title: Mammographic screening for breast cancer in a resource-restricted environment.
abstract: BACKGROUND
  Mammographic screening is carried out at public sector hospitals as part of clinical practice.
  
  
  OBJECTIVE
  We report the experience of such screening at Tygerberg Academic Hospital (TBAH), a tertiary referral hospital in the Western Cape Province, South Africa.
  
  
  METHODS
  All mammograms performed between 2003 and 2012 at TBAH were analysed regarding patient demographics, clinical data, indication and outcome according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). Screening mammography was offered to patients > 40 years of age and mammograms were read by experienced breast surgeons. Patients with BIRADS 3 and 4 lesions were recalled for short-term follow-up, further imaging or tissue acquisition. Patients with BIRADS 5 lesions were recalled for tissue acquisition. Further imaging, method of tissue acquisition, histology results and use of neo-adjuvant therapy were also recorded.
  
  
  RESULTS
  Of 16 105 mammograms, 3 774 (23.4%) were carried out for screening purposes. The median age of patients undergoing screening was 54 years. Of 407 women with mammograms that were reported as BIRADS 3 - 5 (10.8% of screening mammograms), 187 (46% of recalled women) went on to have further imaging only. Tissue was acquired in 175 patients (43% of recalled women), comprising a biopsy rate of 4.6% of the total series. The malignancy rate in cases in which tissue acquisition was done was 25%. Forty-three breast cancers were diagnosed (11.4/1 000 examinations). Of the cancers, nine (31%) were ductal carcinomas in situ. Of 20 invasive cancers, nine (45%) were < 10 mm in size. Of the invasive cancers, 40% were node-positive.
  
  
  CONCLUSIONS
  The cancer diagnosis rate indicates a high breast cancer load in an urbanised population.
authors.forename: S P
authors.initials: SP
authors.lastname: Apffelstaedt
authors.forename: L
authors.initials: L
authors.lastname: Dalmayer
authors.forename: K
authors.initials: K
authors.lastname: Baatjes
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000473:pathology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D013019:South Africa; D062606:Tertiary Care Centers