The College of Radiology Mammogram Subsidy Programme at IIUM Breast Centre, Kuantan : an audit (2004 -2008)

INTRODUCTION & OBJECTIVE The IIUM Breast Centre is an accredited mammogram provider under the College of Radiology Subsidised Mammography Programme (CMP) from 2004. We wish to present an audit of the results on 1344 Malaysian women who had mammogram under the programme at the Centre from 2004 - 2008. METHODS All women who came for mammogram under the CMP Programme were included in this 5-year review. Social and demographic data were analyzed and mammogram studies were reported based on BIRADS categories. Breast Ultrasound was performed on subjects with dense breasts and whenever mammogram findings were abnormal. Lesion sampling was performed on indeterminate or suspicious lesions, based on mammographic and sonographic features and lesion vascularity on Colour Flow Imaging (CFI). Probably benign BIRADS 3 lesions were monitored by short term ultrasound surveillance. Results of sampling were classified into normal, benign breast disease and breast cancer. RESULTS A total of 1344 subjects had breast imaging under the programme, with preference given to women with a family history of breast cancer. Chinese women were the largest racial group participating in the programme (59%). A family history of breast cancer was present in 9.5% of subjects. Most subjects (55.2%) had normal findings (BIRADS 1); 28.6% had benign findings (BIRADS 2); while 3.7% were in BIRADS 4 & 5 categories. Breast Ultrasound was done in 52% of women, and lesion sampling in 44 patients (3.2%). Sampling techniques used were FNAC (47%) and core biopsy (43%), and 5 women had image-guided hook-wire localization prior to excision. Pathology results showed benign breast disease in 47.6% and breast cancer in 45.3%. The cancer detection rate in this group is 19/1344 (1.4%). CONCLUSION Mammography offers the best chance of detecting early breast cancer. Subsidised mammography programmes are available in the country in the absence of national level population screening. This audit of 1344 women who participated in the College of Radiology Subsidised Mammography Programme showed that mammography supplemented with ultrasound prior to lesion sampling yielded a positive sampling rate of 45.3% and a cancer detection rate of 1.4%