On July 13, an 18-wheeler will leave Maryland, bound for the Navajo Indian Reservation in Arizona. On board will be an astonishing array of the latest in digital breast mammography equipment and sophisticated satellite systems for relaying the mammography images back to expert radiologists at the U.S. Army's Walter Reed Medical Center in Maryland and to Johns Hopkins in Baltimore.

It's all part of a high-tech initiative to demonstrate that state-of-the-art mammography screening and diagnosis can be made available to women in traditionally underserved regions and to determine the feasibility of extending the service to other underserved populations.

Conceived by Johns Hopkins, with support from the Walter Reed Army Medical Center, the Army Medical Research and Material Command and the Indian Health Service, the initial phase of the project was funded with a $250,000 grant from the Susan Komen Foundation. The initiative will bring real-time digital mammography to Navajo women along with training in breast self-examination and follow-up counseling.

Unlike conventional X-ray mammography, which requires films to be processed and printed, digital mammography produces visual results that can be viewed by technologists at the mobile center and relayed immediately via satellite to experts at Walter Reed and Hopkins. Based on the expert readings, the women can be informed if they need additional tests or procedures, such as diagnostic mammography or breast biopsies, while they are still at the center, helping ensure they receive prompt, effective follow-up care. Another advantage of digital mammography is that it can reduce patient call-backs, an important consideration in remote or underserved areas. Call-backs occur when patients must return for imaging because of uncertainty over findings. With digital technology, doctors can enhance the digital image in a variety of ways with a computer, obtaining multiple views from a fewer number of images. As an added plus, digital mammography uses less radiation than conventional mammography.

The Mobile Breast Care Center was dedicated on Friday at the university's Applied Physics Laboratory, where it has been undergoing tests. Attending the dedication were representatives from the School of Medicine, the Navajo Nation, the U.S. Army Medical Department, General Electric, the U.S. Department of Health and Human Services' Office of Women's Health, the Food and Drug Administration and the Indian Health Service.

The mobile unit housing the mammography equipment stretches to 80 feet long and 40 feet wide when in operation but retracts to a more manageable length of 53 feet and a width of 8.5 feet when on the road. Within the van, sophisticated computer equipment and interfaces to a satellite telecommunications link provide high-speed transmission of images for interpretation within minutes. The GE mammography system, recently approved by the FDA, digitizes X-ray mammography images and displays them on a workstation for local viewing to assure image quality. Image acquisition to display takes only seconds. Digitized images are then sent via satellite to experts at Walter Reed for interpretation and to Hopkins for quality assurance.

Breast cancer will affect one in eight women during their lifetimes and is the second leading cause of cancer death in women. Mammography cancer screening is one of the most important tools for detecting breast cancers early, when they are most responsive to treatment. The Mobile Breast Care Center is especially important for Native American women, who often have limited access to breast cancer screening compared with many other women. An Oct. 13, 2000, NIH study reports that 4.9 percent of Native American women undergoing their first mammography screening for breast cancer are found to have suspicious findings in their breast.

"This project takes us to the patient, so that we can detect problems and treat them early on, when treatment is most effective," says Joseph Gitlin, associate professor of radiology at Hopkins, who spearheaded the design of the mobile digital telemammography project. "It also is designed to be a model for reaching other underserved groups of women. Once we prove the effectiveness of this approach to providing mammography services, we envision developing similar mobile units to reach women in other remote areas as well as women in urban settings who have limited access to breast cancer screening.

"The key to success is the immediacy of reporting the results of the examinations to the patients," says Lillie Shockney, director of Hopkins' Breast Cancer Outreach Program. "Immediate reports allow a woman to get counseling from experts who are there with her and to ask questions about getting treatment. This is especially important for many of these women, because they often don't have telephones and primary care physicians and tend to move frequently. The chances of a patient getting the appropriate care are greatly increased if she receives a report and counseling before she leaves the Mobile Breast Care Center."