Women’s Imaging in Global Health Radiology

  • Lisa A. Mullen
  • Susan C. Harvey
  • Erica B. PollackEmail author
  • Niranjan Khandelwal
  • Tulika Singh


This chapter discusses women’s imaging with a focus on early detection of breast cancer and osteoporosis screening. Key concepts include the epidemiology of breast cancer and osteoporosis in low- and middle-income countries, development of multidisciplinary breast and bone care programs, feasible healthcare guidelines in limited resource settings, and mobile imaging to improve access. These themes are discussed in the context of RAD-AID’s experience in providing breast cancer and osteoporosis screening services.


Osteoporosis screening Dual X-ray absorptiometry (DXA) Osteopenia Bone mineral density Osteoporotic fracture Breast cancer Screening Early detection Mobile screening 


  1. 1.
    Sloan FA, Gelband H, editors. Institute of Medicine (US) Committee on cancer control in low- and middle-income countries. Washington DC: National Academies Press; 2007.Google Scholar
  2. 2.
    Chia K-S, Reilly M, Tan C-S, Lee J, Pawitan Y, Adami H-O, et al. Profound changes in breast cancer incidence may reflect changes into a Westernized lifestyle: a comparative population-based study in Singapore and Sweden. Int J Cancer. 2005;113(2):302–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Porter P. “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med. 2008;358(3):213–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Vanderpuye V, Grover S, Hammad N, PoojaPrabhakar, Simonds H, Olopade F, et al. An update on the management of breast cancer in Africa. Infect Agent Cancer. 2017;12:13.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Kanis JA. WHO scientific group on the assessment of osteoporosis at the primary health care level. Brussels: WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School; 2008.Google Scholar
  8. 8.
    Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239–56.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Osteoporosis Fact Sheet [Internet]. [cited August 27, 2017]. Available from:
  10. 10.
    Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, et al. International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone. 2008;43(6):1115–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Malabanan AO, Rosen HN, Vokes TJ, Deal CL, Alele JD, Olenginski TP, et al. Indications of DXA in women younger than 65 yr and men younger than 70 yr: the 2013 official positions. J Clin Densitom. 2013;16(4):467–71.PubMedCrossRefGoogle Scholar
  12. 12.
    2015 ISCD Official positions – adult and pediatric, [updated June 16, 2015; cited 2017 August 27]. Available from:
  13. 13.
    Lewiecki EM, Binkley N. Bone density testing intervals and common sense. Curr Osteoporos Rep. 2012;10(3):217–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254–9.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Carey JJ. Fracture risk models in clinical practice [cited 2017 August 27]. Available from:
  16. 16.
    Cauley JA, Wu L, Wampler NS, Barnhart JM, Allison M, Chen Z, et al. Clinical risk factors for fractures in multi-ethnic women: the Women’s Health Initiative. J Bone Miner Res. 2007;22(11):1816–26.PubMedCrossRefGoogle Scholar
  17. 17.
    Lewis CE, Ewing SK, Taylor BC, Shikany JM, Fink HA, Ensrud KE, et al. Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res. 2007;22(2):211–9.PubMedCrossRefGoogle Scholar
  18. 18.
    FRAX® website [cited 2017 August 27]. Available from:
  19. 19.
    Edwards BJ. Osteoporosis risk calculators. J Clin Densitom. 2017;20(3):379–88.PubMedCrossRefGoogle Scholar
  20. 20.
    Bhat KA, Kakaji M, Awasthi A, Kumar K, Mishra K, Shukla M, et al. Utility of osteoporosis self-assessment tool as a screening tool for predicting osteoporosis in Indian men. J Clin Densitom. 2017;20(2):160–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Park HM, Sedrine WB, Reginster JY, Ross PD. Osta. Korean experience with the OSTA risk index for osteoporosis: a validation study. J Clin Densitom. 2003;6(3):247–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD. FRAX® with and without bone mineral density. Calcif Tissue Int. 2012;90(1):1–13.PubMedCrossRefGoogle Scholar
  23. 23.
    Gadam RK, Schlauch K, Izuora KE. FRAX® prediction without BMD for assessment of osteoporotic fracture risk. Endocr Pract. 2013;19(5):780–4.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    El-Hajj Fuleihan G, Chakhtoura M, Cauley JA, Chamoun N. Worldwide fracture prediction. J Clin Densitom. 2017;20(3):397–424.PubMedCrossRefGoogle Scholar
  25. 25.
    Bennett HS, Dienstfrey A, Hudson LT, Oreskovic T, Fuerst T, Shepherd J. Standards and measurements for assessing bone health-workshop report co-sponsored by the International Society for Clinical Densitometry (ISCD) and the National Institute of Standards and Technology (NIST). J Clin Densitom. 2006;9(4):399–405.PubMedCrossRefGoogle Scholar
  26. 26.
    Lewiecki EM, Binkley N, Morgan SL, Shuhart CR, Camargos BM, Carey JJ, et al. Best practices for dual-energy X-ray absorptiometry measurement and reporting: International Society for Clinical Densitometry Guidance. J Clin Densitom. 2016;19(2):127–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, et al. Interim report and recommendations of the World Health Organization task-force for osteoporosis. Osteoporos Int. 1999;10(4):259–64.PubMedCrossRefGoogle Scholar
  28. 28.
    Zethraeus N, Borgstrom F, Strom O, Kanis JA, Jonsson B. Cost-effectiveness of the treatment and prevention of osteoporosis--a review of the literature and a reference model. Osteoporos Int. 2007;18(1):9–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19(4):437–47.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Lauby-Secretan B, Loomis D, Straif K. Breast-Cancer screening--viewpoint of the IARC Working Group. N Engl J Med. 2015;373(15):1479.PubMedGoogle Scholar
  31. 31.
    Ferlay JSI, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, et al. GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide IARC CancerBase No. 11 edition. International Agency for Research on Cancer: Lyon; 2013.Google Scholar
  32. 32.
    Lynch-Kelly K, Singer M, Williams NR. The landscape of randomised controlled trials of therapies in breast Cancer in low and middle income countries. Int J Breast Cancer. 2017;2017:1.CrossRefGoogle Scholar
  33. 33.
    Lukong KE, Ogunbolude Y, Kamdem JP. Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants. Breast Cancer Res Treat. 2017;166(2):351–65.PubMedCrossRefGoogle Scholar
  34. 34.
    Pace LE, Shulman LN. Breast cancer in Sub-Saharan Africa: challenges and opportunities to reduce mortality. Oncologist. 2016;21(6):739–44.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Edge J, Buccimazza I, Cubasch H, Panieri E. The challenges of managing breast cancer in the developing world – a perspective from sub-Saharan Africa. S Afr Med J. 2014;104(5):377–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Thomas AS, Kidwell KM, Oppong JK, Adjei EK, Osei-Bonsu E, Boahene A, et al. Breast cancer in Ghana: demonstrating the need for population-based cancer registries in low- and middle-income countries. J Global Oncol. 2017;3(6):765–72.CrossRefGoogle Scholar
  37. 37.
    Newman LA, Kaljee LM. Health disparities and triple-negative breast Cancer in African American women: a review. JAMA Surg. 2017;152(5):485–93.PubMedCrossRefGoogle Scholar
  38. 38.
    Galukande M, Wabinga H, Mirembe F, Karamagi C, Asea A. Molecular breast cancer subtypes prevalence in an indigenous Sub Saharan African population. Pan Afr Med J. 2014;17:249.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Chavarri-Guerra Y, Blazer KR, Weitzel JN. Genetic cancer risk assessment for breast cancer in Latin America. Rev Invest Clin (organo del Hospital de Enfermedades de la Nutricion). 2017;69(2):94–102.Google Scholar
  40. 40.
    Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, et al. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. The Cochrane Database of Systematic Reviews. 2017;9:CD011086.Google Scholar
  41. 41.
    Gutnik LA, Matanje-Mwagomba B, Msosa V, Mzumara S, Khondowe B, Moses A, et al. Breast Cancer screening in low- and middle-income countries: a perspective from Malawi. J Glob Oncol. 2016;2(1):4–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, et al. Breast cancer in limited-resource countries: an overview of the breast health global initiative 2005 guidelines. Breast J. 2006;12(Suppl 1):S3–15.PubMedCrossRefGoogle Scholar
  43. 43.
    Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang ES, et al. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer. 2008;113(8 Suppl):2244–56.PubMedCrossRefGoogle Scholar
  44. 44.
    Trupe LA, Rositch A, Dickerson L, Lucas S, Harvey SC. Knowledge and attitudes about breast Cancer in Limpopo, South Africa. J Glob Oncol. 2017;3(5):509–14.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Provencher L, Hogue JC, Desbiens C, Poirier B, Poirier E, Boudreau D, et al. Is clinical breast examination important for breast cancer detection? Curr Oncol. 2016;23(4):e332–e9.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Allen TL, Van Groningen BJ, Barksdale DJ, McCarthy R. The breast self-examination controversy: what providers and patients should know. J Nurse Practitioners. 2010;6(6):444–51.CrossRefGoogle Scholar
  47. 47.
    Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self-examination in shanghai: final results. J Natl Cancer Inst. 2002;94(19):1445–57.PubMedCrossRefGoogle Scholar
  48. 48.
    Semiglazov VF, Manikhas AG, Moiseenko VM, Protsenko SA, Kharikova RS, Seleznev IK, et al. Results of a prospective randomized investigation [Russia (St.Petersburg)/WHO] to evaluate the significance of self-examination for the early detection of breast cancer. Voprosy onkologii. 2003;49(4):434–41. Rezul’taty prospektivnogo randomizirovannogo isledovaniia [Rossiia (Sankt-Peterburg)/VOZ] znacheniia samoobsledovaniia v rannem vyiavlenii raka molochnoi zhelezy.Google Scholar
  49. 49.
    Jones S. Regular self-examination or clinical examination for early detection of breast cancer. Int J Epidemiol. 2008;37(6):1219.PubMedGoogle Scholar
  50. 50.
    Miller AB. Practical applications for clinical breast examination (CBE) and breast self-examination (BSE) in screening and early detection of breast cancer. Breast Care (Basel). 2008;3(1):17–20.CrossRefGoogle Scholar
  51. 51.
    Devi BC, Tang TS, Corbex M. Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia. Ann Oncol. 2007;18(7):1172–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Mittra I, Mishra GA, Singh S, Aranke S, Notani P, Badwe R, et al. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer. 2010;126(4):976–84.PubMedGoogle Scholar
  53. 53.
    Ngoma T, Mandeli J, Holland JF. Downstaging cancer in rural Africa. Int J Cancer. 2015;136(12):2875–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Sood R, Rositch A, Pollack E, Pool K, Mollura D, Harvey SC. The potential use of ultrasound for breast cancer detection in low-resource settings: a literature review. Annual Symposium on Global Cancer Research at The Consortium of Universities for Global Health. New York, March 2018.Google Scholar
  55. 55.
    Bae MS, Moon WK, Chang JM, Koo HR, Kim WH, Cho N, et al. Breast cancer detected with screening US: reasons for nondetection at mammography. Radiology. 2014;270(2):369–77.PubMedCrossRefGoogle Scholar
  56. 56.
    Perry N, Broeders M, de Wolf C, Tornberg S, Holland R, von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document. Ann Oncol. 2008;19(4):614–22.PubMedCrossRefGoogle Scholar
  57. 57.
    Klabunde CN, Sancho-Garnier H, Taplin S, Thoresen S, Ohuchi N, Ballard-Barbash R, et al. Quality assurance in follow-up and initial treatment for screening mammography programs in 22 countries. Int J Qual Health Care. 2002;14(6):449–61.PubMedCrossRefGoogle Scholar
  58. 58.
    Klabunde C, Bouchard F, Taplin S, Scharpantgen A, Ballard-Barbash R, International Breast Cancer Screening Network. Quality assurance for screening mammography: an international comparison. J Epidemiol Community Health. 2001;55(3):204–12.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Mango VL, Ha R, Nguyen B, Mema E, Kobeski J, Singh T, et al. RAD-AID Asha Jyoti Mammogram quality assessment in India: optimizing mobile radiology. J Am Coll Radiol. 2016;13(7):831–4.PubMedCrossRefGoogle Scholar
  60. 60.
    Groot MT, Baltussen R, Uyl-de Groot CA, Anderson BO, Hortobagyi GN. Costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America, and Asia. Breast J. 2006;12(Suppl 1):S81–90.PubMedCrossRefGoogle Scholar
  61. 61.
    da Costa Vieira RA, Biller G, Uemura G, Ruiz CA, Curado MP. Breast cancer screening in developing countries. Clinics. 2017;72(4):244–53.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Mehrotra J, Ganpat MM, Kanaan Y, Fackler MJ, McVeigh M, Lahti-Domenici J, et al. Estrogen receptor/progesterone receptor-negative breast cancers of young African-American women have a higher frequency of methylation of multiple genes than those of Caucasian women. Clin Cancer Res. 2004;10(6):2052–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Fackler MJ, Lopez Bujanda Z, Umbricht C, Teo WW, Cho S, Zhang Z, et al. Novel methylated biomarkers and a robust assay to detect circulating tumor DNA in metastatic breast cancer. Cancer Res. 2014;74(8):2160–70.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Sabel MS, Kaufman CS, Whitworth P, Chang H, Stocks LH, Simmons R, et al. Cryoablation of early-stage breast cancer: work-in-progress report of a multi-institutional trial. Ann Surg Oncol. 2004;11(5):542–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Sabel MS, Arora A, Su G, Chang AE. Adoptive immunotherapy of breast cancer with lymph node cells primed by cryoablation of the primary tumor. Cryobiology. 2006;53(3):360–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Sabel MS. The interrelationship between cryoablation, the immune response, and the tumor microenvironment: stimulatory and suppressive effects. In: Keisari Y, editor. Tumor ablation. Dordrecht: Springer; 2013. p. 77–107.CrossRefGoogle Scholar
  67. 67.
    Zhao Z, Wu F. Minimally-invasive thermal ablation of early-stage breast cancer: a systemic review. Eur J Surg Oncol. 2010;36(12):1149–55.PubMedCrossRefGoogle Scholar
  68. 68.
    Poplack SP, Levine GM, Henry L, Wells WA, Heinemann FS, Hanna CM, et al. A pilot study of ultrasound-guided Cryoablation of invasive ductal carcinomas up to 15 mm with MRI follow-up and subsequent surgical resection. AJR Am J Roentgenol. 2015;204(5):1100–8.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Pfleiderer SO, Marx C, Camara O, Gajda M, Kaiser WA. Ultrasound-guided, percutaneous cryotherapy of small (< or = 15 mm) breast cancers. Investig Radiol. 2005;40(7):472–7.CrossRefGoogle Scholar
  70. 70.
    Gajda MR, Mireskandari M, Baltzer PA, Pfleiderer SO, Camara O, Runnebaum IB, et al. Breast pathology after cryotherapy. Histological regression of breast cancer after cryotherapy. Pol J Pathol. 2014;65(1):20–8.PubMedCrossRefGoogle Scholar
  71. 71.
    Lanza E, Palussiere J, Buy X, Grasso RF, Beomonte Zobel B, Poretti D, et al. Percutaneous image-guided Cryoablation of breast Cancer: a systematic review. J Vasc Interv Radiol. 2015;26(11):1652–7. e1.PubMedCrossRefGoogle Scholar
  72. 72.
    Cazzato RL, de Lara CT, Buy X, Ferron S, Hurtevent G, Fournier M, et al. Single-centre experience with percutaneous cryoablation of breast cancer in 23 consecutive non-surgical patients. Cardiovasc Intervent Radiol. 2015;38(5):1237–43.PubMedCrossRefGoogle Scholar
  73. 73.
    Littrup PJ, Jallad B, Chandiwala-Mody P, D'Agostini M, Adam BA, Bouwman D. Cryotherapy for breast cancer: a feasibility study without excision. J Vasc Interv Radiol. 2009;20(10):1329–41.PubMedCrossRefGoogle Scholar
  74. 74.
    Manenti G, Perretta T, Gaspari E, Pistolese CA, Scarano L, Cossu E, et al. Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy. Eur Radiol. 2011;21(11):2344–53.PubMedCrossRefGoogle Scholar
  75. 75.
    Pusztaszeri M, Vlastos G, Kinkel K, Pelte MF. Histopathological study of breast cancer and normal breast tissue after magnetic resonance-guided cryotherapy ablation. Cryobiology. 2007;55(1):44–51.PubMedCrossRefGoogle Scholar
  76. 76.
    Morin J, Traore A, Dionne G, Dumont M, Fouquette B, Dufour M, et al. Magnetic resonance-guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results. Can J Surg (Journal canadien de chirurgie). 2004;47(5):347–51.Google Scholar
  77. 77.
    Miya K, Saji S, Morita T, Niwa H, Takao H, Kida H, et al. Immunological response of regional lymph nodes after tumor cryosurgery: experimental study in rats. Cryobiology. 1986;23(4):290–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Islam RM, Billah B, Hossain MN, Oldroyd J. Barriers to cervical cancer and breast cancer screening uptake in low-income and middle-income countries: a systematic review. Asian Pac J Cancer Prev. 2017;18(7):1751–63.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Dey S. Preventing breast cancer in LMICs via screening and/or early detection: the real and the surreal. World J Clin Oncol. 2014;5(3):509–19.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Lin SJ. Factors influencing the uptake of screening services for breast and cervical cancer in Taiwan. J R Soc Promot Heal. 2008;128(6):327–34.CrossRefGoogle Scholar
  81. 81.
    Maheswaran R, Pearson T, Jordan H, Black D. Socioeconomic deprivation, travel distance, location of service, and uptake of breast cancer screening in North Derbyshire, UK. J Epidemiol Comm Health. 2006;60(3):208–12.CrossRefGoogle Scholar
  82. 82.
    Dinshaw K, Mishra G, Shastri S, Badwe R, Kerkar R, Ramani S, et al. Determinants of compliance in a cluster randomised controlled trial on screening of breast and cervix cancer in Mumbai, India. 2. Compliance to referral and treatment. Oncology. 2007;73(3–4):154–61.PubMedCrossRefGoogle Scholar
  83. 83.
    Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI. Fear, anxiety, worry, and breast cancer screening behavior: a critical review. Cancer Epidemiol Biomark Prev. 2004;13(4):501–10.Google Scholar
  84. 84.
    Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: a systematic review. Cancer Nurs. 2010;33(2):127–40.PubMedCrossRefGoogle Scholar
  85. 85.
    Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, et al. Patient navigation: state of the art or is it science? Cancer. 2008;113(8):1999–2010.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Gupta S, Vij A, Cafiero E, Bloom D, Agarwal S, Donelan K, et al. Retail venue based screening mammography: assessment of women’s preferences. Acad Radiol. 2012;19(10):1268–72.PubMedCrossRefGoogle Scholar
  87. 87.
    Breen N, Gentleman JF, Schiller JS. Update on mammography trends: comparisons of rates in 2000, 2005, and 2008. Cancer. 2011;117(10):2209–18.PubMedCrossRefGoogle Scholar
  88. 88.
    Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin. 2006;56(3):168–83.PubMedCrossRefGoogle Scholar
  89. 89.
    Gierisch JM, Earp JA, Brewer NT, Rimer BK. Longitudinal predictors of nonadherence to maintenance of mammography. Cancer Epidemiol Biomark Prev. 2010;19(4):1103–11.CrossRefGoogle Scholar
  90. 90.
    Rahman S, Price JH, Dignan M, Rahman S, Lindquist PS, Jordan TR. Access to mammography facilities and detection of breast cancer by screening mammography: a GIS approach. Int J Canc Prev. 2009;2(6):403–13.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: a meta-analytic review. Prev Med. 2007;45(4):252–61.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Vyas A, Madhavan S, LeMasters T, Atkins E, Gainor S, Kennedy S, et al. Factors influencing adherence to mammography screening guidelines in Appalachian women participating in a mobile mammography program. J Community Health. 2012;37(3):632–46.PubMedCrossRefGoogle Scholar
  93. 93.
    Greenspan SL, Perera S, Nace D, Zukowski KS, Ferchak MA, Lee CJ, et al. FRAX® or fiction: determining optimal screening strategies for treatment of osteoporosis in residents in long-term care facilities. J Am Geriatr Soc. 2012;60(4):684–90.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Greenspan S, Nace D, Perera S, Ferchak M, Fiorito G, Medich D, et al. Lessons learned from an osteoporosis clinical trial in frail long-term care residents. Clin Trials. 2012;9(2):247–56.PubMedCrossRefGoogle Scholar
  95. 95.
    Ulrich U, Browning M, Gaffney EV, Schoter KH, Chesnut CH 3rd. Implementation of an osteoporosis research program with a mobile dual-energy X-ray absorptiometry unit: the Montana/Wyoming experience. Osteoporos Int. 1997;7(6):583–8.PubMedCrossRefGoogle Scholar
  96. 96.
    Newman ED, Olenginski TP, Perruquet JL, Hummel J, Indeck C, Wood GC. Using mobile DXA to improve access to osteoporosis care: unit design, program development, implementation, and outcomes. J Clin Densitom. 2004;7(1):71–6.PubMedCrossRefGoogle Scholar
  97. 97.
    Wahner HW, Looker A, Dunn WL, Walters LC, Hauser MF, Novak C. Quality control of bone densitometry in a national health survey (NHANES III) using three mobile examination centers. J Bone Miner Res. 1994;9(6):951–60.PubMedCrossRefGoogle Scholar
  98. 98.
    Reuben DB, Bassett LW, Hirsch SH, Jackson CA, Bastani R. A randomized clinical trial to assess the benefit of offering on-site mobile mammography in addition to health education for older women. AJR Am J Roentgenol. 2002;179(6):1509–14.PubMedCrossRefGoogle Scholar
  99. 99.
    Schweitzer ME, French MT, Ullmann SG, McCoy CB. Cost-effectiveness of detecting breast cancer in lower socioeconomic status African American and Hispanic women through mobile mammography services. Med Care Res Rev. 1998;55(1):99–115.PubMedCrossRefGoogle Scholar
  100. 100.
    DeBruhl ND, Bassett LW, Jessop NW, Mason AM. Mobile mammography: results of a national survey. Radiology. 1996;201(2):433–7.PubMedCrossRefGoogle Scholar
  101. 101.
    Agarwal G, Ramakant P, Forgach ER, Rendon JC, Chaparro JM, Basurto CS, et al. Breast cancer care in developing countries. World J Surg. 2009;33(10):2069–76.PubMedCrossRefGoogle Scholar
  102. 102.
    Salem DS, Kamal RM, Helal MH, Hamed ST, Abdelrazek NA, Said NH, et al. Women health outreach program; a new experience for all Egyptian women. J Egypt Natl Canc Inst. 2008;20(4):313–22.PubMedGoogle Scholar
  103. 103.
    Haikel RL Jr, Mauad EC, Silva TB, Mattos JS, Chala LF, Longatto-Filho A, et al. Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units. BMC Women’s Health. 2012;12:32.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Orem J, Wabinga H. The roles of national cancer research institutions in evolving a comprehensive cancer control program in a developing country: experience from Uganda. Oncology. 2009;77(5):272–80.PubMedCrossRefGoogle Scholar
  105. 105.
    Badar F, Faruqui ZS, Uddin N, Trevan EA. Management of breast lesions by breast physicians in a heavily populated south asian developing country. Asian Pac J Cancer Prev. 2011;12(3):827–32.PubMedGoogle Scholar
  106. 106.
    Harford JB. Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol. 2011;12(3):306–12.PubMedCrossRefGoogle Scholar
  107. 107.
    Madan K, Breuning MH. Impact of prenatal technologies on the sex ratio in India: an overview. Genet Med. 2014;16(6):425–32.PubMedCrossRefGoogle Scholar
  108. 108.
    Knaul F, Bustreo F, Ha E, Langer A. Breast cancer: why link early detection to reproductive health interventions in developing countries? Salud Publica Mex. 2009;51(Suppl 2):s220–7.PubMedGoogle Scholar
  109. 109.
    Reeler A, Qiao Y, Dare L, Li J, Zhang AL, Saba J. Women’s cancers in developing countries: from research to an integrated health systems approach. Asian Pac J Cancer Prev. 2009;10(3):519–26.PubMedGoogle Scholar
  110. 110.
    Shetty MK, Longatto-Filho A. Early detection of breast, cervical, ovarian and endometrial cancers in low resource countries: an integrated approach. Indian J Surg Oncol. 2011;2(3):165–71.PubMedPubMedCentralCrossRefGoogle Scholar
  111. 111.
    Everton K, Nordvig AS, Cinelli CM, Khandelwal N. Women’s imaging in global health radiology. In: Mollura DP, Lungren MP, editors. Radiology in global health. 1st ed. New York: Springer; 2014. p. 241–57.Google Scholar
  112. 112.
    Gounder CR, Chaisson RE. A diagonal approach to building primary healthcare systems in resource-limited settings: women-centred integration of HIV/AIDS, tuberculosis, malaria, MCH and NCD initiatives. Tropical Med Int Health. 2012;17(12):1426–31.CrossRefGoogle Scholar
  113. 113.
    Singh T, Khandelwal N. Asha Jyoti women’s healthcare mobile outreach 5 year review. 2017. Unpublished work.Google Scholar
  114. 114.
    Kanwari S. Workshop on mammography organized in PGI. The Times of India. 28 Aug 2012; 2012.Google Scholar
  115. 115.
    Experts talk about breast cancer. The Times of India. 13 Nov 2016; 2016.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lisa A. Mullen
    • 1
  • Susan C. Harvey
    • 1
  • Erica B. Pollack
    • 2
    Email author
  • Niranjan Khandelwal
    • 3
  • Tulika Singh
    • 3
  1. 1.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins MedicineBaltimoreUSA
  2. 2.RAD-AID InternationalChevy ChaseUSA
  3. 3.Department of Radiodiagnosis and ImagingPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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