The College of Radiology & MMA Foundation Radiology Fund Subsidised Mammogram Programme (SMP) 2002 Highlights

• Organised by the College of Radiology (COR), Academy of Medicine of Malaysia and MMA Foundation Radiology Fund (MMARF)

• Made possible by volunteer mammogram providers

• This programme is partly aimed to provide the impetus and model upon which all medical centres can provide specially priced mammograms with breast health counseling.
   

Introduction

Year 2001 was the first time a one-month breast cancer awareness campaign offering subsidised mammograms was organized. The programme was pioneered by the College of Radiology and the MMA Foundation Radiology Fund. The participants had to pay only a fraction of the normal cost (not more than RM30) for value added mammograms. The Subsidised Mammogram Programme service includes mammograms with additional diagnostic views and adjunct ultrasound of the breasts where necessary and counseling of the patient on receipt of their reports. In some deserving cases, the participants were fully subsidized for their mammograms. For example in 2002, 34% needed adjunct ultrasounds.

Participants were vetted and had to fulfill specific criteria before being accepted into the SMP. It was also open to men who had suspicious breast lesions.
 

Objectives of the Programme

Background Information
In Malaysia, many women are misinformed about the mammogram. Some will not venture forth for the mammogram even if their doctors feel they should have one. Many have not even heard of this investigation.
 
Aims

1. The SMP helps increase awareness on the availability of the mammogram investigation for the breast, especially in those who have detected something amiss or perhaps, may be harbouring a lump.

2. The SMP makes the mammogram affordable to those who have no or difficult access to the already heavily subscribed government mammogram facilities.

3. The SMP forms part of the 3-prong strategy for breast health and early detection of breast cancer. People should be aware of their breasts, have an annual physical examination by the health care provider (in those above 40 years of age) and in high risk groups and symptomatic women – a regular mammogram once a year or two depending on the age group and risk profile.

The SMP therefore, is to encourage women (especially those who were financially challenged) above 40 years and either of high risk groups (eg Immediate family history of breast cancer, previous breast cancer) or with breast symptoms and signs to come forward for mammography.

The SMP is not primarily a screening programme as until the report of the National Cancer Registry 2002 on 4 July 2003, there was no accurate statistics on the prevalence or incidence of breast cancer in Malaysia. Many of the participants entering the programme have “problems’ with their breasts.
 

Electronic Resource Centre on www.radiologymalaysia.org

For the year 2002, a private resource centre was set up on the Radiology Malaysia website to provide self service for volunteer centres. The resource centre hosted downloadable leaflets, pamphlets, posters, as well as the Manual for the SMP for printing at the relevant centres/states. Where it was available, materials were also couriered to the various centres as part of the campaign collaterals. However, a self service styled electronic resource centre proved most useful as different states with different requirements could access materials of their choice to be reproduced with permission for their breast health programmes.
 

The Volunteer Subsidised Mammogram Providers

Centres who volunteer for this programme must be capable of delivering the value added mammogram package to all participants and comply with the administrative requirements to participate in the programme. Being electronically enabled is compulsory so that the costs of organising and administration of the SMP is at the lowest possible and all money raised for the SMP is actually almost fully utilized for subsidising mammograms only.

As promised in 2001, the SMP was expanded to cover more states in 2002. There were 12 providers in 7 states in SMP 2002. They were in Penang, Perak, Selangor, Federal Territory, Malacca, Kelantan and Sabah. Dr Ravi Mandalam, with the Sabah Medical Centre supporting the College’s initiative organized the Launch of the Breast Cancer Awareness and COR/MMARF Subsidised Mammogram Programme 2002 in Kota Kinabalu. This was a huge success and complemented the NCWO breast cancer awareness campaign amongst the grassroots in Sabah.

The 2002 centres involved were Loh Guan Lye Hospital, Penang Gleneagles Medical Centre, Island Hospital Penang, Kinta Medical Centre, Pantai Cheras Medical Centre, Pantai Medical Centre (Bangsar), National Cancer Society of Malaysia (Kuala Lumpur), Sunway Medical Centre, Megah Medical Specialists Group, Mahkota Medical Centre, Hospital Universiti Sains Malaysia and Sabah Medical Centre.
 

Number of participants in the SMP

A total of 1547 women participated in the 2001 subsidised mammogram programme while in 2002, there were 1872 women. The total number only increased by 21% as the funds were limited and each centre had to cope with existing workloads in each radiology department.

Participant profile

By State

In 2001, although the 2 main regions involved in this pilot programme were Klang Valley (Selangor/Federal Territory) and Kelantan, there were 3.5% from other states (Penang, Perak, Negeri Sembilan, Malacca, Johor, Pahang, Terengganu and even 1 lady from Sarawak).

69.1% of the participants were from the Klang Valley region and 27.4% were from Kelantan. This is to be expected as Selangor is the most populous state (4.19million) in Malaysia (Population & Housing Census 2000). Besides population density, there were also more mammography centres to cope with the “workload”!

In 2002, 24.7% was from Selangor and 25.2% was from Federal Territory. 17% was from Penang, 13.1% from Sabah, 6.9% from Perak, 5.2% from from Kelantan and 4.6% from Malacca. The remaining 3.3% were from Kedah, Terengganu, Pahang, Negeri Sembilan, Johor and Sarawak.

The centres in Penang also served Kedah, while Klang Valley centres also serviced Negeri Sembilan and Pahang as well. In other words, although a particular state was not specifically part of the SMP, women accessed the closest SMProvider.
 

By Ethnic Composition

Chinese women (70.9%) again made up the majority of the participants accessing the service as was the case in 2001. This may be due to a higher level of awareness in this ethnic group. The Malays made up 16.2% while the Indians made up 9.3%, and other ethnic groups made up the remaining 3.5% of the SMP.

By Ethnic Composition and Region

In 2002, in all centres, Chinese women formed the biggest number accessing the SMP. In Kelantan, Malays made up 37% of in the SMP.
 

By Age

The majority of the women (54%) were either 50 years or less in age. The age range was from 33 to 81 years old! The majority of the women were in the target age group i.e. 49.1% from the 41-50 years age group. The 51-60 years age group made up 36% of the participants.
 

How many had their First Mammogram during the programme?

In 2001, one mammography provider in the Klang Valley had data showing that 80% of the women in this subsidy programme was going through their mammogram for the FIRST time! Some were doing it for the second time, but the first mammogram was almost a decade ago!

In 2002, out of the 1872 women in the SMP, 69.1% were having their mammograms for the first time.
 

>>> More facts and figures

Check out the National Cancer Registry's 2002 Report

This report will give you some insight as to the cancer statistics in Malaysia will shape the government's future health policies. Please click here!