Results of a pilot study for breast cancer screening by mammography in Sfax region, Tunisia

Objectives. Evaluation of three rounds of mammography screening pilot programme operated between 2004 and 2010 in Sfax by the founders of Dar El Amal association. Patients and methods. A biennial screening was offered to women aged over 45 years and residing in five delegations of Sfax. Two radiologists independently interpret the mammograms. Results. Twelve thousand six hundred and fifty-seven mammographies were performed. The rate of participation was 17.35%. Women under 50 years had the higher rate of participation (34.7%). Some 17.2%/8% (prevalent/incident round) of participants were recalled for further assessment. The chirurgical biopsy rate was 2.1% in prevalence and 1.34% in incidence. The predictive positive value (PPV) of biopsy was 26.5% and 47.14% in the prevalent and incident rounds, respectively. The cancer detection rate amounted to 5.6 parts per thousand in prevalent round and to 6.3 parts per thousand in incident round. Twenty-five percent of invasive detected cancers were less or equal to 10 mm in size and 65.5% were node-negative. The rate of interval cancer was 0.78 parts per thousand. The performance of screening in this study was undermined by the relative importance of women younger than 50 years. The cost of one test was 26,200 TD and the cost of one cancer case screening was 6142 TD. Conclusion. This study identified the benefits and limitations of this pilot programme to inform policy makers on the importance and feasibility of an organized mammography screening of breast cancer in Tunisia in a context of a generalization. (C) 2013 Elsevier Masson SAS. All rights reserved.