This document discusses breast cancer epidemiology and screening in Vietnam. It begins with epidemiology, noting that breast cancer is the most common cancer in women worldwide and a leading cause of death. Incidence rates have been increasing in Vietnam. The majority of breast cancer cases in Vietnam are diagnosed at later stages. The document then covers breast cancer screening recommendations from the American Cancer Society. It recommends yearly mammograms starting at age 45-54 for average risk women. For higher risk women, it recommends annual MRI screening plus mammograms. Common screening tools in Vietnam include ultrasound and mammography, with MRI used for higher risk cases. The document reviews imaging findings and standardized reporting system (BI-RADS). Overall, the document provides an

1. 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

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

3. 1. EPIDEMIOLOGY
3
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)

4. 1. EPIDEMIOLOGY
4

5. 1. EPIDEMIOLOGY
Trends in incidence of female
BC in selected countries:
ASR per 100,000
5
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

6. 1. EPIDEMIOLOGY
Estimated age-standardised rate (ASR) of BC in VN
Source:Trends of BC in Vietnam,
VN Cancer Society, 04-2013
6
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

7. 1. EPIDEMIOLOGY
7
11,9
26,6
41,1
86,8
107,1
128
115,3110,4
63,5
49
0
20
40
60
80
100
120
140
0-4 5-9 10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-74 75+
Tỉlệ
Nhóm tuổi
Breast cancer incidence by age (2004-2008)
Source:Trends of BC in VN,
VN Cancer Society, 04-2013

8. 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

9. 9
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

10. 10
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

11. 11
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

12. 12
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

13. 13
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

14. 14
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.

15. 15
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

16. 16
2. BREAST CANCER SCREENING
BC screening in VN
Main diagnostic imaging modalities:
— US
— Mammogram
— MRI

17. 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

18. 2. BREAST CANCER SCREENING
ACR BI-RADS
ACR 2013
18

19. ACR 2013
19

20. 2. BREAST CANCER SCREENING
BI-RADS LEXICONS MRI
20
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

21. 21

22. 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

23. TYPE OF BREAST

24. 2. BREAST CANCER SCREENING
24

25. 25
2. BREAST CANCER SCREENING
Mammograms, suspicious calcifications
The Radiology Assistant

26. 26
2. BREAST CANCER SCREENING
Mammograms, architectural distorsion

27. 27
2. BREAST CANCER SCREENING
Mammograms, asymmetry
The Radiology Assistant

28. 2. BREAST CANCER SCREENING
US
Background influence sensitivity
Sonoworld

29. 2. BREAST CANCER SCREENING
US, cyst vs solid
29

30. 2. BREAST CANCER SCREENING
US, Galactocele vs papillary neoplasm
Sonoworld
30

31. US, BIRADS 4C
Sonoworld

32. 32
2. BREAST CANCER SCREENING
MRI

33. 2. BREAST CANCER SCREENING
MRI, Mass and non-mass like BIRADS 4
33

34. 34
2. BREAST CANCER SCREENING
Practical situation in Viet Nam:
Majority:
¢ US and Mammograms
¢ MRI after US, Mammograms in high risk women

35. 35
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

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