Challenges in the management of inconclusive breast findings on mammography in educated Nigerian women

Abstract

Introduction: Breast cancer is one of the leading causes of morbidity and mortality among women in middle to low-income countries with most women presenting with late disease. Mammography is a major screening tool for the early detection of breast cancer with wide coverage in developed countries when compared to low-income countries. This study aims to evaluate the mammographic findings of women in southwest Nigeria, and also the follow-up rate of women with inconclusive findings on mammograms, Methodology: This is a descriptive study of findings in women who presented for mammography at the Radiology Department of LAUTECH Teaching Hospital, Ogbomoso. Mammograms with two standard views were performed after the completion of a structured questionnaire and informed consent. The data was entered and analyzed using SPSS version 26 with a p-value ≤ 0.5. Results: A total of 250 women participated in the study with an average age of 52.3±8.70 years and an age range of 36-86 years. Diagnostic mammography (55.2%) was more common than screening mammography and the commonest indication was breast lumps (25.2%). Heterogeneously dense breast density pattern (BIRADS C) which may obscure small masses is the most common (40.8%) while the most common final BIRADS category is 2, benign findings (51.6%), followed by BIRADS 0 (20%). Only 13 out of the 51 cases of BIRADS 0 had complementary imaging studies, and 38 (75%) failed to show up. Further, telephone interviews revealed that the most common reason for failure of follow up is poor counselling and ignorance. Conclusion: There is a need to increase the awareness of regular mammograms for screening purposes in this environment as observed in developed climes and also for women to understand the clinical implication of their breast density pattern to reduce anxiety and increase their cooperation for further imaging studies.