China chooses CR for breast screening

A planned population-based breast screening program in China looks likely to benefit vendors of computed radiography mammography solutions. Organizers of an ambitious project to screen one million Chinese women for breast disease are assessing available technologies with a view to increasing orders.

The incidence of breast cancer among China's 1.3 billion citizens is rising steadily. The World Health Organization predicts that 170,000 new cases will be diagnosed this year, resulting in a 155% rise in detected breast cancers in China between 2000 and 2005.

Little is known about the natural history of breast cancer in Chinese women. Observers have noted that the disease can occur earlier than in Western populations, with two distinct peaks around the ages of 35 and 55. Detailed data on breast cancer in Asian populations, however, are thin.

The Chinese Ministry of Health, together with the Chinese Anti-Cancer Association, is taking steps to plug the data gap and assessing the viability of screening its female population. The resulting "One Million Women" project is slated to run until 2010, with the goal of determining the impact of diagnostic breast exams for women over the age of 30.

Project planners envision that screening will be conducted at 160 separate sites, each seeing around 10,000 to 15,000 women. A total of 110 dedicated units will be set up in existing hospitals, while another 50 vans will be kitted out as mobile screening units. Digitized images will be sent to a centralized reporting center in Beijing, where the project's administrative and educational activities will also be managed.

The complete equipment inventory has still to be confirmed, though details of major suppliers are starting to emerge. Finnish mammography equipment manufacturer Planmed Oy has been contracted to supply 100 to 130 mammography units and several stereotactic biopsy devices. Agfa and Kodak are both providing mammography-enabled CR systems and dry printers, with each anticipating a sizable share of the final order. Kodak is also expecting to provide its MIN R-EV system to any sites that insist on screen-film mammography.

Planmed's participation in the Chinese screening project has given the company its largest ever supply contract. The order is to be fulfilled over the next two years, said Timo Ihämaki, Planmed's export manager for the Asia-Pacific region.

"There was quite a fierce competition when this tender went out," Ihämaki, said. "What really turned things in Planmed's favor was that all our systems can be connected to CR readers, and all can be fitted with a stereotactic device."

The choice of CR provides the reliability and reproducibility of a digital solution, but with an acceptable price tag, according to Hermann Raats, general manager for Agfa Healthcare in China. While screen-film mammography provides the best image resolution, conditions for wet processing - especially in mobile vans - could compromise quality. Such uncertainties are eliminated with a digital solution, but purchasing DR technology for all 160 screening sites would be prohibitively expensive.

"If you compare the investment required for CR and DR, there is a huge difference," Raats said.

In addition to CR-based mammography, the women will receive breast ultrasound and a clinical examination by a trained radiologist, he said. Onsite biopsies will also be possible, if required.

Phased roll-out of the program has already started, though planners are prepared to take their time, given the relative novelty of breast screening in China. Organizers are focusing on the mobile screening units, which offer greater flexibility in reaching target populations. The dedicated vans also fulfill a core requirement of keeping screening exams separate from routine diagnostic work.

"Just as in the U.K. breast screening program, people have to go to a separate area rather than walking through a hospital radiology department," said Anne Richards, mammography clinical specialist with Kodak's Health Group. "This idea is very new to the Chinese radiological environment."

Kodak has equipped four vans with its CR systems and is working on another six. The company expects to have 20 to 30 systems installed by the end of 2005. Agfa expects eventually to supply a CR-based solution to more than half of the screening sites.

"In Asian countries, they like to give chances to different suppliers," Raats said. "We understand we will get the majority of orders, but whether that means 90% or 51% we don't know. All will be determined by the quality of work we deliver and the professionalism we show."

What is clear, however, is that vendors engaging in China's One Million Women breast screening program must be as committed to training and education as they are to securing sales. This may include organizing of medical workshops or assisting in public campaigns to highlight the relevance of healthcare screening, in addition to site-specific equipment training.

"Because mammography itself is relatively new in China, and especially screening, the project organizers recognize that there is a lot of work to be done in training and in raising awareness," Richards said. "Training and enrollment issues are very common when one starts a screening program."