Using surgeons to interpret mammograms

© Tyler Olson - Fotolia.com

His research, published in the April issue of South African Medical Journal, concluded that screening mammograms, though not policy, are regularly done at public sites as part of clinical practice and are undertaken by multi-tasking resources such as surgeons, with great success.

Breast cancer is the most common female cancer in South Africa and accounts for 20% of all cancers diagnosed in women in South Africa and the research in the public sector indicates a higher breast cancer load in an urbanised population.

At present, limited resources make mammographic breast screening difficult to implement in developing countries such as South Africa; consequently population screening for breast cancer is not part of Western Cape's health policy at present nor will it be within the near future. Despite this, numerous screening mammograms are done at public sites as part of clinical practice.

This type of screening could be termed opportunistic screening. In contrast to organised screening, opportunistic screening is when women are not invited to screen but rather opt to have the screening out of their own volition for unrelated pathology. This may be a family history of breast cancer or simple general concern about breast cancer risk.

The report tracks the results of surgeon read mammograms at an academic teaching hospital in the Western Cape over a period of nine years. Out of 16 105 mammograms performed between January 2003 and May 2012, 3 774 (23.4%) were done for screening purposes. 407 patients were recalled (10.8%) and 187 (46% of recalled women) went on to have further imaging that was reported as benign. The biopsy rate for the whole series was 4.6%; the malignancy rate of tissue acquisition was 25% and 43 breast cancers were diagnosed.

The results described are remarkably similar to major international organised screening programmes, which warrants further exploration into a larger programme, especially as the age composition in the series was much younger than similar cancers (32% in the 40-49 years age group). That means that a more aggressive set of cancers were diagnosed.

The results compare well to international benchmarks and signal that the desired early diagnosis of breast cancer was achieved.

Breast centres to supplement shortages

The establishment of breast centres to take care of the rising number of cases of breast cancer in South Africa, as long as there are experienced and trained surgeons with a special interest in breast health available to interpret breast imaging, could therefore supplement the well-documented shortage of radiologists and specifically breast radiologists.

"It is scientifically well described and accepted that specialists become very adept at interpreting the imaging in their specific fields. In the context of a country with limited resources such as South Africa, it should be realised that clinical services often function well where specialists take on the responsibility for imaging. This is already an established principal as illustrated by reviews and official enquiries conducted by medical professional organisations. It is time that regulatory authorities and funders in this country realise this trend in order to avoid constricting the supply of medical services to the majority of the population by restricting specialists from interpreting imaging," adds Professor Apffelstaedt.