The ACR Education Center takes its breast imaging workshop to Saudi Arabia as part of its efforts to improve global health.
Breast cancer kills more than 500,000 women worldwide annually. In countries with few resources and limited screening programs, women with breast cancer are often diagnosed in advanced stages of the disease and have low chances of survival.
As part of its efforts to encourage better breast health around the globe, the ACR Education Center recently hosted its Breast Imaging Boot Camp halfway around the world, in the Kingdom of Saudi Arabia.
ACR took its boot camp to Jeddah, Saudi Arabia, through a partnership with GE Healthcare and King Faisal Specialist Hospital and Research Center. The course, held May 23-25, provided 40 practicing radiologists from Saudi Arabia and Kuwait with the same case-based training offered at the Education Center, along with a component on whole breast ultrasound. Michael N. Linver, MD, FACR, director of mammography at X-Ray Associates of New Mexico and course co-director of the Breast Imaging Boot Camp, and Jocelyn A. Rapelyea, MD, assistant director of breast imaging and associate professor of radiology at The George Washington University Medical Center in Washington, D.C., led the course.
The Education Center has offered its Breast Imaging Boot Camp with sellout attendance for six years, but this is the first time it has delivered the workshop outside of the United States. Vinay Sandhir, senior director of the center, says hosting the boot camp — a combination of lectures and simulated learning experiences — in the Middle East reinforces radiology's integral role in advancing global health. "The course dovetailed really well with some of the initiatives going on in Saudi Arabia to improve women's health, particularly in screening mammography," he says.
Behind lung cancer, breast cancer is the second most deadly cancer in Saudi Arabia. One driver of this statistic is cultural. Most Saudi women forego breast cancer screening, when the disease can be detected early, and delay care even when signs of the disease are present. By the time the majority of Saudi women with breast cancer are diagnosed, they are already in the late stages of the disease. "In the United States, the mean size of the tumors we find through breast cancer screening is about 1.3 cm, and even when a patient has a lump, the mean size is about 2.1 cm," explains Linver. "In Saudi Arabia, the average tumor size is much larger, because women just aren't going in early enough."
Breast cancer screening in Saudi Arabia is free — like all health care — but social stigma and other challenges inhibit most women there from having the exams. A 2013 survey to inform national breast cancer health programs revealed that 92 percent of the 1,135 Saudi women aged 50 and older who responded had never had a mammogram. "There are major cultural differences in Saudi Arabia that interfere with the ability of women to come in for screening mammography," Linver notes. "But breast cancer is becoming a higher priority, so hopefully they will embrace screening."
The United States has seen a 34 percent decrease in breast cancer deaths since 1990 as a result of improved treatment and early detection. Some European countries with sophisticated breast cancer screening programs have seen an even larger reduction in breast cancer deaths, Linver says. "Screening mammography is highly regarded as the number one way to diagnose early breast cancer," he notes. "We know the potential of these tools and have an obligation to offer this to the rest of the world and to try to promote it."
Despite the challenges surrounding breast screening and women's issues in Saudi Arabia, 30 of the 40 radiologists who participated in the Breast Imaging Boot Camp were women and all participants were highly skilled in breast imaging — which surprised Linver. "Breast imaging is not a high priority in the Middle East for a whole bunch of reasons, so I didn't expect the radiologists there to be so knowledgeable about it," he says. "It turns out some programs developing in the Middle East focus on screening mammography and diagnostic mammography, and these particular individuals are involved in a lot of these projects."
Fatina M. Al Tahan, MD, senior consultant radiologist, breast imaging and screening specialist, and director of the National Breast Cancer Early Detection Program with the Saudi Arabia's Noncommunicable Disease Ministry of Health, helped organize the boot camp in Saudi Arabia. "This type of training is an important strategy in our program to build a skilled team of breast imagers," Al Tahan says, adding that the course was well organized and beneficial, especially for junior breast imagers. "We want to hold the course in different cities to make it accessible to all radiologists from different regions in the country."
While the ACR Education Center has no immediate plans to return to Saudi Arabia, Linver envisions similar programs in the future. "Radiologists are much more interested now than they ever have been in reaching out to the rest of the world," he says. "The ACR is interested in promoting these kinds of global exchanges and becoming more involved in world health. We certainly have our own issues here to resolve, but we have the resources and interest in providing radiology education to the rest of the world."
By Jenny Jones, Imaging 3.0® content specialist