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For other articles and previous issues click here. June 21, 2004 Mammo to Go Convenience isn’t just a factor at mealtime. Mobile mammography increases access and convenience—improving the fortunes of many women. If you can’t bring women to the technology, bring the technology to women. It’s a lifesaving concept that’s crisscrossing the country and taking screening technology where it’s needed most: where people live and work. Despite a frequent lack of profitability, hospitals, imaging centers, and a host of community programs across the country are increasingly putting mammography units on wheels and even in planes. These programs offer screening mammography to women who otherwise would not have access to it or make it more convenient for women to be tested. In either case, such mobile programs increase the chance of detecting breast cancer in the earliest stages when it is most treatable. One in eight women in the United States will develop breast cancer. It’s the most common form of cancer among American women and the leading cause of death in women between the ages of 40 and 55. In 2002, more than 211,000 women were diagnosed with breast cancer in the United States; 40,000 of these women died from the disease. According to the Centers for Disease Control and Prevention (CDC), 16% of all breast cancer deaths could be prevented if women aged 40 and older had timely mammography screening. However, says the agency, “3.5 million women between the ages of 40 and 64 are uninsured, have limited income, and are less likely to be screened. These women are more likely to have their cancers diagnosed at a later stage and therefore have a higher risk of dying from the disease.” Research clearly shows that mammography saves lives, and the federal government endorses annual or biannual mammography for women aged 40 and older. Nevertheless, many American women don’t receive mammograms for reasons ranging from lack of insurance, low income, fear of the results, and lack of transportation to the unavailability of nearby screening facilities. Mobile Units Mobile Health Outreach has been doing mobile mammography on a not-for-profit basis for 12 years. The Charlotte, N.C., company relies on two Planmed mobile units: one Sophie Classic and a Sophie Classic outfitted with the new MaxView system, which increases the amount of breast tissue brought into the field of vision. Planmed, says Mobile Health’s Executive Director Sheila Moran, makes a beautiful mobile unit that looks like a little R2D2. “It’s perfect for us because as we’re traveling down the road, the equipment stays safe in a tucked-up, folded-up position,” she says. Moreover, Moran explains, it’s smaller than a traditional x-ray machine, which gives technologists more room in their cramped rolling quarters. “The vehicles can only be 8 feet wide to travel down the road, so the size of the Sophie works well. It’s a tough machine, built for travel. It handles all the bumps and curves.” The second unit is equipped with Planmed’s MaxView, an innovation developers think can make a significant difference in detecting more cancers. While compressing the breast, the MaxView system rolls forward two thin sheets of clear plastic to pull the breast tissue a bit further. When trying it for her own study, Moran braced herself for discomfort but was happily surprised. “It sounds very painful, but I couldn’t tell the difference,” she says. “I just knew that it got more tissue, and that’s the idea—to catch those potentially missed breast cancers against the chest wall.” Mobile mammography is an expensive endeavor. The mobile x-ray units alone cost more than $80,000. And that, says Moran, is just the beginning. “The processor is another $15,000, the film cassettes cost almost $5,000, and the vans can range from $200,000 to $300,000, depending upon the degree of luxury.” Staffed by mammography technologists, often along with nurses or administrative aides, the mobile mammography vans can travel to wherever women live or work. Major cancer centers, university and community hospitals, and freestanding imaging centers run screening programs. Mobile units may be for-profit businesses or not-for-profit community-based services. They bring mammography to the corporate workplace, community centers, churches, prisons, and mental health facilities—making it available to diverse populations of women. Mammography vans are as likely to bring x-ray services to corporate executives as they are to prison inmates, homeless people, homebound senior citizens, those with disabilities, rural populations, and Native Americans on reservations. Reaching More Women In contrast, Mobile Health Outreach notes that 70% of its efforts target women in the corporate workforce. “There are many manufacturers, as well as administrative offices, in North Carolina,” Moran says, “so our mobile unit is available around the clock for first-, second-, and third-shift women seven days a week.” The remainder of its services are rendered in community sites such as shopping centers, churches, schools, and community centers. Through a partnership with the Charlotte affiliate of the Susan G. Komen Breast Cancer Foundation, it’s able to provide reduced rate or free mammograms for women without insurance. Geographic Challenges On any given day, the team of mammography technologists Lisa Claiborne and Tracy Chiefer, two of six staffers, may begin their day at dawn at a company like Townsend Poultry in Siler City, N.C. They’ll roll in, set up, and catch the third-shift workers before they go home and then screen the workers from the first and second shifts. They’ll see everyone from production workers to administrative office staff and executives. On another weekday, the team might visit the Charlotte Corporate Offices at the Government Center. On Sunday, it might roll up to Our Lady of Guadalupe, a Catholic church in Charlotte that offers seven masses every Sunday. North Carolina’s rural population demonstrates the clear need for mobile services. Moran says Charlotte is one of the largest cities in North Carolina with 17 registered x-ray facilities in Mecklenburg County, but you can drive east to the next county—Union County—and find only one registered x-ray machine, despite the presence of 23,000 women eligible for mammography. Approximately 15 of the state’s 100 counties have no mammography equipment at all, she says, “so being mobile gives us the ability to even the playing field.” Serving this area has taken a toll on the program’s first mammography van, which has logged more than 400,000 miles, averaging more than 4,000 patient visits each year. Maintenance problems forced Mobile Health to scale back its operations temporarily, but a new unit will get the technologists back on the road bringing screening to the state’s rural women. Sometimes access to screening is hampered by difficult terrain and weather. The mobile mammography program at Alice Hyde Medical Center in Malone, N.Y., serves a population of older residents that straddles the Canadian border. Says Shannon Legacy, RT, interim manager of the medical imaging department, “We have some very rough winters, and the mobile program allows people to stay closer to their homes.” Geography isn’t the only impediment to access,
says Moran. “Sometimes there’s a challenge getting women
to participate, which has a lot to do with fear of what a mammogram
could find.” This, she says, can be tackled through education.
In many rural areas, she says, churches have enormous influence
over residents. Working with the churches to educate communities
helps mobile teams overcome that barrier to screening. According to Moran, there are two reasons women don’t get mammography. “No. 1 is affordability and No. 2 is access. If you eliminate both those barriers, then they don’t have an excuse. We give them access, and if they don’t have the money to cover it, grant money tackles the affordability issue.” Research supports her view, indicating that since its inception, mobile mammography has demonstrated clear benefits. According to the Agency for Healthcare Research and Quality, which has been studying the practice for two decades, mobile mammography has boosted screening rates by 15% among low-income older adults of all races and by as much as one-half among some minority populations. Overcoming Obstacles A study published in the Journal of Health Care for the Poor and Underserved in May 2002 found that mobile mammography can increase access to screening in church-based settings. According to the researchers, “Among 1,117 women ages 50 to 80 from 45 Los Angeles County churches, 31.7% said they would definitely use a mobile van at church, 21.9% would probably use one, 28.7% would probably not use one, and 17.6% would definitely not use one. The odds of saying yes to mobile mammography were six times higher for Spanish-speaking Latinas than for whites, over two times higher for English-speaking nonwhites than for whites, five times higher for the uninsured than those with public or private health insurance, and three times higher for women who reported no mammogram in the previous 24 months than for women who had reported a mammogram.” The CDC is so convinced of the effectiveness of mobile screening that last year it provided funding for eight community organizations to implement mobile mammography screening programs to research underserved women. The Susan G. Komen Breast Cancer Foundation and the Avon Foundation are also major supporters of mobile mammography. Technologist Demands Moran is quick to point out that mobile mammography technologists require special qualities. “There is no lead interpreting radiologist down the hall for them to share their films with. They have to be highly competent, confident, and independent. [Films from the screening side are read by a radiology group under contract with Mobile Health Outreach.] They like the independence,” she says, “and they like the idea of reaching out to their patients rather than sitting back waiting for their patients to come to them.” Chris Oldham, director of North American Sales, Planmed, agrees. He says they must be resourceful to meet the challenges that come up along the way, including weather problems, van breakdowns, and technical difficulties, and they must be able to meet the job’s physical demands, which include carting heavy and unwieldy equipment. There’s a misperception, says Moran, that a mobile mammography unit is somehow an ersatz screening tool—an inferior approach demanding less skilled practitioners. “Some people envision mobile and think hot dog cart—it’s not. People think it’s ‘just’ a mobile facility,” says Moran. But there’s nothing inferior about it, she insists, nor are the demands upon the staff any less rigorous. On the contrary. “We have to meet the same guidelines—in fact, we have to work harder than most hospitals and fixed facilities to meet the same guidelines.” These challenges, she observes, are not lost on technicians, who often prize the opportunity to work on mobile units. She advises anyone interested in reaching out to bring screening to more women to explore the possibility by riding along with a mobile unit for one day. They, too, may want to take it to the streets. — Kate Jackson is a staff writer for Radiology Today. |
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