How a US-Kuwait collaboration set the framework for a mammographic screening program

A collaboration between New York-based Memorial Sloan Kettering Cancer Center (MSKCC) and the Kuwait National Mammography Screening Program (KNMSP) allowed for the successful implementation of a national mammographic screening program. Program highlights were published online Sept. 25 in the Journal of the American College of Radiology.

Current key objectives of the KNMSP are to ensure the early detection of breast cancer, aligned with international standards, to decrease mortality rates and to bring screening closer to the point of care. While Kuwait has the financial resources to meet these goals, Kuwaiti imaging specialists sought more training.

“The program included training in the U.S. and Kuwait with follow-up to assess image quality, screening program results and a continuing medical education course in Kuwait for Middle Eastern radiologists and technologists,” wrote lead author Victoria L. Mango, MD, of MSKCC, and colleagues. “Although mammographic interpretation was the focus, training in breast ultrasound, MRI and breast biopsy performance was also essential, with the goal of having those trained become breast imaging leaders in Kuwait and to train others.”

Five Kuwaiti radiologists participated in a six-month breast imaging program in the U.S. under the instruction of a MSKCC radiologist. Similarly, six Kuwaiti technologists observed close to 600 cases over the three-month teaching period. Both groups attended educational conferences.

Post training, more than 6,900 Kuwaiti women were screened at KNSMP centers — and 83 cancers were detected. About 80 percent of women with breast cancer were diagnosed by biopsy within four weeks of abnormal results on screening mammography, which met KNMSP goals.

The mammograms were performed with a sensitivity of approximately 98 percent and a specificity of 88 percent.

“The KNMSP demonstrates the successful implementation of national mammographic screening, with acceptable sensitivity and specificity as defined by the Mammography Quality Standards Act (MQSA) and timely diagnosis of early stage breast cancers, in conjunction with a collaborative training program,” Mango et al. wrote.

A key limitation was the inability of Kuwaiti technologists and radiologists to perform imaging procedures in the U.S. and a potential obstacle may be differences in culture and language.

While the program was successful, the authors noted its essential to incorporate formal breast imaging training into residencies, include breast imaging in board examinations, establish a breast imaging society and create minimum mammographic reading requirements.

“Future directions for the KNMSP include increased breast cancer awareness campaigns to reach more women, aiming to screen 70 percent of the population,” the authors concluded. “Training more radiologists and technologists and increasing imaging capacity is necessary to provide quality screening to this extent. Long-term follow-up will determine the KNMSP’s effect on breast cancer mortality.”