LIST OF TABLES

                          

Table 1: Age and gender distribution of patients for different years studied

Table 2: Distribution of mammography investigations according to patient’s clinical indication

Table 3: Distribution of patients according to indications and gender

Table 4: Distribution of patients for different age groups and side of breast examined

Table 5: Distribution of mammography findings according to patient age 

Table 6: Distribution of mammography findings according to gender of patients

  

Background: Mammography is an indispensable tool in breast imaging

Aim: This work was carried out to determine: frequency of mammography investigation, age and gender distribution of patients referred for mammography examination, major reasons for referral and to document the findings.

Patients and Methods: A retrospective study of 1643 patients who underwent mammography investigations at MEDICAID RADIOLOGY Wuse Abuja between January 2010 to December 2012 was conducted. Tables, T-test and Chi square were used to analyze the data.

Result: The frequency of females referred for mammography investigations was significantly more than males (99.1%, n=1628; 0.9%, n=15). Routine screening (79.12%) was the major reason for referral of patients for mammography examination. The research revealed however, that the common finding in mammography investigation is cysts (38.34%, n=630) while the least finding is carcinoma (0.37%, n=6). Majority of females examined were within the age group of 40-44 (27.7%, n=455). About 35 patients (all females) presented at an earlier age group of between 30-34 years.

Conclusion: The result of this study showed that females were referred for mammography investigation more than males and that routine screening was the major reason for referral of patients for mammography examination. Cysts was a predominant finding in most of the patients and there was no significant difference between male and female patients referred for mammography investigations.

Keywords: Breast, mammography investigation, referral, findings, Medicaid radiology.

                               

Title page  i

Approval page  ii

Certification  iii

Dedication  iv

Acknowledgement  v

List of tables  vi

Abstract  vii

Table of content  viii

CHAPTER ONE

1.0 Introduction  1

1.1 Statement of problem  2

1.2 Objective of the study  3

1.3 Significance of the study  4

1.4 Scope of the study  4

1.5 Literature Review  5

CHAPTER TWO

2.1 Embryological development of the mammary gland  14

2.2 Anatomy of the mammary gland  16

2.2.1 Vascular supply and lymphatic drainage  18

2.2.1.1 Arterial supply   18

2.2.1.2 Veinous drainage  19

2.2.1.3 Lymphatic drainage  20

2.2.1.4 Innervation  21

2.3 Mammary equipment  21

2.3.1 High voltage generator  22

2.3.2 X-ray tube  22

2.3.3 Tube filteration  23

2.3.4 Compression device  23

2.3.5 Reciprocating anti-scatter grid  23

2.3.6 Image recording system  23

2.3.7 Exposure factor  24

2.4 Mammographic film processing  24

2.5 Radiation protection  25

2.6 Lesion characteristics identified in mammogram  26

2.6.1 Masses  26

2.6.2 Calcification  27

2.6.3 Architectural distortion  27

2.6.4 Focal increased density  27

2.7 Quality assurance in mammography  28

2.8 Preparation for mammographic examination  29

2.9 Mammographic recommendation  31

2.10 Breast Imaging Reporting And Data System (BIRADS)

        Category of classifying Breast Diseases  31

2.10.1 BIRADS 0  31

2.10.2 BIRADS 1  32

2.10.3 BIRADS 2  32

2.10.4 BIRADS 3  32

2.10.5 BIRADS 4  33

2.10.6 BIRADS 5  33

2.10.7 BIRADS 6  34

2.11 Alternative medical imaging modalities   34

2.11.1 Ultrasound   34

2.11.2 Magnetic resonance imaging   34

2.11.3 Nuclear medicine   35

CHAPTER THREE

3.1 Research design   36

3.2 Sources of data   36

3.3 Sample size   36

3.4 Inclusion criteria   37

3.5 Exclusion criteria   37

3.6 Method of data collection   37

CHAPTER FOUR

4.0 Data analysis  38

4.1 Presentation of data  39

CHAPTER FIVE

5.1 Discussion   57

5.2 Summary of finding   60

5.3 Recommendation   61

5.4 Limitation   62

5.5 Area of further research  62

5.6 Conclusion  63

Reference 

Appendix

                                         

Screening mammography is an x-ray examination of the breast on women who has no symptoms. Screening for early detection and diagnosis of disease and health condition is an important public health principle1. The ultimate goal of a screening mammogram is to detect breast cancer when it is still too small to be felt by a woman or doctor, which greatly improves a woman’s chance for successful treatment. The use of Mammography has resulted in increased number of cancer in-situ detected2. Mammography is the most preferred modality for breast cancer examination, especially in women older than 40 years, the age group with the highest incidence2. Some studies have shown that mammography may be particularly beneficial for women who are 80 years of age and older3,4.  Cancers in all form are responsible for about 12 per cent of deaths throughout the world while breast cancer alone causes 376,000 deaths annually worldwide5.

Moreover, breast cancers are cancers that start in the tissue of the breast, and the most common malignancy among women between ages 44 and 506. Breast cancer is the most common cancer and the second cause of deaths in women worldwide6. Similarly breast cancer is the most prevalent worldwide about one million new cases reported annually7. The incidence of the disease appears to be rising faster in population groups that have hitherto enjoyed low incidence of the disease6. The peak age of breast cancer in Nigerian women is about a decade earlier than caucasian7,8.  For women with symptomatic breast cancer, prolonged delay, defined arbitrarily as an interval greater than 3 months from first detection to time of diagnosis and treatment has been shown to be associated with increased tumor size, more advanced stage of the disease and with poor long term survival9-14. 

Indeed, about 70% of Nigerian women present at advanced stages of the disease at which time little or no form of benefit will be derived from any form of therapy administered, thus the 5 year survival of breast cancer in Nigeria is less than 10%7. In Nigeria, it has overtaken cancer of the cervix to become the commonest malignancy in women16. About 50% of all cases of breast cancers are diagnosed in developing countries including Nigeria18-19. 

MEDICAID RADIOLOGY Wuse, is a major hospital in Nigeria. It is located in Abuja, the Federal Capital Territory and precisely in Wuse II of the F.C.T. On May 22nd 2009, the ultra modern radiology centre was commissioned11. The hospital is strategically located between the exit and in-route expressway of the central Business District of wuse, Abuja. The corporate objective of the hospital was to create a friendly atmosphere for the care of all discerning patients without discrimination15.  Abuja in characterized by large population density of different ethnic group and geopolitical zone of the country.

This research is essential because in addition to determining the common findings from screening mammography, it will also demonstrate the age range of women that present themselves for routine mammography screening. It also will elucidate the major reasons for referral of patients for mammograms.