Mammographic Assessment of a Geographically Defined Population at a Mastology Referral Hospital in São Paulo Brazil

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Abstract
To evaluate the results of screening and diagnostic mammography in a geographically defined population attending a regional mastology referral hospital of the State Public Service of São Paulo. A total of 7508 women, who received screening or diagnostic mammography examinations from 06/2004 to 06/2005, with follow-up until 06/2006, were included in this study. Data corresponding to age, the Breast Imaging-Reporting and Data System (BI-RADS), biopsy, surgery and the stage of breast cancer were collected. Five-year survival of patients with breast cancer was posteriorly calculated during this period. This study included a total of 713 diagnostic and 6795 screening mammograms. The average age of the population was 51.2 years, with a BI-RADS end result of 4 and 5 (abnormal) in 1.9% of the screening and 11.4% of the diagnostic mammograms, respectively. All BI-RADS category zero was complemented. Of the 228 nonsurgical biopsies performed (71 CNB, 94 mammotomy and 63 FNAB), 63 (27.6%) biopsies were malignant findings. Among the 33 surgical biopsies, 10 (30.3%) biopsies were malignant findings, and of the 82 surgeries, 55 (67, 1%) procedures showed malignant findings. Seventy-one (0.9%) breast cancers (25/6795 on screening exams and 46/713 on diagnostics) were diagnosed. A total of 28.6% small cancers (≤10 mm) were observed, with 27% of the cancers in stages zero and I. Approximately 47.6% of the cases showed nodal invasion, and 4.5% of cases were not staged. Overall detection rate of breast cancer was 8.8/1000 (3.2/1000 screening and 61.7/1000 diagnostic). The overall 5-year survival rate of patients with breast cancer in this population was 79.1%. Survival is a key index of the overall effectiveness of health services in the management of patients with cancer. Our results suggest that this approach is feasible and can potentially improve breast cancer outcomes for many women in São Paulo.

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