Breast-light device as an adjuvant for clinical breast examination in breast examination clinic/Al-Yarmouk Teaching Hospital-Baghdad

Rasha W Omar; Jamal M Alkhudhair

doi:10.4103/IRJCM.IRJCM_3_21

ORIGINAL ARTICLE

Year : 2020 | Volume : 33 | Issue : 2 | Page : 61-64

Breast-light device as an adjuvant for clinical breast examination in breast examination clinic/Al-Yarmouk Teaching Hospital-Baghdad

Rasha W Omar¹, Jamal M Alkhudhair²
¹ Iraqi Ministry of Health, Al-Yarmouk Teaching Hospital, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
² Department Family and Community Medicine, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq

Date of Submission	01-Oct-2020
Date of Decision	30-Oct-2020
Date of Acceptance	20-Nov-2020
Date of Web Publication	6-Jul-2023

Correspondence Address:
Dr. Jamal M Alkhudhair
Department Family and Community Medicine, College of Medicine, Al-Mustansiriyah University, Baghdad
Iraq

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IRJCM.IRJCM_3_21

Abstract

Background: The low survival rates of breast cancer in less developed countries such as Iraq are mainly attributed to a lack of awareness programs, resulting in a high proportion of women presenting in late stages, in addition to the limited capacity for early diagnosis and effective multimodality treatment. Objectives: The objective of the study was to compare the outcome of clinical breast examination with breast light device use. Patients and Methods: This descriptive hospital-based cross-sectional study was conducted on a sample of 305 women attending a breast examination clinic in Al-Yarmouk Teaching Hospital-Baghdad, from January 1, 2015 to July 30, 2015. Study tools included “The Breast light” which is a handheld device that transilluminates the breast with a red light that is absorbed by hemoglobin yielding dark shadows in areas of high vascularity (including malignancy). The breast-light device was used for breast examination, together with a clinical breast examination. Results: The study showed moderate agreement in the detection of breast abnormalities between clinical breast examination and breast light examination (kappa 43%). Neither breast mass size nor its location showed significant differences when comparing the results of the two methods. Moreover, mastalgia appeared to be the most frequent presentation in the examined women. Conclusion: Detecting ability of breast abnormalities could be raised, when integrating clinical breast examination with breast light. In addition, breast light could be a valuable aid for family doctors at the primary health care level, as it is easy to use, portable, and not invasive.

Keywords: Breast examination clinic, breast light, clinical breast examination

How to cite this article:
Omar RW, Alkhudhair JM. Breast-light device as an adjuvant for clinical breast examination in breast examination clinic/Al-Yarmouk Teaching Hospital-Baghdad. IRAQI J COMMUNITY MED 2020;33:61-4

How to cite this URL:
Omar RW, Alkhudhair JM. Breast-light device as an adjuvant for clinical breast examination in breast examination clinic/Al-Yarmouk Teaching Hospital-Baghdad. IRAQI J COMMUNITY MED [serial online] 2020 [cited 2023 Oct 2];33:61-4. Available from: http://www.journalijcm.org/text.asp?2020/33/2/61/380712

Introduction

Breast cancer is responsible for about one-third of the registered Iraqi female cancers and almost one-quarter of deaths within the last two decades. Its incidence has been increased to be one of the major threats to Iraqi female health. It is often diagnosed in advanced stages yielding high mortality incidence ratio.^[1],[2]

Screening tools include clinical and self-breast examinations, mammography, genetic screening, ultrasound, and magnetic resonance imaging. Clinical breast examination (CBE) is a simple, noninvasive, and safe early detection measure (sensitivity 40%–70% and specificity 86%–99%) performed by a trained health-care provider.^[3],[4] CBE in primary health care centers, along with diagnostic mammography in major hospitals for referred cases, could offer cost-effective approaches for early detection of breast cancer in Iraq. The resources required to provide these services are within the reach of all countries with limited resources.^[3]

The breast light introduced in 2012, is a handheld device that transilluminates the breast with a red light (wavelength 617 nm) that is absorbed by hemoglobin yielding dark shadows in areas of high vascularity (including malignancy). Transillumination light scanning is a noninvasive modality with low-intensity emissions of red light to visualize breast tissues.^[5] When a tumor takes hold in the breast, a new blood vessel grows to feed it.

The breast light would show as a dark patch long before it can be felt, thus it provides an additional dimension to palpation.^[6],[7] The normal image reveals the superficial blood vessels, the nipple, and areola as dark shadows against a mainly red background. Owing to the angiogenesis in the malignant lumps, they should appear by that device as dense dark opacities within a bright red background.^[7]

The device is easy to use, relatively affordable, noninvasive, safe, portable, chargeable, lacks radiation risk, and favorable in women with large breasts.^[7] It can detect mass as small as 0.7 cm.^[6] The breast light detection rate of malignant tumors ranges 67%–73%.^[8] Age, menopause, and breast size/density do not affect breast light performance.^[8] On the other hand, benign lesions without vascularity (e.g., simple cyst) may not be detected, so assume malignancies not causing an increase in blood flow. The current study aimed to assess breast-light imaging in comparison with clinical examination of the breast in terms of breast mass/shadow: its size, location, and associated lymph nodes, for women attending breast examination clinics.

Patients and Methods

This is a cross-sectional, hospital-based, descriptive study with an analytic element conducted under official and ethical approvals, in the breast examination clinic at Al-Yarmouk teaching hospital/Baghdad, from January, 1 2015 to July 30, 2015. A sample of 305 patients was included from women attending breast examination clinics. Sampling involves a nonrandom selection of all women presents during research days. A pilot study was carried out before the actual study to ascertain the acceptability of women for breast light examination. Inclusion criteria involve any women aged >30 years attending a breast clinic (referred or not), during the study period.

Pregnant women were excluded because breast light is not suitable during pregnancy, as the hormonal effects increase breast vascularity masking possible shadows. The researcher started by an interview with each participant. Privacy and confidentiality were considered after verbal consent. Women were given the right to withdraw from the study at any time.

The study relied on clinical breast examination and breast light examination. Clinical breast examination was done for any palpable mass, location, site, and size (classified into <2, 2–5, and >5 cm), followed by breast light illumination is a fully dark room, for any shadow, location, site, and size.(<2, 2–5, >5 cm). The device is almost safe, because it is a non-X ray, noninvasive modality, does not contain any radioactive materials, and uses low-intensity emissions of red light at wavelength 617 nm which is safe for human tissue.

First, water lubricant based was applied on the breast, then the breast light was held tightly underneath the breast and against the skin with the highest brightness setting indicator. The adjustment was done until reaching the suitable brightness level. Slowly, the device was moved around to see all the breasts. The researcher reported any shadow noticed with its position and diameter in the sketch presentation. Statistical analysis was done using SPSS v. 20, including data summarization, presentation, statistical tests for significance, and test of agreement (Cohen's kappa), as it is generally thought to be a more robust measure than simple percent agreement calculation, takes into account the possibility of the agreement occurring by chance. P = 0. 05 cut-off was used to denote significant results.

Results

Clinical breast examination results revealed breast mass in (28.5%) of them. The mass size was small in 78.2%, medium in (19.5%), and large in (2.3%) of women. The physical examination of the study group also showed that only 6.2% had palpable axillary lymph nodes. According to the breast light examination test, breast shadow appeared in 16.7% of 305 examined females. About 80.4% of those shadows were small, 17.6% were medium, and only 2% of them were found to be of large size [Table 1].

Table 1: Clinical breast examination and breast light findings among studied women

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Breast abnormalities detected by clinical breast examination moderately agreed with breast light examination (κ = 0.431, P < 0.0001) [Table 2]. A nonsignificant difference between breast abnormalities locations also showed in comparison between clinical and breast light examination. The average of breast mass size, which had been measured by CBE and breast light, did not show any significant differences and they were approximately convergent in their mean size. The mean size of breast mass achieved by clinical examination was accessed by the researcher to the nearest 0.5 cm [Table 3].

Table 2: Breast-light and clinical breast examination agreement for the presence of breast abnormalities

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Table 3: Comparison between breast light and clinical breast examination of included women for breast mass location and size

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Discussion

Personnel breast light which has been recently used as an adjunct to BSE and CBE offers low-income countries a good chance for implementing mass breast screening. Breast-light offers a potential for mass screening of younger, denser breasts for which mammography is not recommended.^[8] When data of the current study was revised, there were 305 women from different age groups consulting breast clinic, and about three quarters (74.4%) were younger than 50 years (not tabulated). This continuing trend for the disease to affect younger generations has been comprehensively illustrated in the Iraqi Cancer Registry and is a reflection of the younger demographic profile.^[9] This was similarly documented in neighboring countries.^{[10],[11],[12]} We should target our screening programs to younger women. The leading complaint for breast clinic visits in the current study was mastalgia (60%) (not tabulated) which agrees with a study conducted in Turkey 2010.^[13] Mastalgia disrupts the quality of life, especially due to the worry of having cancer. Leading complaints differ in other studies, e.g., a retrospective study in Sheffield^[14] which revealed that 66% of the women presented with a lump or mass. This reflects the weak practice of breast self-examination of Iraqi women who come only when mastalgia starts. This goes in the same line with an Iraqi study in 2011 which showed that only 48.3% practiced BSE. The most common reason for not doing so was a lack of knowledge of how to perform the technique correctly.^[15] The physical examination (CBE) of the studied group showed that (28.5%) of them had palpable mass. Nearly one-fifth of them had moderate-size breast mass. That reflects the late presentation and the weak practice of clinical breast examination at the primary health care level. It is known that CBE may be important for women who do not receive regular mammograms. Specifically, CBE presents an opportunity for health-care providers to educate women about breast cancer, its symptoms, risk factors, and advances in its early detection, as well as normal breast composition and variability. It also lets clinicians discuss the benefits and limits of breast self-examination (BSE) and demonstrate BSE for women who elect to do it.^[16] Among studied patients, examination by breast light revealed shadow in about one-sixth of the studied sample. The majority of those shadows were small in size, and one-fifth of them with no palpable mass detected clinically. Accordingly, breast light could be a valuable aid to the doctor at the primary health level to distinguish between normal breast tissue and areas where new blood vessels are present indicating potential abnormality even in small or not palpable breast mass.^[17] This agrees with a hospital-based cross-sectional study conducted at the National Cancer Institute, Cairo University (2013) which revealed that breast light would be of great assistance to women for whom palpation is not an effective way to identify suspicious masses. The study also stated that it is an easy-to-use tool suitable for primary health care physicians or at-home use.^[17] Although cancer research in Britain commended stopping their pharmacies from stocking this device due to the full availability of mammograms and ultrasound resources, the device is not prohibited in Iraq and the Middle East area. In Iraq, as one of the developing countries, resources for establishing a fully equipped nationwide early detection system for the target population at risk are limited, i.e., mammography machines and ultrasound. In addition to an inadequate number of well-trained radiologists and radiographers and the insufficient standardized quality control procedures. Therefore, it is logical to search for a device easy to use as an adjuvant to CBE at the primary health care level to detect breast abnormalities as early as possible.

The current study showed moderate agreement in the detection of breast abnormalities between CBE and breast light (kappa 43%).This agrees with another Iraqi study carried out in Main Training and Research Center for early detection of breast cancer in 2014 which concluded that the accuracy of the detection rate of the breast light in palpable lumps detected by clinical examination was significant.^[7] This finding can increase the chance of early detection of breast abnormalities by performing clinical breast examination alongside with translumenation method. Thus by combining both, extra cases can be referred to be evaluated by the other imaging tests. The most common site for breast abnormalities detected by breast light was subareolar area followed by the upper outer quadrant. This disagrees with the fact that revealed that the upper outer quadrant is the most common site of origin of breast cancer, followed by the central area.^[18]

Conclusion

The mean of breast mass size in the current study, which had been measured by CBE and breast light, did not show any significant differences and they were approximately convergent in their mean size. In conclusion, detecting breast abnormalities would be raised, when integrating clinical breast examination with breast light. The study recommends its use for family doctors at the PHC level.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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