Department of Health and Human Services/Central Intelligence Agency Brief Russian Health Minister on Their Unique Collaboration to Develop New Breast Imaging Technologies

Overview

The Public Health Service’s Office on Women’s Health, within the U.S. Department of Health and Human Services (HHS) has initiated a unique partnership with the Central Intelligence Agency to apply imaging technologies used for missile guidance and target recognition to new use to improve the early detection of breast cancer, a disease that is diagnosed in over 180,000 women annually, resulting in over 45,000 deaths each year. Secretary Shalala will join Russian Health Minister Aleksandr Dmitrievich Tsaregorodtsev and his delegation for a demonstration of the application of these technologies to breast cancer diagnosis. The project was initiated by HHS Deputy Assistant Secretary for Women’s Health, Susan J. Blumenthal, M.D., M.P.A., who has been working with CIA scientists and national experts in radiology over the past 18 months to transfer these technologies from the intelligence to the medical community.

Background

The incidence of breast cancer in the United States has increased from 1 in 20 women in the 1950s to 1 in 8 over a lifetime today. Early detection of the disease means the best chance for effective treatment (when the 5-year survival rate is 96%). Mammography, an x-ray-based imaging technique, can decrease the death rates from breast cancer by as much as 30%.

However, mammography is a 40-year-old technique that has a 10-15% "false negative" rate (not detecting a cancerous lesion when present) and as high as a 40% "false positive" rate in some studies (suggesting a potentially cancerous lesion when not present, leading to unnecessary and costly medical procedures including surgical biopsy). Additionally, a recent national survey of radiologists suggests that accurate diagnosis of breast cancer based on mammography varied widely. Recent efforts to improve mammography include both the publication of Clinical Practice Guidelines by the Agency for Health Care Policy and Research and the Food and Drug Administration’s implementation of the Mammography Quality Standards Act that requires mammography facilities across the nation to meet uniform standards for personnel, equipment and recordkeeping, and be inspected annually.

In July 1994, the Public Health Service’s Office on Women’s Health convened a conference with representatives from the intelligence community, the Department of Defense (DoD), the National Aeronautic and Space Administration (NASA), the National Cancer Institute (NCI), the Food and Drug Administration (FDA), and private industry to explore whether imaging technologies from the defense, intelligence, and space communities might be applied to improve the detection of breast cancer in women. The fruits of the collaborations resulting from this conference and a subsequent Capitol Hill briefing in October 1994 are being realized in preliminary evaluation of the technology in clinical settings today.

The Missiles to Mammograms Project

The U.S. Public Health Service’s Office on Women’s Health, the focal point for women’s health in the U.S. Department of Health and Human Services, charged with coordinating Federal breast cancer activities initiated a collaboration with the CIA and DoD to redeploy missile targeting and reconnaissance imaging technologies to develop a new generation of equipment that can more accurately detect breast cancers by enhancing current mammographic technology and newer sophisticated medical imaging methods, such as magnetic resonance imaging (MRI).

This initiative builds upon a series of meetings on new frontiers in breast cancer imaging and early detection, convened by Susan J. Blumenthal, M.D., M.P.A., Deputy Assistant Secretary for Women’s Health and head of the PHS Office on Women’s Health in collaboration with NCI. Subsequently, a number of scientific meeting convened by the PHS Office on Women’s Health and the National Information Display Laboratories (NIDL), a technology development organization working with the CIA, brought together CIA imaging scientists with leading radiologists from academic centers. Several of the products of this technology transfer initiative include—

Pattern Recognition Tools: Working from automatic target recognition (ATR) technologies that can detect small objects in large pictorial images (such as missile targets in reconnaissance imagery), NIDL has developed a computer-assisted pattern recognition system that helps better identify the characteristics of cancerous tissue in mammograms. The technology, called neural networks, is based on object recognition with an environmental context through a sophisticated computer design that emulates the way brain cells communicate. As missile targets can be identified in the context of a changing landscape, so breast cancers can be detected in the context of surrounding tissue structures such as mammary ducts and blood vessels. This work is being developed in partnership with the University of Chicago School of Medicine (IL) and the Robert Wood Johnson Medical School (NJ).

Two-dimensional Image Alignment Technology: Mammograms provide two-dimensional views of breast tissue, not dissimilar to the "flat" images rendered by aerial reconnaissance film. In both cases, a series of images compared over time are able to detect change. In reconnaissance film, the change might be troop movements; in mammography it is the growth of cancerous tissue in the breast. By superimposing new and older images precisely and deleting areas that remain unchanged over time, subtle alterations in both the geographic and physiological terrain can be detected. The potential for improving on the current false positive and negative rates found in screening mammography is considerable. This application is now being tested in collaboration with radiologists at the Massachusetts General Hospital of the Harvard Medical School (MA) and the University of Pennsylvania Medical Center (PA).

Three-dimensional Volume Alignment Technology: Moving from two-dimensional images to 3-D images, intelligence imaging alignment technologies used to compare changes in target scenes from images taken from different viewpoints are being evaluated for similar use in comparing three-dimensional breast scans using magnetic resonance imaging, MRI. MRI uses high-contrast agents that highlight or "light up" potentially cancerous breast lesions. A scan taken before introduction of the agent is then compared by a radiologist to that taken after administration of the agent. Precise alignment of these images becomes a key in more accurate identification of changes in breast tissue. This application is being tested in collaboration with the University of Pennsylvania Medical Center (PA) and the Harvard Medical School (MA).