Not long ago in Singapore, Anne Bibbings stood in line to get on a bus parked on the street. The 47-year-old teacher wasn’t going anyplace in particular. She was there to get a mammogram.
With breast cancer, early detection is vital. Like other healthcare professionals around the world, the Singapore Breast Cancer Foundation urges yearly screenings for women once they turn 40, then a mammogram every two years for women 50 and up. “The survival rate of breast cancer in earlier stages such as stage 1 is 90%, compared to 21% for those diagnosed at stage 4,” says Kong Kum Yin, head of business development for National Healthcare Group Diagnostics (NHGD), Singapore’s leading provider in public primary healthcare for imaging and laboratory services.
The trouble is that not enough women are following these recommendations. Though breast cancer is the most common cancer among Singaporean women, fewer than 40% of women get the recommended annual screening. Meanwhile, the incidence of breast cancer in Singapore has doubled over the last 40 years, with about 1,930 new diagnoses each year, and about 420 annual deaths. “Based on the current statistics in Singapore, a lot more needs to be done to create a call to action,” Kong says.
Boarding that high-tech bus, Anne Bibbings was taking advantage of a fairly new tactic that Singaporean health officials are trying to get more women to get breast screenings: the Community Mammobus Programme. Rather than encourage women to visit clinics to get breast screenings, it brings the screenings to them.
NHGD launched the Community Mammobus Programme in 2018 in partnership with the Singapore Breast Cancer Foundation and the Singapore Cancer Society. A mobile screening facility on wheels, the bus stops where the people are, be that community centers or housing developments — sort of like a food truck. Women board it for quick and affordable mammograms.
Under the program, Singaporean women and permanent residents getting their first mammogram at 40 years old receive the screening for free; for successive screenings, they pay between $7 and $26. In its first year, the Mammobus program doubled the number of first-time participants accessing screenings through NHGD, and increased the number of women who went for breast screenings by 68%.
“The waiting time is minimal, the staff on the bus are lovely,” said Anne Bibbings, who was there for her second screening. “When something like the Mammobus makes the process of getting it done so easy, it is great for all of us who are busy juggling work and home life.”
Women may skip mammograms because they’re short of time or aren’t aware that they need them — they might also shy away for other reasons, too. “They are afraid,” Claire Goodliffe, marketing director for women’s health at GE Healthcare, told GE Reports in 2017. “They are afraid of the examination, they are afraid of the pain they may feel, and they are afraid of the results. They are afraid of getting cancer.”
GE Healthcare is working to take fear out of the process — and since 2018, building on the swift success of the program’s beginnings, NHGD has been working with GE Healthcare on an updated Mammobus that brings the company’s digital mammography technology to the streets. GE Healthcare’s Senographe Pristina was designed for women by women to make mammography more comfortable; it includes, for example, rounded corners and a thinner image detector. Comfortable armrests, rather than conventional hand grips, help women relax their muscles during the exam, which simplifies positioning, compression and image acquisition.
“The misconception of pain is also something we want to address with the technology, which was designed with patient comfort in mind,” says NHGD’s Kong.
To promote accessibility in housing development estates — home to some 70% of the Singaporean population — the new bus is shorter, helping it navigate narrow roads. Kong and her colleagues hope it will build on the success they’ve already established: “We are very encouraged by the support from organizations and the community, which has led to a 40% increase in screening events organized for their workforce, residents and tenants over the past year,” she says. “With the new bus, we are targeting a similar increase this year.”
Says Kong: “It is our hope that if we can improve the accessibility and patient experience, perhaps we can reduce the number of skipped mammogram screenings and increase the chances of catching cancer earlier.”