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

Sep 29, 2026

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Breast cancer incidence and mortality in Uganda are rising, prompting the Improving Breast Cancer Care Coordination (IBCCC) program to bring screening and diagnostic services to hard-to-reach communities, including immediate on-site mammography readings. Agreement between BI-RADS assessments on-site and in a standard off-site radiology unit was unknown. This cross-sectional study described mammographic findings and quantified BI-RADS concordance for women attending early detection outreach in Northern Uganda. Mammography images were read by program and study radiologists, and concordance was evaluated using Kappa statistics. Results showed moderate agreement overall.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

Background

Global and regional context

Prevention and early detection rationale

Kitongo etal. BMC Cancer (2026) 26:15 BMC Cancer [https://doi.org/10.1186/s12885-025-15378-0](https://doi.org/10.1186/s12885-025-15378-0) RESEARCH Open Access Mammographic findings and BI-RADS concordance in women attending a community outreach program in Uganda Eric Kitongo 1*, Enock Suubi Segawa2, Nayiga Joyce 1, Nabbosa Valeria3, Bugeza Samuel 1 and Kibudde Solomon3 Abstract Background 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. Methods 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. Results 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) . Conclusion 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 offsite readings. *Correspondence: Eric Kitongo [kitongoeric@gmail.com](kitongoeric@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of

FAQs

What was the purpose of the IBCCC program in this study?

It aimed to bring breast cancer screening and diagnostic services closer to women in hard-to-reach communities across Uganda, including providing immediate on-site mammography readings.

How were on-site and off-site BI-RADS readings compared?

Mammography images were read by radiologists on-site through the program and also read again by study radiologists, and BI-RADS concordance was assessed using unweighted, linear weighted, and quadratic weighted Kappa statistics.

What level of BI-RADS agreement was found between on-site and off-site readings?

The quadratic weighted BI-RADS concordance was 0.58 with a 95% confidence interval of 0.44–0.71, indicating moderate agreement.

Sep 29, 2026

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