BREAST CANCER

EPIDEMIOLOGY AND SCREENING

IN VIETNAM

BS Đỗ Thị Ngọc Hiếu,

BS Hồ Hoàng Thảo Quyên BS Võ Tấn Đức

UNIVERSITY MEDICAL CENTER HCMC HANOI 11/2015

CONTENTS 1.  Epidemiology 2.  Screening ¢  American Cancer Society Recomendations ¢  Application of diagnostic imaging

modalities in Vietnam

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1. EPIDEMIOLOGY

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Breast cancer (BC): ¢ Most common cancer in

women worldwide ¢  Leading causes of death ¢  IARC-International Agency

for Research on Cancer 2012: �  # 1.7 million new cases

(25% cancer in female) �  522.000 deaths (#15% cancer)

1. EPIDEMIOLOGY

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1. EPIDEMIOLOGY

Trends in incidence of female BC in selected countries: ASR per 100,000

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30,6 33,5

36,2 38 40,5

19 21,9 23,9

26,4 27,7

0 5

10 15 20 25 30 35 40 45

2004 2005 2006 2007 2008

ASR in Ha Noi and HCMC

Ha Noi TPHCM

Trends in incidence of female BC in Hanoi and HCMC Source:Trends of BC in Vietnam VN Cancer Magazine, 04/2013

1. EPIDEMIOLOGY

Estimated age-standardised rate (ASR) of BC in VN

Source:Trends of BC in Vietnam, VN Cancer Society, 04-2013

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Ha Noi

TP HCM

Cần Thơ

Thừa thiên Huế

Hai Phong

Thai Nguyên

Viet Nam

2004-2008 39.4 26.0 22.6

20.7 16.1

14.5

26.6

2020 38.1

1. EPIDEMIOLOGY

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11,9 26,6

41,1

86,8

107,1

128 115,3 110,4

63,5 49

0

20

40

60

80

100

120

140

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Tỉ lệ

Nhóm tuổi

Breast cancer incidence by age (2004-2008)

Source:Trends of BC in VN, VN Cancer Society, 04-2013

1. EPIDEMIOLOGY

BC stages

Source:Trends of BC in Vietnam, VN Cancer Society, 04-2013 8

Stage BC cases in 5 regions

(%)

I 463 11.7

II 1.105 27.9

III 2.387 60.4

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2. BREAST CANCER SCREENING

American Cancer Society (ACS): ¢  Tests and exams used to find BC before it

causes symptoms ¢  Improves the chances that BC can be

found early and treated successfully

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2. BREAST CANCER SCREENING

ACS Guideline, Oct 20, 2015 For women at average risk (most women) ¢ Age 45 – 54: yearly mammograms 40 - 44: Start screening, if they want to ¢ ≥ 55: mammograms every 2 or 1 years ¢ Regular mammograms as long as in good health ¢ Breast exams, medical provider or self-exams, are

no longer recommended. Still, all women should be familiar with how their breasts normally look and feel

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2. BREAST CANCER SCREENING

ACS Guideline, Oct 20, 2015 Women at higher risk: MRI+mammogram every year Includes: ¢ Lifetime risk ≥ 20%-25% (tools, based mainly on family history) ¢ Known BRCA1 or BRCA2 gene mutation ¢ First-degree relative with BRCA1, BRCA2 mutation ¢ Had chest radiation therapy ¢ Have Li-Fraumeni, Cowden, or Bannayan-Riley-

Ruvalcaba syndrome, or first-degree relatives have

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2. BREAST CANCER SCREENING

ACS Guideline, Oct 20, 2015 MRI screening: ¢ The ACS recommends against MRI screening for

whose lifetime risk of BC < 15%. ¢ Not enough evidence for yearly MRI screening for

moderately increased risk �  Lifetime risk of BC 15% - 20% �  Personal history of BC, DCIS, LCIS, ADH, ALH �  Having dense breasts on a mammogram

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2. BREAST CANCER SCREENING

ACS Guideline, Oct 20, 2015 MRI screening: ¢ do at a facility that can do an MRI-guided biopsy at

the same time. Otherwise, a second MRI done at another facility when she has the biopsy.

¢ more sensitive than mammograms, higher false-positive rate

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2. BREAST CANCER SCREENING

ACS Guideline, Oct 20, 2015 Ultrasound (US) as a screening test : ¢ Some studies have suggested US + mammogram

screening for dense breast ¢ US aren’t used by themselves for screening ¢ Less sensitive than MRI ¢  Automated USàneed a second handheld US

�  To get more pictures �  Guide a needle biopsy of a suspicious mass.

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2. BREAST CANCER SCREENING ACS Guideline, Oct 20, 2015 US most often used to: ¢ evaluate breast problems ¢ guide a needle biopsy of a suspicious mass. ¢ look at lymph nodes/ breast tumor

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2. BREAST CANCER SCREENING

BC screening in VN Main diagnostic imaging modalities:

� US � Mammogram � MRI

2. BREAST CANCER SCREENING ACR BI-RADS

¢ The American College of Radiology Breast Imaging Reporting and Data System

¢ Standardize reporting and follow-up ¢ 1980s: for mammograms, from 2003: for US and MRI newest: 5th Edition 2013

2. BREAST CANCER SCREENING ACR BI-RADS

ACR 2013 18

ACR 2013

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2. BREAST CANCER SCREENING BI-RADS LEXICONS MRI

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BREAST MRI LEXICON

Mass Shape Margin Internal Enhancement

Non-Mass-Like Distribution Internal Enhancement

Symmetry

Kinetics Initial phase Rapid Medium Slow

Delayed phase Wash-out Plataeu Persistent

Associated Findings

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MAMMOGRAM VS US

Mammogram advantages

US advantages

Fatty breast Calcifications outside mass Architectural distorsion Asymmetry

Mass/Dense breast DDX cyst vs solid Tumor vascularization Realtime

Screening vs Diagnosis v Screening: no symptoms or signs of BC v Diagnosis: breast problem or an abnormal area found in a

screening test, exam

TYPE OF BREAST

2. BREAST CANCER SCREENING

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2. BREAST CANCER SCREENING Mammograms, suspicious calcifications The Radiology Assistant

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2. BREAST CANCER SCREENING Mammograms, architectural distorsion

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2. BREAST CANCER SCREENING Mammograms, asymmetry The Radiology Assistant

2. BREAST CANCER SCREENING

US Background influence sensitivity

Sonoworld

2. BREAST CANCER SCREENING

US, cyst vs solid

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2. BREAST CANCER SCREENING

US, Galactocele vs papillary neoplasm Sonoworld

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US, BIRADS 4C

Sonoworld

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2. BREAST CANCER SCREENING

MRI

2. BREAST CANCER SCREENING

MRI, Mass and non-mass like BIRADS 4

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2. BREAST CANCER SCREENING Practical situation in Viet Nam: Majority: ¢ US and Mammograms ¢ MRI after US, Mammograms in high risk women

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2. BREAST CANCER SCREENING Practical situation in Vietnam: ¢ In some regions:

�  US screening �  if US or exam find problem à Mammograms

Maybe due to : �  Dense breast �  US: low cost, widely available �  BC screening fee have not coveraged by Insurance �  Lack of BC screening information

THANK YOU!

THANK YOU!

THANK YOU!