Document Type : Research Articles
Authors
1
Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
2
Section of Women’s Imaging, Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan.
3
Department of Surgery, UT Health San Antonio, Texas, USA.
4
North Alabama Medical Center, Alabama, USA.
5
Jinnah Medical and Dental College, Karachi, Pakistan.
6
Departments of Medicine & Epidemiology and Biostatistics, University of California San Francisco, California, USA.
7
Department of Community Health Sciences, The Aga Khan University Hospital Karachi, Pakistan.
Abstract
Background: This study evaluated opportunistic screening mammography outcomes in a mobile mammography unit (MMU), performed for breast cancer detection among populations with limited access to breast imaging in Pakistan. Methods: This cross-sectional study was conducted among women undergoing screening at the MMU stationed at two secondary hospitals of Aga Khan University Hospital from March 2019 to March 2021. Women aged ≥40 years and those <40 years at high risk for breast cancer were screened. Performance indicators included the cancer detection rate (CDR), BI-RADS assessment, and recall rate. Results: 1042 women were screened at the MMU. The median age was 49 years. 76.6% of women underwent screening for the first time. 64.7% of women had dense or heterogeneously dense breasts; however, heterogeneously dense breasts constituted the largest proportion (57.1%). The overall recall rate was 65.5%, out of which breast ultrasound was advised in 59.8% for dense breasts and additional mammographic views in 10.3% because of suspicious findings. Biopsy was advised for 20 women, of whom 13 (65%) completed the biopsy, yielding 11 cancers (CDR 10.6 per 1,000), Of all the diagnosed malignancies, 8 were invasive, 2 were ductal carcinoma in situ and histology of one cancer was unknown, with 72.7% of invasive cancers being node negative. Conclusion: This cohort of a largely first-time screened population with dense breasts yielded a high CDR and predominantly early-stage, node-negative cancers. The elevated CDR highlights a substantial reservoir of undiagnosed disease in underserved populations. MMU-based screening is known to be effective at identifying early breast cancers; however, its deficiency in a low-middle-income country (LMIC), such as Pakistan, calls for the immediate establishment of screening programs, preferably in mobile units across the country. Integrating MMUs with targeted outreach, on-site diagnostic tools, and patient navigation may improve follow-up adherence and further enhance early detection efforts.
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