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Telemedicine Promises Greater Access for Breast Cancer Screening & Treatment

Susman, Ed

doi: 10.1097/01.COT.0000294400.71418.66

New studies into advances in telemedicine techniques show promise for increasing access to mammography screening for women and for assembling a treatment team, even when the patients or the doctors are far away.

For example, at last year's Radiological Society of North America Annual Meeting, Alan Melton, MD, Assistant Clinical Professor of Radiology at New York Presbyterian Hospital-Columbia University Medical Center, demonstrated that standard Internet connections permitted high-grade transmission of digital mammography to a remote location where a dedicated specialist in breast radiology could read those images.

And at the San Antonio Breast Cancer Symposium about a week later, Ian Kunkler, MB, a consultant oncologist at Western General Hospital in Edinburgh, Scotland, showed that a breast cancer team from three different institutions could arrange satisfactory telemedicine meetings to discuss the management of patients.

“We decided to evaluate whether we could transmit rapidly and accurately full-field digital mammography in which each scan included more than 95 megabytes of information,” Dr. Melton explained.

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110 Miles Away

The report he presented included the first 1,300 of those transmissions from two centers in the metropolitan New York City area to his mammography-reviewing workstation 110 miles away in Avon, CT. Simultaneously, another set of scans was being archived at other locations to be available to reviewers.

A total of 8,400 transmissions had been accomplished at that time, and only once did a scan have to be re-sent due to dropped information—easily seen by a horizontal line across the scan, Dr. Melton said.

“This system is beneficial on several levels. It gives the mammography reader a steady flow of work in a manner where he can dedicate certain time to review the films.”

Once a mammography reviewer settles into his workstation, a specialist can review hundreds of scans in a matter of hours.

“I think that this system will also help stem the tide of mammography specialists who are either leaving the field. It may encourage others to decide to enter it because it will simplify their workload,” he said.

“Most importantly, digital mammography telemedicine will reduce the waiting time for women who want to receive a mammography screening test.”

At his institution, Dr. Melton said the waiting time for a screening mammogram has been reduced from six months to three months since remote digital mammography screening has been in operation. The study represented work performed from February 2005 to mid-April 2005.

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Potential to Reduce Recalls

He said that by improved efficiency and backlogs of scans, the telemedicine system has the potential to improve accuracy and reduce the dreaded “recalls” in which women are asked to undergo another test, which may later prove to have been unnecessary, because of something suspicious.

Dr. Melton said that when the system is fully operational, and a mammography reader does find a suspicious lesion, the diagnostic workup and biopsy would be performed at the referring institution. He said that diagnostic mammography is not amenable to telemedicine because a radiologist performing those studies will need access to the patient to scan the lesion from different angles.

He said that what makes the development of tele-mammography exciting is that all the devices needed to set up the workstation system can be purchased off-the-shelf—there is no new technology required, but just the establishment of the system with necessary privacy safeguards.

Dr. Melton suggested that telemedicine could find its way to underserved areas or for use by mobile mammography units if they can make broadband Internet connections. Satellite technology, though, he noted, is not accurate enough to do the job of transmitting every critical pixel.

Data by Ian Kunkler, MB, showed that a breast cancer team from three different institutions could arrange satisfactory telemedicine meetings to discuss the management of patients.

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Controversy Because of Detail Needed

An expert who was not connected with the study, Mary Mahoney, MD, Associate Professor of Radiology and Director of Breast Imaging at the University of Cincinnati, commented that there is a lot of controversy about whether tele-mammography can be performed due to the detail of the transmission required.

“Tele-radiology has been around for several years, but the difference between being able to detect a broken bone on a transmitted scan and a breast cancer lesion is immense,” she explained.

Dr. Mahoney predicted that the system was ready for widespread use and she acknowledged that it might resolve delays in access to mammography screening.

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Treatment-Planning Teleconferencing

Dr. Kunkler and his colleagues tested whether doctors sitting in offices in different parts of the country could meet through teleconferencing and adequately discuss and plan treatment for their breast cancer patients.

The study involved two groups of clinicians from offices in Fife and Dumfries, one of which was connected to the Edinburgh office through teleconferencing equipment and the other group met as they normally would in a standard face-to-face meeting.

“We conducted a series of interviews and asked the clinicians to fill out several questionnaires—one before the trial, several during the trial, and another after completing the trial,” Dr. Kunkler said at his poster presentation.

In the study, health care teams at the Edinburgh Breast Unit, in Dumfries, and in Fife constituted the multidisciplinary breast team and were paired with patients with histologically confirmed breast cancer or recurrent breast cancer.

That breast team and patient cohort were divided into a standard treatment team that met face-to-face and an interventional team that met vie teleconferencing. The primary endpoint was the satisfaction of the cancer professionals with the decision process—that is, the consensus on management of the patient and the confidence in the decision making.

More than 90% of the doctors in both the standard and the telemedicine groups either strongly agreed or agreed with the consensus of the team; similarly more than 90% of the doctors in both the standard or telemedicine groups either strongly agreed or agreed that they were confident of their decision.

“The clinical effectiveness of telemedicine as a mode of delivery of multidisciplinary breast cancer meetings is high and similar to standard ‘face-to-face’ meetings,” Dr. Kunkler concluded.

“Telemedicine provides a tool to facilitate regional multicenter multidisciplinary team meetings of cancer professionals for decisions on patient management.”

© 2006 Lippincott Williams & Wilkins, Inc.
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