BREAST SCREENING SERVICES AVAILABLE AT MAMMOCARE-GHANA

                   

             MAMMOCARE(GHANA)  

                                 CENTRE FOR BREAST CANCER AWARENESS,SCREENING AND                                                               TREATMENT RESOURCE

*LATEST TECHNOLOGY FOR BREAST SCREENING AVAILABLE AT MAMMOCARE, GHANA

*MOBILE MAMMOGRAM COMING SOON

*EARLY STAGES OF BREAST CANCER IS USUALLY PAINLESS AND POTENTIALLY    CURABLE.
*EARLY DETECTION SAVES LIVES!
*OUR BREAST SCREENING SERVICES IS BY APPOINTMENT ONLY
*FOR APPOINTMENT: 
   
CALL:+233-0243030115
               +233-0277524689

                    
CAPE COAST AND TAKORADI
    CALL: +233-262734225                                

THE BREASTLIGHT / BREASTCHECKER

A NOVEL MODE OF DETECTING BREAST LESIONS AND BREAST CANCER IS AVAILABLE AT MAMMOCARE-GHANA.

THE BREASTLIGHT/BREASTCHECKER [Product Overview]

The breastlight works on the principle that a breast cancer can be demonstrated in situ by the transmission of light through living tissues and has been designed ORIGINALLY for use by women in the home as an adjunct to breast self–examination. The problem to be overcome is to design a device which provides a sufficiently high light intensity without itself becoming too hot or heating the tissues. In addition the distribution of light must be such that the smallest possible tumours are revealed. The light guide has to be designed to achieve the optimum intensity distribution. Also the light intensity level must be reproducible from examination to examination and the high intensity light must be suppressed, or reduced to a low level, except when the device is in contact with the skin / breast tissues. The ideal solution is a hand held, battery powered device so as to avoid the risks obvious with mains operation. The device has to be non diagnostic. In practice this means  that some non cancerous lesions can also be detected. It has to provide  an indication for the user to seek advice from their GP{doctors}. A diagnostic device would be unacceptable because the ultimate outcome needs to be conveyed to the woman [ after diagnosis she becomes  a patient ] in a medical setting. Blood filled cysts, abscesses and bruising can all give rise to shadows not unlike those that arise when cancers are present.

When light generated by the breastlight  is incident on the inferior surface of the breast it is scattered within the tissues and only a few percent of incident light emerges from the superior aspect. The transmitted light is strongly absorbed by blood vessels and  angiogenesis surrounding life threatening cancers  gives rise to  a shadow seen on the superior breast surface.    Angiogenesis comprises a chaotic mass of blood vessels which allow a cancer to grow rapidly by supplying additional oxygen and nutrients. The angiogenesis is initially stimulated by tumour angiogenesis factor (TAF ) released by the tumour when microscopic cancers move into the exponentially growing phase.

It has to be appreciated that the breastlight  can only detect cancers which have associated angiogenesis.  Thus the breastlight  does not and will not compete with X-ray mammography which images tumours by virtue of tissue density. It is almost inconceivable that a domestic device could be devised which utilises X-rays. The optical and X-ray techniques complement each other. Any cancer detected using the  breastlight  is likely to be life threatening  since the friable vessels comprising the angiogenesis are also a major  pathway for dissemination of cancer cells and the seeding of secondary tumours. Because  X-ray mammography has a sensitivity of around 85% it is reasonable to surmise that in the future the optical technique should be used to supplement mammography and even by Surgeons prior to operation and also by Oncologists during treatment. The sale of this device has hit one million pounds sterling in Europe and Asia.

The  breastlight  comprises a variable light source sufficient to penetrate the female breast and utilises no ionising radiation or significant breast compression. It is a hand held device to be used in conjunction with monthly self examination and is purposely designed to be advisory but not diagnostic. It is safe and relatively easy to use. Skin pigment does not appear to limit its use to Caucasian women.

The absorption bands of oxyhaemoglobin occur  at  a wavelength of 550 nm and tissues become partially  transparent to light at around 600 nm . To visualise breast and tumour tissues we have compromised by using  [ 3 x 3 Watt ]  light emitting diodes LEDs whose output is centred at 618 nm and this choice  demonstrates  blood vessels in breast tissues and cancers within the breast.  The technology which allows us to use only 3 LEDs has only been available for 6 months. This has in turn meant the light guide could  be reduced in area [ diameter ] which is expected to permit visualization of very small tumours.  The light guide also reduces the path length of light traversing the tissues.

A more sophisticated Clinical  breastlight  [Figure 1.]  is under development for use by Doctors and Nurses in Primary Health care.

 Figure 1.

Figure. 4.1.2.b. Breast 2675 jpg lt. An impalpable lesion in a 62 year old lady at 2 o'clock.

Figure 4.1.2.c. Breast 3233 jpg Ghana 150708c  mass is 1.5 cm size  situated at 12 o'clock. in a 61 year old lady.

                IMAGES, COURTESY MAMMOCARE GHANA, 2007 - 2010

A Study to Evaluate the new handheld device, the BreastLight as a useful adjunct to breast screening by Mammocare Ghana,

from 16^th July 2007 to 22^nd December 2009

Start date...16^th July, 2007........                                Date of report....22^nd December, 2009...

Description	Frequencies / percentage	Additional comments.
No. of women screened for breast lesions	8,188	Screened by Manual inspection and palpation of breasts plus breastlight.
No. of women found  to have  a lump or other  breast symptoms  (breast lesions)	571 (6.97%)	Screened by Manual inspection and palpation of breasts plus breastlight.
No. of women with benign breast masses/lesions.	452 (5.52%)	Screened by Manual inspection and palpation of breasts plus breastlight.
No. of breast lesions followed up with mammography / Ultrasonography.	151 (26.44%)	High default rate by patients, 73.56%.
No. of breast lesions followed up by  Fine Needle Aspiration Cytology	Approx. 25% of those with  palpable lesions	High default rate by patients, follow up is ongoing
No. of women with confirmed breast cancer	50 (0.61%)	Mammography, ultrasonography, FNAC, breastlight applied.
No. of benign breast lesions positive with Breastlight. TRUE POSITIVES	77 (74.76%)	Palpable lesions, 1.5 cm – 6.0 cm in longest diameter.
No. of benign breast lesions 'missed' by Breastlight. FALSE NEGATIVES	26 (25.24%)	Mammography, ultrasonography, FNAC, breastlight applied.
No. of malignant breast lesions missed by Breastlight. FALSE NEGATIVE	1 (2.00%)	Mammography, ultrasonography, FNAC, breastlight applied.
No. of women with non-palpable breast lesions revealed by breastlight	16 (0.2%)	Haemorrhagic lesions (non-palpable). 0.5 cm – 2.5 cm in longest diameter.
No of malignant breast lesions, positive with breastlight. TRUE POSITIVE	49 (98%)	Palpable lesions, 1.5 cm – 8.0 cm in longest diameter.
No of malignant breast lesions where woman herself saw abnormal image with Breastlight.	49 (98%)	Using the breastlight.

 
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MAMMOCARE -  GHANA.

OVERVIEW OF PROJECTS AND RESEARCH 1999 – 2008.

Important landmarks:

·         A REVELATION OF NEW NATIONWIDE STATISTICAL ESTIMATES FOR BREAST CANCER IN GHANA;

·         AN EVALUATION OF THE “BREASTCHECKER”, A NEW HANDHELD DEVICE, AN ADJUNCT TO VISUAL INSPECTION OF BREASTS DURING BREAST SCREENING AND BREAST SELF EXAMINATION. IDEAL FOR DEVELOPING AND DEPRESSED ECONOMIES.

SECTION ONE:

AN ASSESSMENT OF THE LEVEL OF AWARENESS OF BREAST CANCER IN GHANA 1995

This project was designed to scientifically evaluate and assess the level of awareness of breast cancer among Ghanaian women (both literate and illiterate).

SPECIFIC OBJECTIVES

(a)       To provide scientific data on the nationwide level of awareness of breast cancer in Ghana.

(b)       To identify and assess gaps in knowledge about breast cancer within and between the illiterate and literate women population.

(c)      To provide educational material on breast cancer to the public, to enhance the community awareness of the disease and thereby encourage early detection.

SUBJECTS AND METHODS

Participants for the study were selected at random from work places, churches, market places, hospitals, women's organizations, family planning clinics, students' groups, etc.

All women between the ages of 18 and 70 years qualified to participate in the study. A total of 431 women comprising literate and illiterate women volunteered to participate in the study. The participants were interviewed by trained interviewers. Each participant was taken through a previously tested Questionnaire.

The country was divided into 3 zones namely southern zone, middle zone and northern zone to establish a basis for comparison, since most of the awareness programs, have been organized in Accra and Kumasi which fall within the Southern and Middle Zones respectively.

The southern zone comprised of Accra, Tema, Takoradi, Prampram and Dawhenya. A total of 198 participants were interviewed; 158 literate women and 40 illiterate women.

The middle zone comprised of Kumasi, Techiman, Kintampo, Juaben and Sunyani. A total of 133 participants were interviewed; 80 literate women and the remaining 53 were illiterate.

Northern zone comprised of Tamale, Tatale, Salaga and Yendi. A total of 100 participants were interviewed; 23 literate women and the remaining 77 were illiterate women. All data obtained were assembled, organized and analyzed using a Microsoft Excel soft ware.

For effective awareness program, education about symptoms and breast self-examination were presented to the population. The package included:

(a)       The definition of breast cancer,

(b)       The anatomical structure and function of the breast,

(c)       Instructions on breast self-examination (BSE),

(d)       Early detection,

(e)       Symptoms, diagnosis and treatment/management,

(f)       Types of breast cancer.

Every woman was encouraged to examine her own breast every month, and made aware that every woman's breasts are different and experience changes with age, menstruation, pregnancy, taking of birth control pills.

An assessment of the amount of information and knowledge each woman selected for this study had about breast cancer was made by posing the following questions:

1.     What do you know about breast cancer?

2.     List any changes which may be found in the breast and may also be associated with breast cancer.

3.     Which of the treatments for breast cancer do you know about?

4.     Do you examine your breasts, i.e. do you perform BSE?

The various responses to questions 1 and 2 were categorized or rated as "GOOD", "AVERAGE" or "POOR".

For question 1 a response was rated as "GOOD" if any of the following was given as an answer to the question:

(i)        Breast cancer is a malignant disease which spreads to other organs and kills if not diagnosed and treated early.

(ii)       Breast cancer usually starts as an unusual lump in the breast and can be treated successfully when discovered early.

(iii)      Breast cancer occurs when cells in the breast become abnormal and divide out of control or order.

Responses equivalent in meaning to anyone of those listed above were rated as “GOOD".

A response was rated "AVERAGE" if any of the following was given as an answer:

(i)        Breast cancer is a deadly disease of the breast and leads to amputation of the affected breast.

(ii)       Breast cancer is a breast lump.

(iii)      Breast cancer is a disease that affects the female breast.

Other responses equivalent in meaning to any of those listed above were rated as "AVERAGE".

Responses rated as “POOR” to question numbered 1 include:

(i)        Breast cancer is caused by a boil in the breast.

(ii)       Breast cancer is caused by excessive suckling or massaging of the breast by adult males.

(ii)       Breast cancer occurs when one keeps money or coins in her brassier.

The principal signs and symptoms of breast cancer are:

v  A lump or thickening in or near the breast or in the underarm area; A change in the size or shape of the breast;

v  A discharge from the nipple; or

v  A change in the color or feel of the skin of the breast, areola, or nipple (dimpled, puckered, or scaly).

For question 2 a response that included any 2 or more of the symptoms listed were rated 'GOOD', 1 symptom was rated 'AVERAGE' whereas ones inability to list any symptoms was rated 'POOR’.

RESULTS AND DISCUSSION

·         The average age at first menstrual period for Ghanaian women was 14.91 years and the mode was 15 years. It was estimated that 88.19% of the females had their menarche at age 16 or below. Early menarche is known to increase risk for breast cancer (7). Pike reported that Polish girls who started menstruating before the age of 16 carried a 1.8 times increase in risk for breast cancer compared with those whose menarche was later than 16 (8).

·         The average age at menopause calculated from our data was 47.77 years, 44.29% of the post-menopausal women had their menopause at the ages 47.77 years or below, whereas 2.86% of them had their menopause 55 years or above. Late menopause is known to increase risk for breast cancer (7). Trichopoulous et al reported a doubling of risk for women who continued menstruating beyond the age of 55 compared with those whose natural menopause was before 45 years. This is attributed to the fact that breast tissues exposed to hormones for a longer period have an increased risk for breast cancer (9, 10,11).

·         In this survey we observed that 93.02% of Ghanaian women have breast-fed their children, while 6.98% did not . 2.78% breast-fed their children for three to six months, 15.97% breast-fed for seven months to one year and 81.25% breast-fed for more than one year (13-36 months). There is some evidence that breast-feeding protects women from breast cancer, this benefit is seen in post-menopausal women who breast-fed any of their babies for a year or more during their pre-menopausal ages (11). The present study indicates a large majority of Ghanaian women population unknowingly enjoy the protection breast -feeding offers from breast cancer.

·         For the study population 21.84% of all the literate women gave responses to question 1 that were rated "GOOD" ; 33.33% gave responses rated "AVERAGE" whereas 44.83% of the responses were rated 'POOR" . 55.17% of literate Ghanaian women could be said to have some information about breast cancer whiles 44.83% do not .

·         For illiterate Ghanaian women less than 1 % of the study population gave responses to question 1 rated as "GOOD", 4.12% gave responses rated "AVERAGE" whereas 95:88% of the responses rated ”POOR". This implies that only 4.12% of illiterate Ghanaian women had some information about breast cancer whiles 95.88% did not .

·         Responses from literate women to question 2. 10.34% of literate women provided responses which were rated "GOOD", 26.44% of the responses were rated "AVERAGE" while 63.22% were rated "POOR". It can be inferred that 36.78% (10.34+26.44%) of literate women had some knowledge about symptoms of breast cancer while 63.22% had none .

·         Responses from illiterate Ghanaian women to question 2, revealed the following. Responses rated "GOOD" were provided by 0.59% of illiterate women, 5.88% provided responses rated "AVERAGE" whiles 93.55% provided responses rated “POOR". It can be inferred that 6.47% (0.59+5.88%) of illiterate women had some knowledge about the symptoms of breast cancer while 93.55% do not.

Breast cancer is treatable and indeed curable. Treatment options open to the patient and his doctor depends on the stage of the disease on presentation. Methods of treatment for breast cancer are local or systemic. Surgery and radiation therapy are local treatments whiles chemotherapy and hormonal therapy are systemic treatments.

·         Among literate women surgery was the most widely known -57.62% followed by chemotherapy -13.41%, hormonal therapy and herbal treatments were known to 5.79% and 5.18% of the literate women respectively. 18.00% of these women had no idea of any of the treatment options.

·         With respect to methods of treatment for breast cancer, among illiterate Ghanaian women surgery was the most widely known -25.29% followed by herbal treatment -10%, chemotherapy - 4.12% and finally hormone therapy-1.18% of this study population. The remaining 59.41% of this study population had no idea of any of these treatment options. It is evident that literate women are better informed about conventional treatments than their illiterate counterparts, while the illiterate women are more likely to know about alternative treatment i.e. herbal treatment. This is attributable to the fact that a large proportion of illiterate women reside in rural areas where health facilities are thinly distributed. Most of them resort to traditional herbal healing remedies for all their medical needs.

·         36.78% of the literate women were aware of at least one symptom of breast cancer  and 63.22% were not. 69.74% of them examined their breasts whiles 30.26% of them did not. Chi-square(X²) analysis of responses to question 1 indicated that the geographical zone in which a literate Ghanaian woman resides has significant influence on the amount of information she has about breast cancer – H_o. X² = 9.026, the critical value (X²c) = 9.448: df = 4: p < 0.05 when a two-sided X² test was performed.

·         6.48% of the illiterate women were aware of at least one symptom of breast cancer. 93.53% were not. 20.58% of them examined their breasts whiles 79.42% of them did not. Chi-square analysis of responses to question 1 indicated that the geographical zone in which an illiterate Ghanaian woman resides has significant influence on the amount of information she has about breast cancer - H_A. X² =1.509, the critical value X²C = 3.841: df= 1: p < 0.05 when a two-sided X² test was performed. This indicates that there is no significant difference in the amount of information about breast cancer between illiterate women from different geographical zones .

·         Chi-Square (X²) analysis of responses to question 2 indicated that; the geographical zone in which a literate Ghanaian woman resides significantly influences her knowledge about symptoms of breast cancer - H_A. X² = 8.507: df = 2, P < 0.05; X²c = 5.991.

·         X² analysis of responses to question 2 indicated that the geographical zone in which an illiterate Ghanaian woman resides significantly influenced her knowledge about symptoms of breast cancer -H_A. X² = 8.163, df = l, P < 0.05, X²c = 3.841.

·         Responses to question 1 were analyzed under these two groups of women, namely illiterate and literate and the Chi-square analysis indicated that, the amount of information a Ghanaian woman has about breast cancer is significantly influenced by her literacy status - H_A. The X² test yielded a value of 117.904; df = 1; P < 0.05; X²c = 6.635 when a two-sided X² test was performed.

·         Knowledge about symptoms of breast cancer among Ghanaian women is significantly influenced by their literacy status. X² = 51.395; df = 2; P < 0.05, X²c = 5.991 when a two-sided X² is performed. Thus, revealing a statistically significant difference in knowledge about symptoms of breast cancer between literate and illiterate Ghanaian women.

·         24.83% of all participants in this study were aware of at least one symptom of breast cancer whereas 75.17% of them were not aware of any symptom of breast cancer. Among literate women there are significant differences in awareness of symptoms as one moves from one geographical zone to the other. Those in the southern zone were in the lead, followed by the middle zone and finally the northern zone.

CONCLUSION

Performing BSE presupposes that the performer is aware of changes in the breast she wants to pick up if there are any - and report to her doctor. In our survey we observed that; 24.83% of all the participants selected were aware of at least one symptom of breast cancer whereas 75.17% of them are not. 50.3 5% of the women examine their breasts and 49.65% do not. It can be deduced that 25.52% (i.e. 50.35% - 24.83%) of the women who examine their breasts do not know what change to look for although they do BSE (assumption; all women aware of at least one symptom of breast cancer do BSE). 49.65% of the women do not examine their breasts and 25.52% of the women who do BSE do not know about any symptoms of breast cancer. Similarly by deduction 75.17% (49.65% + 25.52%) are not aware of any symptom for breast cancer; this figure equals what was actually observed through data collection.

This proves our assumption that all women who are aware of at least one symptom of breast cancer do BSE. In reality women who are aware of at least one symptom of breast cancer are more likely to examine their breasts. Those who are not aware of any symptoms will normally not perform BSE.

For BSE women from the southern zone are more likely to examine their breasts, followed by those from the middle zone and finally the northern zone. This trend is observed among literate and illiterate women.

Among the literate women those from the southern zone were the most informed followed by those from the middle zone and finally those from the northern zone. The same trend was observed for the illiterate women. One can deduce with some degree of confidence that this pattern observed so far is a reflection of the fact that most awareness programs and functions for breast cancer have been implemented in Accra which falls within the southern zone of our set boundaries for this survey. In addition these programs have not made the expected impact on the target group yet.

Although the overall awareness in the entire women population is not impressive and rather low the illiterate women populations are clearly far below, compared with their literate counterparts who are in turn, below, expectation.

*                    Awareness for breast cancer in Ghana is still very low among the target population. There are significant knowledge gaps between literate and illiterate women groups as well as within literate women groups and the illiterate women groups studied.

*                    For both literate and illiterate women, those within the southern zone were ahead in terms of knowledge about breast cancer, followed by middle zone and finally the northern zone. The knowledge gap between literate and illiterate women is extremely wide.

RECOMMENDATIONS

*                    A special awareness package should be developed with Ghanaian women in mind.

*                    A breast disease awareness service/center should be set up to organize and coordinate awareness programmes in a more organized and consistent manner.

*                    A national body/association for breast cancer patients and their relatives be organized.

*                    A breast cancer awareness week should be celebrated every year probably in August to coincide with world breast feeding day i.e. 1st August.

ACKNOWLEDGMENT

It is a pleasure to acknowledge our indebtedness to The Health Foundation of New York for sponsoring this project. The good work of our data collection personnel contributes greatly to the value of the information provided in this report.

Finally, we are indebted to V. Rev. Fr. Theodore Quaye of the Martyrs of Uganda Parish of the Catholic Church, Mamprobi, Accra for assisting with logistics required for data collection in the Northern sector of the country.

REFERENCES

1. Archeampong EQ. Breast Cancer in Ghana, National Cancer Foundation. Dec. 1990.
2. Oxford Textbook of Pathology. Vol2a, Oxford University Press, New York.1992: 1643-81.
3. Quartey-Papafio JB. Breast Cancer in Accra, Ghana Medical J. 1977: 16; 189-191.
4. Quartey-Papfio JB and Anim IT. Cancer of the Breast in Accra, Ghana Medical J. Sept. 1980: 159-161.
5. Wiredu WK. Personal Communication, Department of Pathology, Ghana Medical School. Oct. 1995.
6. Darko R.  Personal Communication, Department of Surgery, Ghana Medical School. Oct. 1995.
7. MacMahon B, Cole P, Brown J. Etiology of human breast cancer: A review. J Natl Cancer Inst. 1973: 51; 1479.
8. Pike MC, Krailo MD, Henderson RE et al.Hormonal risk factors, breast tissue age and age at incidence of breast cancer. Nature.1983: 303; 767-70.
9. Trichopoulos D, MacMahon B, Cole P. The menopause and breast cancer, J Natl Cancer Inst.1972: 48; 605-13.
10. MacMahon B, Feinleib M. Breast cancer in relation to nursing and menopausal history. J Natl Cancer Inst.1960: 24; 733-53.
11. Feinleib M. Breast cancer and artificial menopause: a cohort study. J Natl Cancer Inst. 1968: 41; 315-29.
12. McTiernan A. Thomas DB. Evidence for a protective effect of lactation on risk of Breast cancer in young women. Am J Epidemiol. 1986:124; 353-8.

SECTION TWO:

A NATIONWIDE AWARENESS AND SCREENING FOR BREAST CANCER 1999 – 2008

This follow up project was designed to study the basic epidemiology of breast lesions in Ghana. Over 47,000 women from all 10 regions of Ghana were screened for breast lesions and educated on breast awareness.

AIMS AND OBJECTIVES:

•       TO STUDY THE DESCRIPTIVE EPIDEMIOLOGY AND PATHO – BIOCHEMICAL NATURE OF BREAST CANCER RELEVANT TO ITS TREATMENT IN GHANA

•       TO HELP IMPROVE BREAST CANCER AWARENESS AND EARLY DETECTION IN GHANA.

•       TO ESTIMATE THE PREVALENCE OF BREAST CANCER IN GHANA

CONCLUSIONS

•       54.84% of breast cancer patients in Ghana are pre / peri – menopausal

•        45.16% are of post-menopausal status (F.N. GHARTEY et al, 2008.).

•       Ghanaian women (black Africans) develop breast cancer some 10 to 15 years earlier than Caucasians (Whites).

•       Average Age at detection of breast cancer in Ghana = 42.59 years ,

•       In Ghana, the most  affected Age group for breast cancer is 35 years to 45 years

•       Most affected Age for breast cancer = 35 years.

•       Prevalence rate for breast cancer in Ghana ranges from 0.41% – 1.11% (95 %confidence interval) among females aged 15 to 80 years in Ghana (black Africans);

•       Prevalence of benign breast lumps ranges from 0.69% – 6.89% (95 %confidence interval).

•       The average age of breast cancer patients detected through screening in Ghana is 42.59 years; compared to the average age for breast cancer patients reporting for surgical treatment at a major referral centre in Accra being 51.2 years. This is evidence for late/delayed presentation for treatment.

AN EVALUATION OF A NEW HANDHELD DEVICE; THE BREASTLIGHT:

INVENTED BY DR D. J. WATMOUGH, CEO, HIGHLAND INNOVATION CENTRE, INVERNESS, SCOTLAND.

Breaschecker is a handheld device that transilluminates the breast with a red light (617nm) that is absorbed by haemoglobin so that areas of high vascularity (such as malignant tumours) should appear black.

BLOODY NIPPLE DISCHARGE REVEALED BY BREAST CHECKER; AFFECTED DUCTS REVEALED

HISTOLOGICALLY CONFIRMED MALIGNANT BREAST MASS REVEALED WITH  BREASTCHECKER

HISTOLOGICALLY CONFIRMED DIFFUSE MALIGNANT BREAST LESION, DETECTED WITH BREASTCHECKER

AN EVALUATION OF THE NEW BREASTCHECKER FROM JULY 2007 TO DECEMBER 2008

No. of well women examined by clinical examination.	5,048	Additional comments.
No found  to have  a lump or other  symptoms	424
No followed up by mammography	42	High default rate by patients
No followed up by  FNAC	29	High default rate by patients
No with confirmed breast cancer	42
No with benign breast disease.	362
No of benign breast lesions 'missed' by Breastlight.	17	17/60 X 100 = 28.33%
No of benign breast lesions positive with Breastlight	43	43/60 X 100 =  71.66%
No of malignant breast lesions missed by Breastlight.	1	1/42 X 100 = 2.38 %
No of malignant breast lesions, positive with breastlight.	41	41/42 X 100 = 97.62%
No of malignant breast lesions where woman herself saw abnormal image with Breastlight.	41	100.00%

.ACKNOWLEDGEMENTS

·         First of all I thank God Almighty for making this work possible. My thesis supervisors, Dr Mrs. M. T. Frempong, Prof. S. Asante-Poku and Dr. W. K. B. Owiredu have imparted a life-time of knowledge and research skills to me over a short period. I thank them.

·         I thank Dr. David J Watmough, CEO of Highland Innovation Centre, Scotland, for giving me an opportunity to evaluate the breastlight and imparting photography skills to me.

·         I thank the various ladies associations of SSBank, GCBank, Tema oil refinery and Unilever – Ghana for their financial support.

·         I thank the director of Noguchi memorial centre for medical research-Ghana for giving us access to their well-equipped laboratories.

•       Latter Day Saints Charities in Ghana funded the entire data coding and structuring. This was a herculean task since data involved over 47,000 women from all ten regions in Ghana. My special thanks go to Mr Isaac Ferguson for spearheading funding this aspect of the work.

•       I thank Mr. David Renner, the former Managing Director of AngloGold Ashanti   (Iduapriem Mines in Tarkwa) and African Mining Resources for donating funds in support of this work.

•       Support from the departments of Medical Biochemistry and Anatomy (UGMS) with Laboratory space and histology work was key to the successful completion of this work.

•        I express my sincere thanks to Prof. Solomon Ofori-Acquah (Emory University, Medical School, USA) for donating reagents for IHC Assays. I thank histo-technologists of the histology department (UGMS) for providing technical support for IHC work.

•       Many thanks to The world bank office, Accra and my dedicated staff at Mammocare for their support with data collection nationwide.

•       My thanks go to my loving wife and family for their patience and fortitude during long periods when I was away creating awareness and collecting data nationwide.

Early stages of breast cancer is usually painless and potentially curable.
Early detection saves lives!
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