Mammographic findings and BI-RADS concordance in women attending a community outreach program in Uganda

The incidence and mortality of breast cancer in Uganda are on the rise. Therefore, the Improving Breast Cancer Care Coordination (IBCCC) program was initiated to bring breast cancer screening and diagnostic services closer to women in hard-to-reach communities all over Uganda. It was the first mammography community outreach where participants received immediate (on-site) readings. So, the level of agreement between mammographic Breast Imaging Reporting and Data System (BI-RADS) readings taken in the community (on-site) and those taken in the standard radiological reporting unit (off-site) was unknown. The current study aimed to describe the mammographic findings and determine the BI-RADS concordance between on-site and off-site readings for women attending a community outreach breast cancer early detection program in Northern Uganda. A cross-sectional design and data collected from attendees of the IBCCC program were used. Mammography had been performed, and the images had been read by the program’s radiologist. Participants were selected by simple random sampling from attendees of the program in Northern Uganda, and their mammograms were also read by our study’s radiologists. Summary statistics were calculated for mammographic findings, and the BI-RADS concordance was assessed using unweighted, linear weighted and quadratic weighted Kappa (k) statistics comparing on-site to off-site mammogram readings. 201 participants were selected from attendees of the IBCCC program from 9th January to 5th September 2023. The mean participant age was 51 years. Most participants reported at least one symptom (70.7%); the most common symptom was pain (67.6%). The most common breast composition was scattered fibroglandular density (38.3%). Sixty-nine participants (34.3%) had a mass. Thirty-four (16.9%) participants had calcifications, of which nine (26.5%) had suspicious morphology. Off-site and on-site readings awarded a BI-RADS score of 4 or 5 to 18.4% and 13.4% of participants, respectively. The quadratic weighted BI-RADS concordance was 0.58 (95% CI: 0.44–0.71). A considerable proportion of women in the current study had BI-RADS classifications of 4 and 5, suggesting numerous late presentations in the community. Those late presentations likely indicate poor access to breast cancer screening and diagnostic services. The BI-RADS concordance was moderate between on-site and off-site readings.