l 'effectiveness of'screening …. radiology, dharmais hospital, national cancer center,...

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© 2012 BHGI. All rights reserved. 1

LIMITED'EFFECTIVENESS'OF'SCREENING'MAMMOGRAPHY'IN'ADDITION'TO'CLINICAL'BREAST'EXAMINATION'BY'TRAINED'NURSE'MIDWIVES'IN'RURAL'JAKARTA,'INDONESIA'

Benjamin O. Anderson,1 Kardinah,2 Ibrahim A. Ali,1 and David B. Thomas1

1. Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, Washington, USA,

2. Radiology, Dharmais Hospital, National Cancer Center, Jakarta, Indonesia

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BACKGROUND !  A"high"propor)on"of"women"in"Indonesia"with"breast"

cancer"present"with"advanced"stage"disease."The"

purposes"of"this"project"were"to:"

!  Assess"the"u)lity"of"screening"clinical"breast"examina)on"(CBE)"in"this"unscreened"popula)on"

!  Determine"if"screening"mammography"in"addi)on"

to"CBE"improves"breast"cancer"detec)on"

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METHODS !  47"nurse"midwives"and"15"volunteer"health"workers"in"5"

districts"of"Jakarta,"Indonesia"trained"in"breath"health"

educa)on,"screening"and"clinical"breast"examina)on"(CBE)""

!  Women"invited"to"local"health"facili)es"to"receive"a"CBE"

and"independently"administered"mammogram"

!  Demographic"ques)onnaire"completed"by"all"par)cipants"

!  Women"with"suspicious"findings"on"either"mammography"

or"CBE"underwent"diagnos)c"workOup"and"fine"needle"

aspira)on"(FNA)"for"diagnosis"

"

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AGE"GROUP" NUMBER" PERCENTAGE"

<'40' 217' 18.4%'

40'D'49' 566' 48.0%'

50'D'59' 334' 28.3%'

>'60' 62' 5.3%'

TOTAL' 1,179' 100%'

PATIENT POPULATION

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RESULTS !  1,179"women"underwent"both"mammography"and"CBE"

!  289"women"(24.5%)"were"found"to"have"a"suspicious"

finding"on"CBE,"mammography"or"both""

!  14"women"(1.2%)"were"found"to"have"a"breast"cancer"

!  Of"the"14"breast"cancers,"13"(93%)"appreciated"on"CBE"

!  167"(14.2%)"CBE"exams"required"addi)onal"workOup"

to"diagnose"13"of"the"14"cancers"seen"on"

mammography"

"

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"

""

Mammography'Result"TOTAL"

Normal' Abnormal'

CBE'Result"

Normal'890'(75.5%)'[0"cancers]'

122'(10.3%)'[1"cancer]*'

1012"(85.8%)"

[1"cancer]"

Abnormal'98'(8.3%)'[0"cancers]'

69'(5.9%)''[13"cancers]'

167"(14.2%)"

[13"cancers]""

TOTAL"988"(83.8%)"

[0"cancers]"191"(16.2%)"

[14"cancers]"1179"(100%)"

CANCERS DETECTED

*"2cm"nonOpalpable"calcifica)ons"in"42"y.o."woman""

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"

""


Normal' Abnormal'

CBE'Result"


122'(10.3%)'[1"cancer]*'

1012"(85.8%)"

[1"cancer]"


69'(5.9%)''[13"cancers]'

167"(14.2%)"

[13"cancers]""

TOTAL"988"(83.8%)"

[0"cancers]"191"(16.2%)"

[14"cancers]"1179"(100%)"

CANCERS DETECTED


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MAMMOGRAPHIC"DENSITY" NUMBER" PERCENTAGE"

Fa^y' 12' 1.0%'Sca^ered'fibrograndular' 601' 51.0%'

Heterogeneously'dense' 500' 42.4%'

Extremely'dense' 38' 3.2%'

Missing' 28' 2.4%'

TOTAL' 1,179' 100%'

MAMMOGRAPHIC DENSITY

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TREATMENT !  1,179"women"underwent"both"mammography"and"CBE"

!  14"women"(1.2%)"were"found"to"have"a"breast"cancer"

!  8"of"14"pa)ents"(57%)"failed"to"undergo"treatment:"

!  2"of"14"breast"cancer"pa)ents"refused"surgery""

!  6"of"14"breast"cancer"pa)ents"lost"to"followOup""

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CONCLUSIONS !  In an unscreened population in low and middle

income countries such as Indonesia, CBE is nearly as effective as mammography in detecting prevalent breast cancer.

!  Healthcare systems for identifying and locating patients after the initial clinic visit are critical, since the majority of patients in settings like Indonesia may chose alternative care approaches and/or fail to return to the hospital on their own. "

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l 'effectiveness of'screening …. radiology, dharmais hospital, national cancer center,...

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