For women in the developed world, mammography is a familiar ritual. The test is a routine way to screen for breast cancer. Once a woman reaches her 40s (or earlier, in women with risk factors for cancer) a mammogram is recommended every one to two years.
But for most women in the impoverished East African country of Uganda, getting a mammogram is next to impossible. Little advanced medical care is available there, and many women don’t know about the test and wouldn’t have access to it if they did. As a result, breast cancer in Ugandan women usually goes undetected until it is in advanced stages.
But with a 35-foot van refitted by School of Medicine faculty members with the help of Johnson & Johnson, Fred Okuku, M.D., an internal medicine resident at Makerere University in Uganda’s capital city of Kampala, is bringing breast cancer screening to his home country. Okuku visited Yale this year because “I want to know what is the ideal therapy given here, and how I can modify this to fit [our resources] back home,” he says. At his Ugandan teaching hospital, Mulago Hospital, even necessities like gloves and IV fluids are in short supply. Amidst such poverty small things can make an enormous difference, says Okuku. That’s the idea behind the new mammography van initiative, which will introduce the first such equipment to the African continent.
The effort got off the ground when oncologist Kenneth D. Miller, M.D., assistant professor of medicine, learned that Yale-New Haven Hospital was selling one of its old mammography vans. The buyer, who was offering $1,000, planned to strip it and use it as an RV.
“A little light bulb lit up,” Miller says. “[I thought,] ‘Wait a minute, don’t do that—that’s a perfectly good mammography van.’” He upped the bid and won the van, with the Uganda Cancer Institute at Mulago Hospital in mind. Under the auspices of the School of Medicine’s Health Overseas Partnerships in Health and Education (HOPE) program, which is supported by Johnson & Johnson, the School of Medicine has long had a close relationship with Mulago, and Miller had recently returned from a scholarly exchange trip there. Okuku, whom Miller met while in Uganda, had already arranged to come to Yale, with the help of Professor of Medicine Michele Barry, M.D., and Associate Professor of Medicine Majid Sadigh, M.D., co-directors of the HOPE program.
Before it could go to Uganda, though, the van needed some renovations—like relocating the mammography machine’s generator from the undercarriage, where it would have been unlikely to survive Uganda’s bad roads. Bruce L. McClennan, M.D., professor of diagnostic radiology, helped procure an ultrasound machine for the van to supplement the X-ray equipment. Then the van was repainted with vivid graphics. The Yale/Johnson & Johnson program reimbursed Miller for his purchase of the van and funded the renovations, and Barry says that plans are afoot for expanded interactions between the medical school and Mulago to promote cancer screening and education.
Okuku spent six months at the School of Medicine. Instead of just observing the work of attending physicians during clinical rotations, he learned take-home skills. A former X-ray technician, he was already at ease performing mammograms, but Liane E. Philpotts, M.D., associate professor of diagnostic radiology, taught him to interpret mammograms as well as ultrasound images.
After embarking on a seven-week transatlantic journey from a dock in Lake Charles, La., the van will anchor a pilot program in the suburbs of Kampala. Public service announcements will urge women to come to the van for a free screening. Brochures distributed from the van will educate the population about early signs of cancer, emphasizing that many cancers can be treated. “We’ll use this to sensitize people about cancer,” says Okuku, who plans to become an oncologist and practice in Uganda, becoming only the third such specialist in the landlocked nation of 31 million.
Mammography films from the van will be interpreted at Mulago Hospital. Women with suspicious lesions will be urged to come to Mulago at their own expense for further testing and treatment.
Prevention and early detection is crucial in countries like Uganda, where there are few health care resources or physicians, says Okuku. It is much less expensive to remove a breast lump than to do a mastectomy with chemotherapy. According to Okuku, Mulago Hospital’s statistics show that 95 percent of Ugandan women with breast cancer have Stage IV disease when they’re diagnosed, because they tend to wait an average of two years after noticing a lump before they seek treatment.
With the help of the van, Okuku hopes those statistics will change. “If we can prevent the cancer,” he says, “that is the way to go.”