Is Breast transillumination a viable option for breast cancer screening in limited resource settings?

Abstract

Background: Mammography is an established screening tool for breast cancer in high-income countries but may not be feasible for most re-source poor nations. Alternative modalities are needed to mitigate the impact of the increasing incidence and mortality due to breast cancer. This may require the development of new technologies or reevaluation of old technologies applicable to resource limited settings. Objective: To determine the sensitivity and specificity of breast transil-lumination as compared to mammography and to describe features of benign and malignant breast lesions as seen with breast transil-lumination. Methods: A single group descriptive analytical study was conducted over a six month period (2011) in the breast unit of Mulago National hospital. Eligible participants were consecutively sampled. Participants underwent Clinical Breast Examination (CBE), breast transillumination (BT), mammography (MG) and histopathological analysis of identified breast lumps. Sensitivity, specificity and predictive values were calculated. Features of the masses detected by transillumination were then described. Results: The number of participants recruited was 201 (mean age 42 years, range 30-80 years). The average palpable lump size was 3.8 cm (range 0.5 to 10 cm). BT had a sensitivity of 63.2% (PPV 86.8%) and a specificity of 89.5% (NPV 61.2%) with mammography as the reference standard. Also, 73.3% of breast lumps with irregular margins and 88.5% with dense opacity at transillumination turn out to be malignant at histopathology examination. Conclusion: The Breast transillumination technique had a moderate sensitivity of 63.2%. This warrants a large scale population-based evaluation of BT as a screening tool. This technique may not substitute mammography but to be considered an option where mammography access is limited.