Detecting Early Breast Cancer Using Diagnostic Breast Ultrasound in Rural Areas: A Novel Approach to Empowering Women Through Better Access to Health Care

The Imaging the World (ITW) approach is to train front line health workers with limited knowledge of anatomy or pathology to generate ultrasound images using a volume-based technique, based on surface anatomic landmarks. These images are captured as cine clips and sent via the local cellular network to the internet to be accessed for remote expert interpretation. Findings and recommendations are sent back to the rural clinics as text messages or emails. This model, incorporating low-cost and low-power ultrasound machines, has been successfully developed and tested for obstetric ultrasound imaging in rural Uganda, with implementation at 11 different healthcare facilities. In October 2011, ITW conducted a feasibility study to investigate adding a diagnostic breast ultrasound protocol at these 11 sites. This successful pilot study validated the ability of mid-level health care providers at rural health units to perform high quality breast diagnostic ultrasound images, and demonstrated the ability of district hospital physicians to perform ultrasound-guided breast procedures. The pilot project confirmed that collaboration with local and national providers (surgeons, radiologists, pathologists, and oncologists) can create an appropriate diagnostic and treatment algorithm. The effectiveness of this new protocol and algorithm will be evaluated by ongoing analysis of the number and quality of breast ultrasounds performed, the number and concordance of ultrasound-guided biopsies performed, and by qualitative analysis of community outreach and sensitization programs.