Accessible Breast Cancer Screening in the Pacific

iBreast study

Overview

This completed pre-pilot study evaluated the iBreastExam (iBE) — a hand-held point-of-care electronic palpation device — as an early breast-cancer detection tool for women of Pacific Islander ancestry. Researchers also assessed community acceptance of the technology through participant interviews.

Background

Late-stage breast cancer rates in Pacific regions with limited mammography access are notably high: Marshall Islands 61 %, Palau 94 %, Samoa 79 %. The iBE device reports a sensitivity of 86 % and represents a potentially accessible alternative screening method for lower-resource settings.

Objective

To assess breast-cancer detection using the iBE device combined with Clinical Breast Exam (CBE), with the hypothesis that this combination would identify invasive lesions sooner than CBE alone without higher biopsy rates than screening mammography.

Specific aims

Characterize iBE elasticity using tissue-like phantoms to understand detectability of malignant lesions by diameter, depth, breast density, and thickness
Investigate iBE sensitivity and specificity versus mammography, and test-retest precision
Assess acceptability by age, race/ethnicity, mammography history, and breast-cancer knowledge among women with Chamoru, Filipino, Native Hawaiian, and other Pacific Island ancestry

Methods

Study recruited 39 women (ages 42–73) in Guam: 19 with mammograms requiring biopsy (BI-RADS category 4+) and 20 with negative screening mammograms. Participants received iBE exams and completed 26-item breast-health questionnaires. Performance was tested using gelatin breast phantoms.

Results

Sensitivity: 20 % (2 true positives, 8 false negatives)
Specificity: 92 % (24 false positives, 278 true negatives)
Cohen’s κ: 0.068 (poor agreement)
Phantom testing: iBE detected tumors ≤ 2.5 cm deep only if lesion > 8 mm diameter
Community acceptance: 67 % reported high trust in iBE as an early-detection device

Conclusions

The iBE had generally poor sensitivity and specificity when tested in a clinical setting, which does not allow its use as a screening tool.

The study demonstrates the need for alternative screening methods in lower-middle-income areas.

Research team

John Shepherd, PhD — Co-Principal Investigator, UH Cancer Center
Gertraud Maskarinec, MD, PhD — Co-Investigator, UH Cancer Center
Kevin Cassel, DrPH — Co-Investigator, UH Cancer Center
Teofila Cruz, PhD, RN — Co-Principal Investigator, University of Guam
Roy Salvador Adonay, MS — Co-Investigator; COO/Administrator, Guam Radiology Consultants

Locations

Guam

University of Guam, UOG Station, Mangilao, Guam 96913
Guam Radiology Consultants, 633 Gov. Carlos Camacho Rd., Tamuning, Guam 96913 — (671) 649-1001

Hawaiʻi

University of Hawaiʻi Cancer Center, 701 Ilalo Street, Honolulu, HI 96813

Funding

National Cancer Institute U54CA143727-09 · 09/01/2018 – 08/31/2020. University of Guam / University of Hawaiʻi Cancer Center Partnership under Dr. Neal Palafox. Part of the Partnerships to Advance Cancer Health Equity (PACHE) program — the only PACHE serving Pacific Islanders, particularly Micronesians, addressing cancer health disparities through research, training, and community outreach since 2003.

Published work

Valdez D, Cruz T, Rania S, Badowski G, Cassel K, Wolfgruber T, et al. Low clinical efficacy, but good acceptability of a point-of-care electronic palpation device for breast-cancer screening for a lower middle-income environment. Med Phys. 2022 Feb 1. DOI: 10.1002/mp.15499