Breast Cancer Diagnostic Efficacy in a Developing South-East Asian Country

Abstract

Background:Breast cancer, is increasing in prevalence amongst South East (SE) Asian women, highlighting the need for high quality, early diagnoses. This study investigated radiologists’ detection efficacy in a developing (DC) and developed (DDC) SE Asian country, as compared to Australian radiologists.Methods:Using a test-set of 60 mammographic cases, 20 containing cancer, JAFROC figures of merit (FOM) and ROC area under the curves (AUC) were calculated as well as location sensitivity, sensitivity and specificity. The test set was examined by 35, 15, and 53 radiologists from DC, a DDC and Australia, respectively.Results:DC radiologists, compared to both groups of counterparts, demonstrated significantly lower JAFROC FOM, ROC AUC and specificity scores. DC radiologists had a significantly lower location sensitivity than Australian radiologists. DC radiologists also demonstrated significantly lower values for age, hours of reading per week, and years of mammography experience when compared with other radiologists.Conclusion:Significant differences in breast cancer detection parameters can be attributed to the experience of DC radiologists. The development of inexpensive, innovative, interactive training programs are discussed. This non-uniform level of breast cancer detection between countries must be addressed to achieve the World Health Organisation goal of health equity.

Improving radiologist's ability in identifying particular abnormal lesions on mammograms through training test set with immediate feedback

“…Previous studies showed that the interpretive performance varies considerably among radiologists in different countries 2 – 4 . According to the literature, approximately 62% of radiologists interpret mammograms as part of their workload, but only 10.5% consider themselves breast imaging specialists 15 .…”

“…Patient treatment outcomes rely heavily on accurate interpretation of radiologists for the early detection of abnormal lesions on mammography, which is currently the most popular X-ray imaging method used for both diagnostic and screening purposes of breast cancer. It has been shown that the diagnostic accuracy of radiologists in screening mammograms varied significantly across countries ranging from below 50% in developing countries to over 80% in developed nations 2 – 4 . Although reasons could partly stem from differences in patient populations, variability has also been documented in the interpretative skills of radiologists.…”

“…It has also been shown that the regular completion of the BREAST test sets improved radiologists’ test based performances 12 , 13 . In recent years, BREAST has been introduced to Vietnam, a developing country in South East Asia, through workshops for radiologists, radiology residents and data showed that Vietnamese radiologists displayed a low mammographic cancer detection of 48% compared with 81% for their counterparts in Australia and Singapore 4 . Importantly, it is found that the detection rate of Vietnamese radiologists for specific types of lesions such as spiculated masses or stellate lesions on mammograms were lower than calcification, discrete mass or asymmetric density 14 .…”

An Australian-based authentic science research programme transforms the 21st century learning of rural high school students

“…Radiologists were provided with a test-set of breast mammograms and were required to decide the absence or presence of a lesion, and if present, the location of the lesion. At the end of the test-set, radiologists were given a sensitivity (true positives) score, a specificity (true negative) score, and lesion sensitivity score, as well as receiver operating characteristic area under the curve (ROC AUC) and jackknife free response operating characteristic figure of merit (JAFROC FOM) scores, which summarised their mammographic detection efficacy (for methods see Jackson et al., 2019).…”

Interpretative characteristics and case features associated with the performances of radiologists in reading mammograms: A study from a non‐screening population in Asia

“…Early detection of breast cancer depends on accurate interpretation of breast images by radiologists and is essential to improve efficacy of treatments and patient prognosis. However, data collected by our group through the Breastscreen REader Assessment Strategy (BREAST), 9 an official training program for radiologists in Australia, showed that Vietnamese radiologists displayed low diagnostic efficacy on mammograms with cancer sensitivity rates below 50% 10 compared with approximately 80% in Australia 11 . Although it is similar with the BREAST's findings in other developing countries in Asia, 12 this discrepancy must be addressed to improve the welfare of women.…”