The Makawalu Study
Breast Cancer Screening in the Pacific using Portable Ultrasound
Advanced-stage breast cancer (stages III and IV) occurs at significantly higher rates in the Pacific compared to the US mainland, particularly in areas lacking mammography services. Hawaiʻi and Guam — despite having insurance coverage and mammography access similar to the mainland — experience much higher advanced-stage rates: 60 % in Guam and 15 % in Hawaiʻi versus 10 % in Northern California. Within Hawaiʻi, advanced staging varies considerably by race/ethnicity, ranging from 17 % among Hawaiian women to 10 % among Japanese women.
Objective & aims
The study’s overarching hypothesis is that introducing portable handheld ultrasound systems paired with AI detection algorithms, operated by trained healthcare workers, can reduce advanced-stage cancer rates in areas without mammography access.
“Our overall objective is to reduce the mortality of breast cancer in the Pacific by reducing the advanced breast-cancer stage rate.”
The portable-ultrasound approach would offer low-cost implementation and potential extension to point-of-care biopsies.
The specific aim focuses on identifying cofactors — including breast density, ethnicity, and BMI — that impact detection sensitivity and specificity across three reader types: radiologists, non-radiologist doctors, and graduate research assistants (representing healthcare workers).
Research team
- Jami Fukui — Principal Investigator, UH Cancer Center
- Dustin Valdez — Graduate Student Assistant, UH Mānoa / UHCC
- John Shepherd, PhD — Co-Principal Investigator / Mentor, UH Cancer Center
- Thomas Wolfgruber — IT Support, UH Cancer Center
Funding
UH Cancer Center Seed Grant · 01/01/2021 – 12/31/2021. Funded through the UH Cancer Center’s P30 support grant from the National Cancer Institute.