November 7, 2002

 

Dear Members of the MCCCARS,

 

The MCCCARS (Multicenter Cooperative Collaborative Action Research Study) is going into another project, after finishing two projects, namely:

1.      Reducing the discrepancy of clinical and pathological tumor and nodal evaluation in patients with breast cancer

2.      Is a recumbent plain abdominal x-ray (without an upright film) sufficient in the evaluation of patients with acute intestinal obstruction?

Details can be seen in http://mcccars.tripod.com

The new project will be on the practice of requesting for mammography and the detection of cancer in nonpalpable breast mass in the Philippines.

Actually, I have started and completed it in one center, specifically, in Manila Doctors Hospital.The initial data revealed problems in rational utilization and questions in cost-effectiveness.†† I want to expand the data gathering nationwide as much as possible to validate the existence and extent of the problem before coming out with a solution.Off-hand, I venture to say that the goal of the problem-solving will be a rational and cost-effective utilization of mammography in the Philippines, if it will continue to be done as a screening procedure.

Needless to say, for this project, I need the cooperation and collaboration of members of the MCCCARS and the other general surgeons in the country.

I hope you will join hands with me in this MCCCARS project and contribute to the solution of a potential health problem in the Philippines, that of irrational and non-cost-effective utilization of mammography.

There will be 3 phases in the study, namely:

1.      Baseline data on utilization and cancer detection yield of mammography

2.      Recommendations/interventional strategies for rational cost-effective use of mammography

3.      Monitoring of changes after interventional strategies

The first phase is relatively easy, because we have a pattern to follow already, the one that I used for Manila Doctors Hospital.

Letís not worry on the 2nd and 3rd phases.We will cross the bridge when we reach there.Letís start with the 1st phase.

 

Instructions:

1.      Read the whole text of the paper from Manila Doctors Hospital to get an idea of the framework of the research.

2.      Fill in the data sheet below.Use the tables as templates for filling in the data.Change the name of MDH to your hospital of responsibility.

3.      If you have problems, contact me.

4.      Minimum data if not all tables can be filled up:

a.      When mammography started

b.     Whether there are facilities for needle localization-biopsy

c.      Total mammography done from start to date

d.     Results of needle-localization biopsy and positive malignancy yield

Target completion date: December, 2002.

 

 

 

Utilization and Cancer Detection Yield of Mammography in the Philippines

Name of hospital:

Researchers:

When mammography services started?

Does it have facilities for needle localization-biopsy of mammography-identified lesions?

Table 1.Frequency of mammography done in Manila Doctors Hospital, 1994-2001.

 

Year

Number

1994

101

1995

633

1996

372

1997

872

1998

1409

1999

1548

2000

1111

2001

1277

Total

7323

 

Table 2.Age distribution of persons undergoing mammograms.

 

Age

Number

Per cent

Per cent

10-19

0

0

 

20-29

192

2.62

52.80

30-39

966

13.19

40-49

2708

36.98

50-59

2410

32.90

47.20

60-92

1047

14.30

 

7323

 

 

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

 

Table 3.Type of physicians requesting for mammography.

 

Type of Persons

Number

Per cent

Obstetrician-Gynecology

2337

31.90

Unknown specialization

2107

28.77

General Surgery

1348

18.40

Not indicated

694

9.48

Internal Medicine

453

6.19

Family Medicine

353

4.82

Radiology

12

0.16

Pediatrics

5

0.07

Opthalmology

5

0.07

Anesthesiology

4

0.05

Pathology

2

0.03

Rehabilitation Medicine

2

0.03

Otorhinolaryngology

1

0.01

 

7323

 

 

 

Table 4.Mammographic results.

 

Mammographic Results

Number

Per cent

Normal

4449

60.75

Benign

2721

37.16

Suspicious for cancer

††† without clinically††

††† palpable mass

99

1.35

Suspicious for cancer

††† With clinically

†††† palpable mass

54

0.74

 

7323

 

 

 

Table 5.Histopathology results of needle localization biopsy of suspicious mammographic findings without clinically palpable mass.

 

Histopathology result

Number

Per cent

Fibrocystic changes

35

70

Cancer

10

20

Indefinite result

5

10

 

50