Assessment of Breast Screening Program in Al -Yarmouk Teaching Hospital

Abstract

Background: Breast screening program had been set in Al-Yarmouk Teaching Hospital since 2001. It involved clinical assessment combined with ultrasound and mammography. Aim of Study: To evaluate the efficacy of breast screening program at AL-Yarmouk Teaching Hospital in early detection of malignant breast diseases. Design: A prospective analytic study for breast screening cases attended for screening breast program at breast clinic in Al-Yarmouk Teaching Hospital for the period from October 2012 to October 2013. Patients and Method: The present study included 6268 cases, 6007 patient were females and 15 patients males were attended breast clinic complaning of symptomatic breast pathology and asking for treatment and 246 asymptomatic females cases asking for breast screening. So we divided the cases in to two groups; (Ι) symptomatic group, and (ΙΙ) asymptomatic cases attended for screening program. Cases in group (ΙΙ) were analyzed according to a questioner which included cause of attendance, age, marital state, menstrual history (age of menarch, age of first child bearing, age of menopause), personal and family history of breast cancer and other malignancy, drug history of contraception, habits (smoking), occupation, and residency.All cases were examined clinically, investigated by mammogram and/or ultrasound according to age group (38 year old and more for mammogram) and those with positive finding in the (clinical and radiological) examination subjected to tissue sampling and histological examination and followed up period was till January 2014. Results: Total number attended breast clinic were 6268 cases including 6022 symptomatic group (Ι) and 246 asymptomatic groups ΙΙ (with a drop of 34 cases from second group in the first round). Only cases in group (ΙΙ) were enrolled in this analysis. Only 165 cases were sent for mammogram (indicated) but only 138 cases did the examination due to cases dropped from the second round of the program. From the 138 cases that did the mammogram only 85 cases had different positive findings. 85cases (with positive mammogram findings) plus 27 cases with younger age group (112 cases) were sent for ultrasonography.Only 96 cases attended ultrasound (16 cases were dropped), from these cases only 58 cases (with positive mammographic and ultrasonography findings) were sent for tissue sampling. Out of those 58 cases only 40 cases attended tissue sampling study but only 22 cases brought their results to the hospital for follow up. From those 22 cases, 9 cases were normal while 3 cases had inflammatory findings, 3 cases had malignant findings and 7 cases had premalignant findings. The Conclusions: Low numbers of cases attending the breast screening and high rate of dropped cases participating in the program in different levels of the program and low number of screened cases who are diagnosed as having malignant breast diseases in relation with long duration of the study. The Recommendations: Promote the process of public awareness and health education about breast cancer and the importance of prevention and methods for early detection of tumors and pre-cancerous lesions. Improvement of the capacity in primary care center and improving the skills of primary care practitioners for breast clinical examination (BCE) and appropriate referral.