By Dr Evelyn Ho
The College of Radiology Value Added Mammogram Programme (CMP)
The programme began with the initiative from MMA Foundation Radiology Fund setting aside a sum for a month-long nationwide campaign in October 2001. It was then called the Subsidised Mammogram Programme, where eligible women above the age of 40 years, paid only RM30 and the rest of the cost of the mammogram was paid for by the MMA Foundation Radiology Fund (MMAFRF). The MMAFRF is managed by the MMA Foundation and came into being with funds from the College of Radiology (then known as the Malaysian Radiological Society).
The primary aim was to drive home the key message that “early detection saves lives“. Proactive, life-saving, breast health messages were disseminated with the help of the media and the College’s electronic arm, www.radiologymalaysia.org. The campaign provided both education to men and women about breast cancer and provided early detection services in the form of subsidised mammograms. The mass media rallied their support and sponsors of which, the major ones were Johnson & Johnson and Meditel Electronics Sdn Bhd in the first few years of the programme, lent their support to make the campaign and CMP a massive success.
In 2002, an appeal went out to all the hospitals through the Association of Private Hospitals Malaysia to get private hospitals involved in the Pink October activities (October is International Breast Cancer Awareness Month) by providing their own mammogram programmes and breast health education services. Over the years, the programme evolved to be called the College of Radiology (CoR) value added mammogram programme (CMP) as even biopsies were sponsored and in Segamat, the ladies were provided transportation to the nearest mammogram provider that was accredited by the CoR. Mammogram provider accreditation was necessary to ensure the mammogram quality and interpretation was at its best. The CoR organised annual breast seminars for mammography technologists and radiologists involved in mammography to ensure continuous professional education/development of personnel involved in the provision of mammography services.
We will always be grateful for and thankful to all the previous donors, corporate bodies as well as individuals who made it possible to kickstart our nationwide campaign in 2001. In particular, Johnson & Johnson, Meditel Electronics and the MMA Foundation Radiology Fund for having been our partners from 2001 to 2006 for the various aspects of our breast health/awareness programmes. Others include Tan Chong Motor, Shell, PS Pipeline, Marti Butler and her group of expatriate ladies and many others who helped to make the programmes such a success!
Estée Lauder Companies (ELC) Malaysia donations has been God sent, and have answered the “prayers” of the breast cancer support groups in Johor where such value added subsidised mammogram was very highly appreciated and much needed. In the annual ELC Malaysia’s breast cancer awareness campaign (BCAC), funds have been raised and the CoR has been one of the beneficiaries to date since 2008. From the ELC BCAC 2012 campaign, RM 200,000 was donated for the CoR to carry on its value added mammogram programmes in the underserved areas of the East Coast.
The CoR worked with many partners as breast health should be approached holistically. The CoR is also a member of the Malaysian Breast Cancer Council. Dr Evelyn Ho was at the helm of the programme from its start in 2001 until 2012 after which where Dr Sumithra Ranganathan took over as the coordinator of the programme. 2012 was the transition year.
Total Number of Participants from 2001 to 2013
A total of 516 and 461 women from CMP2012 and CMP2013 respectively participated in the programme. That brings to number who have benefitted from the CMP since 2001 to date to 9195.
Criteria for admission into the Mammogram Programme – eligibility of participants:
1.At least 40 years old
2.Lower income group – proof of income may be needed.
3.Single mothers and those with a family history of breast cancer may be given priority
Whilst previously the emphasis were for those who never had a mammogram before, eventually, those who needed follow-up mammograms were also given the opportunity to be “repeat participants” of the CMP.
Risk factors for breast cancer includes the following:
•Have a mother, sister or daughter with breast cancer
•Menopause and on hormone replacement therapy
•Have had previous history of breast cancer
•Have breast lump(s) or recent changes in the breasts or your doctor has recommended a mammogram for you
How would a participant of the CMP benefit? – From a value added mammogram!
The mammogram included the basic 4 views, and where necessary, extra mammogram views and adjunct ultrasound would be done at no extra cost to the participant so that when they left the mammogram centre, they would be explained the results of their mammogram. Where necessary, counselling would be given. For those with abnormal or suspicious findings, they were referred for further evaluation to a centre of their choice. It has been shown that giving the results of the mammogram immediately after the procedure helps to reduce anxiety associated with mammograms.
Women with dense breasts (the proportion of glands to fat is very high, thus resulting in a “lot of white” tissue in the mammogram film) may require adjunct ultrasound depending on the pattern of the mammogram as well as the breast symptoms and signs the person has.
The CMP also sponsored the cost of Biopsy (tissue sampling) requiring imaging guidance where needed, especially if the patient was financially challenged. Since 2006, a small percentage of those accessing the CMP needed further investigations under either ultrasound or mammogram guidance for tissue sampling (biopsy). The costs were borne by the CMP and this was particularly important for those from the smaller towns.
Why the need to have an accredited mammogram provider?
As of 2004, centres that volunteered to participate as providers in the mammogram programme had undergo and “pass” an accreditation process established by the College of Radiology. This was to ensure that the mammograms and the interpretation of the findings are of an adequate standard. The COR is concerned about quality and it is important for the participants that they have a good experience with this aspect of taking charge of their breast health. The aim of the game is to detect cancer early and for that mammogram films must be of optimal quality; breasts must be properly positioned and adequately compressed to ensure the miss rate for the interpreting radiologists (reading the films) is minimized. The process is entirely voluntary and we thank all the centres from the target states in Malaysia that responded to this process.
Take charge of your breast health!
The mammogram is not 100% accurate and even in the best of hands, the ability to pick up breast cancers may only go as high as 90%. In women with dense breasts, the pickup rate for cancer will be lower. However, it still offers the BEST chance of picking up early breast cancer, even before it can be felt. As such, the College of Radiology recommends that everyone be self-breast aware (and one way is to know your own breasts through systematic monthly self-breast examination) in addition to regular mammograms as well as a regular physical check up with your health professional for a complete approach to breast health.
CoR Mammogram Programme Reports – click here!