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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?. 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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  1. 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

  2. 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

  3. 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

  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. Self transillumination ASOU AGM Fort Portal, Uganda

  7. ASOU AGM Fort Portal, Uganda

  8. 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

  9. 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

  10. ASOU AGM Fort Portal, Uganda

  11. results ASOU AGM Fort Portal, Uganda

  12. Participant characteristics ASOU AGM Fort Portal, Uganda

  13. 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

  14. Distribution of the false negative picked up by CBE and MG ASOU AGM Fort Portal, Uganda

  15. Comparison of transillumination characteristics to Histology ASOU AGM Fort Portal, Uganda

  16. distribution of lump sizes by technique of detection, ASOU AGM Fort Portal, Uganda

  17. 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

  18. 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

  19. 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

  20. 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

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

  22. 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

  23. THE END tHaNkyOufOrLiStEnInG ASOU AGM Fort Portal, Uganda

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