral hospital in the Western Cape Province, South Africa. Methods. All mammograms performed between 2003 and 2012 at TBAH were analysed regarding patient demographics, clinical data, indication and outcome according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). Screening mammography was offered to patients >40 years of age and mammograms were 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 16 105 mammograms, 3 774 (23.4%) were carried out for screening purposes. The median age of patients undergoing screening was 54 years. Of 407 women with mammograms that were reported as BIRADS 3 - 5 (10.8% of screening mammograms), 187 (46% of recalled women) went on to have further imaging only. Tissue was acquired in 175 patients (43% of recalled women), comprising a biopsy rate of 4.6% of the total series. The malignancy rate in cases in which tissue acquisition was done was 25%. Forty-three breast cancers were diagnosed (11.4/1 000 examinations). Of the cancers, nine (31%) were ductal carcinomas in situ. Of 20 invasive cancers, nine (45%) were <10 mm in size. Of the invasive cancers, 40% were node-positive. Conclusions. The cancer diagnosis rate indicates a high breast cancer load in an urbanised population.http://www.samj.org.za/index.php/samj/article/view/7246Publisher's versio