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Telemedicine improves breast screenings for rural reservations

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ANN ARBOR, Mich. – American Indian women who live in North Dakota and South Dakota are coming to the University of Michigan Comprehensive Cancer Center for their mammograms without ever leaving the reservation.

UM radiologists sought to improve delivery of traditional mobile mammography, in which a large truck equipped with mammography machines travels to various sites. Using digital mammography instead of films and adding satellite capability, they found the digital mammograms could be beamed to radiologists who could read them in Ann Arbor.

“Mobile mammography is a critical way for Native American women to get a mammogram. But what happens when a woman needs to be called back for more images? By transmitting the mammograms by satellite, a radiologist could read them on the spot; and three-quarters of the women who needed more images had those done immediately or within fewer than three days,” said Dr. Marilyn Roubidoux, Sioux Iowa and professor of radiology at the UM Medical School.

Roubidoux will present the results of this pilot program at the annual meeting of the Radiological Society of North America.

From March to July, a mobile mammography unit owned by the IHS visited seven American Indian reservations in North Dakota and South Dakota and performed 515 digital mammograms. The digital images were then transmitted via satellite to radiologists in the Breast Imaging Division of the UM Radiology Department. The average time between sending the films and obtaining a report for these women was 50 minutes. In ideal technological and weather conditions, it was as quick as 30 minutes.

Of the 58 women who needed additional images, 72 percent were able to get those tests done immediately, or returned within three days for more imaging.

Radiologists found the mammogram images transmitted via satellite were of excellent quality, on par with the digital mammograms they read daily in the UM Breast Imaging Clinic.

Only about 10 percent of American Indian women over age 40 get a yearly mammogram. In many cases, women live on rural reservations where they must drive as far as 100 miles to have a mammogram. After the test, it can take up to a week before a woman receives the results. If additional tests are needed, it is often difficult to arrange for that follow-up.

“What I used to have to do is drive about 90 to 100 miles to get a mammogram done,” said one Native woman who participated in the mobile mammography. “It was real convenient to have that unit come directly to our hometown. There are a lot of women in our town who need to have the mammograms done that usually don’t come.”

The IHS plans to implement this service again in 2007, with collaboration from the UM Breast Imaging Division. Roubidoux is a member of “the Spirit of Eagles,” a leadership network to promote cancer control research among American Indians.

In addition to Roubidoux, UM study authors were Drs. Mark Helvie, Caroline Blane, Steven Haugen, Kate Klein, Chintana Paramagul, Alexis Nees, Janet Bailey and Annette Joe. Additional authors were Dr. Edgardo Gimenez, of the Mayo Clinic; and from the Aberdeen Area HIS, Tina Russell, Wileen Druley, Dr. Jackie Quisno, Tony Stayner, Maggie Oyler, Ray Stands and Dr. Sarah Dye.