Mammographic findings and BI-RADS concordance in women attending a community outreach program in Uganda

Abstract

Introduction: The incidence and mortality of breast cancer in Uganda are on the rise. The Improving Breast Cancer Care Coordination (IBCCC) program was initiated to bring breast cancer screening and diagnostic services closer to women in hard-to-reach communities all over Uganda. This is the first mammography community outreach, where participants receive immediate (on-site) readings. The level of agreement between mammographic BI-RADS readings taken in the community (on-site) and those taken in the standard radiological reporting unit (off-site) is unknown. This study utilised data from the IBCCC program to shed more light on these knowledge gaps. Main Objective: To describe the mammographic findings and determine the BI-RADS concordance between on-site and off-site readings for women attending a community outreach breast cancer early detection program in Northern Uganda. Methods: The study utilised a cross-sectional design. It used data from 201 participants from 9th January 2023 to 5th September 2023 who attended the program. Participants were selected by simple random sampling. Their mammographic images and other data were obtained from the program’s database on an external hard drive. Statistical analysis was performed using Stata version 15.0. Summary statistics were calculated for all variables. The BI-RADS concordance was assessed using the Kappa (k) statistic comparing on-site to off-site mammogram readings. Results: The mean participant age was 51 years. Most participants reported at least one symptom (70.6%); the most common symptom was pain (47.8%). The most common breast composition was scattered fibroglandular density (38.3%). Sixty-nine participants (34.3%) had a mass. Thirty-four (16.9%) participants had calcifications and of those, nine (26.5%) had suspicious morphology. Off-site readings awarded a BI-RADS score of 4 or 5 to 18.4% of participants, and the BI-RADS concordance was moderate; 0.58 (95% CI: 0.44 – 0.71). Conclusion: A significant proportion of women in this study had BI-RADS 4 and 5, suggesting late presentation in the community. The BI-RADS concordance was moderate between on-site and off-site readings. Recommendations: The Ministry of Health should conduct more community outreach programs to encourage screening for breast cancer and reduce late presentation. Healthcare institutions should facilitate subspecialist training and continuous medical education for radiologists to improve the reproducibility of mammography interpretations.