LIST OF TABLES
Table 1: Age and gender distribution of patients for different years studied
Table 2: Distribution of mammography investigations according to patient’s clinical indication
Table 3: Distribution of patients according to indications and gender
Table 4: Distribution of patients for different age groups and side of breast examined
Table 5: Distribution of mammography findings according to patient age
Table 6: Distribution of mammography findings according to gender of patients
Background: Mammography is an indispensable tool in breast imaging
Aim: This work was carried out to determine: frequency of mammography investigation, age and gender distribution of patients referred for mammography examination, major reasons for referral and to document the findings.
Patients and Methods: A retrospective study of 1643 patients who underwent mammography investigations at MEDICAID RADIOLOGY Wuse Abuja between January 2010 to December 2012 was conducted. Tables, T-test and Chi square were used to analyze the data.
Result: The frequency of females referred for mammography investigations was significantly more than males (99.1%, n=1628; 0.9%, n=15). Routine screening (79.12%) was the major reason for referral of patients for mammography examination. The research revealed however, that the common finding in mammography investigation is cysts (38.34%, n=630) while the least finding is carcinoma (0.37%, n=6). Majority of females examined were within the age group of 40-44 (27.7%, n=455). About 35 patients (all females) presented at an earlier age group of between 30-34 years.
Conclusion: The result of this study showed that females were referred for mammography investigation more than males and that routine screening was the major reason for referral of patients for mammography examination. Cysts was a predominant finding in most of the patients and there was no significant difference between male and female patients referred for mammography investigations.
Keywords: Breast, mammography investigation, referral, findings, Medicaid radiology.
TABLE OF CONTENTS
Title page i
Approval page ii
List of tables vi
Table of content viii
1.0 Introduction 1
1.1 Statement of problem 2
1.2 Objective of the study 3
1.3 Significance of the study 4
1.4 Scope of the study 4
1.5 Literature Review 5
2.1 Embryological development of the mammary gland 14
2.2 Anatomy of the mammary gland 16
2.2.1 Vascular supply and lymphatic drainage 18
22.214.171.124 Arterial supply 18
126.96.36.199 Veinous drainage 19
188.8.131.52 Lymphatic drainage 20
184.108.40.206 Innervation 21
2.3 Mammary equipment 21
2.3.1 High voltage generator 22
2.3.2 X-ray tube 22
2.3.3 Tube filteration 23
2.3.4 Compression device 23
2.3.5 Reciprocating anti-scatter grid 23
2.3.6 Image recording system 23
2.3.7 Exposure factor 24
2.4 Mammographic film processing 24
2.5 Radiation protection 25
2.6 Lesion characteristics identified in mammogram 26
2.6.1 Masses 26
2.6.2 Calcification 27
2.6.3 Architectural distortion 27
2.6.4 Focal increased density 27
2.7 Quality assurance in mammography 28
2.8 Preparation for mammographic examination 29
2.9 Mammographic recommendation 31
2.10 Breast Imaging Reporting And Data System (BIRADS)
Category of classifying Breast Diseases 31
2.10.1 BIRADS 0 31
2.10.2 BIRADS 1 32
2.10.3 BIRADS 2 32
2.10.4 BIRADS 3 32
2.10.5 BIRADS 4 33
2.10.6 BIRADS 5 33
2.10.7 BIRADS 6 34
2.11 Alternative medical imaging modalities 34
2.11.1 Ultrasound 34
2.11.2 Magnetic resonance imaging 34
2.11.3 Nuclear medicine 35
3.1 Research design 36
3.2 Sources of data 36
3.3 Sample size 36
3.4 Inclusion criteria 37
3.5 Exclusion criteria 37
3.6 Method of data collection 37
4.0 Data analysis 38
4.1 Presentation of data 39
5.1 Discussion 57
5.2 Summary of finding 60
5.3 Recommendation 61
5.4 Limitation 62
5.5 Area of further research 62
5.6 Conclusion 63
Screening mammography is an x-ray examination of the breast on women who has no symptoms. Screening for early detection and diagnosis of disease and health condition is an important public health principle1. The ultimate goal of a screening mammogram is to detect breast cancer when it is still too small to be felt by a woman or doctor, which greatly improves a woman’s chance for successful treatment. The use of Mammography has resulted in increased number of cancer in-situ detected2. Mammography is the most preferred modality for breast cancer examination, especially in women older than 40 years, the age group with the highest incidence2. Some studies have shown that mammography may be particularly beneficial for women who are 80 years of age and older3,4. Cancers in all form are responsible for about 12 per cent of deaths throughout the world while breast cancer alone causes 376,000 deaths annually worldwide5.
Moreover, breast cancers are cancers that start in the tissue of the breast, and the most common malignancy among women between ages 44 and 506. Breast cancer is the most common cancer and the second cause of deaths in women worldwide6. Similarly breast cancer is the most prevalent worldwide about one million new cases reported annually7. The incidence of the disease appears to be rising faster in population groups that have hitherto enjoyed low incidence of the disease6. The peak age of breast cancer in Nigerian women is about a decade earlier than caucasian7,8. For women with symptomatic breast cancer, prolonged delay, defined arbitrarily as an interval greater than 3 months from first detection to time of diagnosis and treatment has been shown to be associated with increased tumor size, more advanced stage of the disease and with poor long term survival9-14.
Indeed, about 70% of Nigerian women present at advanced stages of the disease at which time little or no form of benefit will be derived from any form of therapy administered, thus the 5 year survival of breast cancer in Nigeria is less than 10%7. In Nigeria, it has overtaken cancer of the cervix to become the commonest malignancy in women16. About 50% of all cases of breast cancers are diagnosed in developing countries including Nigeria18-19.
MEDICAID RADIOLOGY Wuse, is a major hospital in Nigeria. It is located in Abuja, the Federal Capital Territory and precisely in Wuse II of the F.C.T. On May 22nd 2009, the ultra modern radiology centre was commissioned11. The hospital is strategically located between the exit and in-route expressway of the central Business District of wuse, Abuja. The corporate objective of the hospital was to create a friendly atmosphere for the care of all discerning patients without discrimination15. Abuja in characterized by large population density of different ethnic group and geopolitical zone of the country.
This research is essential because in addition to determining the common findings from screening mammography, it will also demonstrate the age range of women that present themselves for routine mammography screening. It also will elucidate the major reasons for referral of patients for mammograms.