Project Lead(s): Alphonsus Matovu
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among women worldwide.
Low- and middle-income countries have poorer outcomes for cancer and, in Uganda, breast cancer greatly impacts the lives of women, their families and communities, as women present with later-stage and more aggressive breast cancers than in developed countries.
The project in Uganda was designed to evaluate the feasibility of introducing low-cost, easy-to-perform breast ultrasound scans, along with a diagnosis and treatment pathway, in order to increase early detection, provide effective treatment options and improve health outcomes.
A breast healthcare algorithm appropriate for a rural, low-resource setting was designed that included the use of diagnostic breast ultrasound protocols performed by mid-level, front-line health workers.
In the simple scanning protocol, volume imaging was performed with an ultrasound probe to target a palpable breast mass.
A nurse examiner (who had already performed a breast scan and determined preliminary results) scanned the area, capturing a large number of closely-spaced ultrasound images and sent them electronically for expert secondary interpretations by a distant radiologist.
Ultrasound data was managed via a novel PACS-compatible electronic medical records system, which enabled site data entry and patient management, while preserving data quality, patient confidentiality and remote database access.
Expert radiologists viewed the de-identified images from a distance, using a secure log-on.
Results showed the feasibility of integrating this scanning approach into the existing system of care at the health centre, along with a telemedicine-based diagnosis and treatment pathway.
A total of 212 women enrolled in the study received clinical breast exams (CBE) for queried breast masses for the first time.
Forty-three (43) subjects with true palpable masses on CBE were enrolled into the study and had breast ultrasound examinations.
Ultrasound identified 10 subjects with suspicious (BI-RADS Category 4) or highly suspicious (BI-RADS Category 5) masses.
Of these ten subjects with suspicious lesions, three received biopsies.
Of these subjects, one was diagnosed with high-grade breast cancer and has since died. Another was diagnosed with early (Stage 1) breast cancer and died due to unrelated causes, while the third patient was diagnosed with early (Stage 1) breast cancer and is due to receive surgical treatment.
The project also provided a biopsy training program on-site for three physicians and additional training for over 20 radiologists in Kampala, Uganda.
The study team also developed survey tools that impact process improvements and educational development, and a standardized breast reporting tool that has been adopted by the Association of Radiologists in Uganda.
Educational materials from the project have been distributed to village health teams for community outreach.