ABSTRACT
Background: In India, less than 5% of women get routine screening for breast cancer due to lack of awareness and the absence of a coordinated national breast cancer screening programme. A community health initiative was launched by Niramai in collaboration with City Health officials in Bangalore as a pilot to increase awareness and make breast health screening available to all. Free breast cancer screening using AI powered Thermalytix test is being offered to all the underprivileged women walking into Bruhat Bengaluru Mahanagara Palike (BBMP) government hospitals from November 14, 2017 till today (after a break for 15 months during COVID). Material(s) and Method(s): This observational study was conducted in 22 BBMP-affiliated primary health centers where outpatient women over the age of 18 years and not pregnant were enrolled. The procedure included a briefing on camp procedures, taking patient consent, identification of eligible candidates, general health education, and conducting the Thermalytix test by a healthcare worker who was trained to use the Thermalytix software tool. Women were triaged using the output generated by Thermalytix 180. Those triaged as red were referred for further detailed imaging investigation in a district hospital using mammography, ultrasound and FNAC/biopsy. Result(s): A total of 6935 women underwent Thermalytix screening in 22 BBMP hospitals during Nov 2017 to July 2022. A total of 1687 participants were excluded from the analysis as they did not meet the eligibility criteria. The median age of the 5248 eligible participants was 42 years (range 18-86). Among them, 90 women (1.71%) had previously noticed a lump in their breast, 431 women (8.12%) had breast pain, 16 women had complained of nipple discharge, and 5 women had noticed skin discoloration. When screened, 62 (1.2%) women were detected with abnormalities and triaged positive by Thermalytix. Among them 11 women have so far gone through diagnostic investigations, of which 8 were radiologically positive and were recommended for histopathology correlation. The overall test positivity rate of Thermalytix in this cohort was 1.2% and positive predictive value with radiological positivity as reference was found to be 9/11 = 81.81%. Furhter histological analysis reported 1 DCIS and 8 benign fibroadenoma. The tests were conducted in screening camps and the average cost of conducting the test in the field came to around 6.5 USD per person. Conclusion(s): Thermalytix could be a potential automated screening tool for population-level screening in resource constrained settings. The portable equipment enabled easy movement across different PHCs. Since it is a privacy-aware test, there was less refusal to participate in the test. Community mobilization with the help of the local government health officials was crucial to ensure walk-ins. Conflict of interest: Ownership: yes Board of Directors: yes Corporate-sponsored Research: yesCopyright © 2022 Elsevier Ltd. All rights reserved
ABSTRACT
Introduction/Background• The sudden outbreak of the COVID 19 pandemic led to increased stress on healthcare systems across the globe. They struggled to continue to provide other essential clinical services whilst dealing with the rapid surge of COVID 19 cases. It was therefore essential to optimize patient-centred care safely in a risk adapted environment without compromising outcomes.• We present our experience of telephone triaging of new symptomatic patients referred to a single, tertiary, academic large volume breast unit. Based on our observed outcomes, we propose a novel pathway for management of patients referred with Breast Pain. Methodology• We conducted an audit of patients triaged for telephone consultation at Guy's and St Thomas' NHS foundation Trust, UK between 1st April 2020 to 30th June 2020. Data was collected retrospectively from hospital records following approval from the Trust Audit Committee. Two week wait (2WW) referrals determined to be of low index of suspicion for breast cancer were triaged to telephone consultation. Criteria for low index of suspicion was breast pain, non-suspicious skin changes, bilateral non pathological nipple discharge, gynaecomastia, patients < 30. Patients > 70 were initially offered telephone consultation for risk assessment to avoid potential exposure to COVID19 (shielding of vulnerable cohort). Follow up data was recorded up to October 2020. SResults• There were a total of 685 new 2WW referrals during this time. The total number of patients that were triaged to telephone consultation were 111. The median age of this cohort was 34. There were 105 women and 6 men in this cohort. When classified by symptoms, 47 were referred for breast pain, 46 for suspected breast lumps, 6 for nipple discharge and 12 for other miscellaneous reasons.• The total number of patients that were invited back for imaging or face to face (F2F) consultation or both were 67 (60%).Total number that came back for F2F consultation were 50, out of which 14 were purely for F2F. The total number of patients that came back for imaging were 53, out of which 17 came for imaging only. Total number that came back for F2F and imaging both were 36.• 44 patients were discharged without a F2F consultation or imaging (40%)• F2F consultations (50) when classified by symptoms, 70% presented with breast lump, 14% with breast pain, 6% with nipple discharge, 2% with breast infections and 8% with other benign causes.• Total number of biopsies performed were 9, out of which 2 were cancers and the rest were benign.• There were 3 patients that came back with new referrals after a few months of being discharged following a telephone consultation. They presented with the same symptoms, or their symptoms had worsened or they had new symptoms. However, none of them had any significant finding on F2F consultations or imaging and were reassured and discharged. Conclusion• Our audit (although a small cohort), some published data (Cancer Waiting Times data in the UK comparing 1st 6 months from 2019 with 2020) and literature support the effectiveness of this tool in unprecedented times.• Breast pain is not the most alarming symptom. None of the patients in our cohort with breast pain were found to have any significant finding on imaging or were diagnosed with breast cancer.• Any breast lump or pathological nipple discharge irrespective of age should undergo triple assessment as gold standard.• Our proposal is to design a separate pathway for patients with breast pain as they do not necessarily need a F2F consultation or imaging (can be elicited by the clinician and called only if deemed necessary). This will in turn decrease the strain of 2WW referrals and increased burden on radiology.