Purpose
Mammographic breast density is associated with increased risk of breast cancer and a lower probability of detection of cancer.
Malaysia is contemplating a population-based mammographic breast screening program but because of the diversity of ethnic groups and their different breast cancer risk profiles it might be that the screening protocols should be different for each ethnicity,
and yet,
even within each ethnicity it can be expected that there are density variations with age and between women.
Data from the Malaysian National Cancer Registry 2003-2005,
showed...
Methods and Materials
1655 digital mammograms performed using Siemens Novation and GE Senographe at the University Malaya Medical Centre from Sep 2011 to Feb 2012 were analysed with an automated VBD assessment tool (Volpara Imaging 1.5,
Matakina,
Wellington) (refer to Figure 1).
VBD and FG volume data obtained from Volpara (refer to Figure 2) was paired with ethnicity data extracted from the DICOM header.
The difference in VBD and FG volume among Chinese,
Malay and Indian was tested using ANOVA with Bonferonni post-hoc.
Results
The mean age was 56.8,
53.5 and 56.3 for 851 (51.4%) Chinese,
486 (29.4%) Malay and 318 (19.2%) Indian women,
respectively. Across all three ethnic groups,
the Chinese had a higher VBD than Malay and Indian with mean VBD of 13.0%,
11.0% and 10.3% respectively (p=0.000). The mean volume FG was 47.7 cm3,
63.5 cm3 and 65.0 cm3 respectively. Chinese had significantly lower FG volumes than Malay and Indian (p=0.000) and relatively smaller breast volumes (means of 447.7,
702.8,
and 765.5 cm3 respectively) (refer to...
Conclusion
If we implement a screening program using mammography,
overall sensitivity will be reduced in Chinese women,
who generally have denser breasts.
However,
each population has a broad range of densities so that the optimal screening modality will likely vary by woman with the denser women requiring adjunct ultrasound or even an MRI. Recognizing that there are density differences between the ethnic groups in Malaysia,
we need to tailor the screening program appropriately in order to achieve effectiveness.The higher breast density in Chinese women might help...
References
1.
Malaysian National Cancer Registry 2003-2005.
2.
Volpara User Manual v1.5,
Volpara,
Matakina,
Wellington.
Personal Information
Ng Kwan Hoong PhD,
Department of Biomedical Imaging,
University of Malaya Medical Centre,
Kuala Lumpur,
Malaysia;
[email protected]
Liew Yew Wai MSc,
Department of Biomedical Imaging,
University of Malaya Medical Centre,
Kuala Lumpur,
Malaysia;
[email protected]
Kartini Rahmat MD,
Department of Biomedical Imaging,
University of Malaya Medical Centre,
Kuala Lumpur,
Malaysia;
[email protected]
Caroline Judy Westerhout MD,
Department of Biomedical Imaging,
University of Malaya Medical Centre,
Kuala Lumpur,
Malaysia ;
[email protected]
The Yew Ching MD,
Department of Surgery,
University of Malaya Medical Centre,
Kuala Lumpur,
Malaysia;
[email protected]
Nur...