It’s not every day that Deborah Rhodes, an internist in Minnesota, gets emails from Iran.
But last January, an English teacher in Tehran sent Rhodes, an assistant professor of medicine at the renowned Mayo Clinic, a message thanking her for sharing new information about breast cancer screening. The teacher was referring to a lecture by Rhodes, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (1995-1997), that was posted online in December and went viral soon after.
“I hadn’t shed tears in a long time, and I had had recent losses, believe me,” the teacher wrote. “But I couldn’t help my tears as I, with the audience in your lecture hall, stood up in admiration and applause. I have been deprived of higher education because of protesting against the corrupt system here… Yet I have kept my faith in bright minds like you who have decided to choose the hardest path of giving up individual benefits over a common good.”
The note was one of about a thousand messages—sent by computer, phone, post and in person—that Rhodes received after she delivered her lecture in Washington, D.C., at TEDWomen, a conference sponsored by TED, a nonprofit organization that invites speakers to share inspiring actions and ideas. Hundreds watched the lecture in person on Dec. 8, and countless more watched it live via simulcast from locations around the world. Many, many more have watched it since as it has made its way through the blogosphere.
In her lecture, Rhodes told the story of the many challenges—political and economic as much as scientific—involved in developing a breast cancer screening tool that can better identify tumors than traditional mammograms in women with dense breast tissue.
“Frankly, the response has been overwhelming, given the demands of my day job, to suddenly have this talk go into the stratosphere,” she says. “I feel such a responsibility to answer each individual message.”
In her 18-minute speech, Rhodes tells the inspiring story of her unlikely partnership with Michael O’Connor, Ph.D., a nuclear physicist, Carrie Hruska, Ph.D., a biomedical engineer, and a team of radiologists who are working together to develop a tool that could overcome the limitations of mammography in women with dense breast tissue. In traditional mammography, dense breast tissue looks like a cumulus cloud, often obscuring tumors lodged in the tissue. The team’s new screening tool, a gamma camera that uses radiation and as such is not influenced by breast density, depicts tumors that would otherwise go undetected.
Rhodes’ Long, Hard Journey Begins with a Classic ‘A-ha’ Moment
The story begins in 2003 with what Rhodes describes as “the classic a-ha moment.” She was working in the Breast Clinic at Mayo Clinic, where many of her patients were young women with risk factors for breast cancer. “Women experience such a sense of relief after receiving the report of a normal mammogram, but I was concerned that we could be providing false reassurance for those women with very dense breast tissue,” Rhodes recalls.
Rhodes started to look into the body of radiological research literature and was startled to find a trove of studies documenting the relative ineffectiveness of mammograms in women with very dense breasts. For these women, mammography was essentially a 50-50 gamble; for every tumor identified among women with dense breasts, one went unidentified—and untreated.
“I realized we didn’t have a good option for women who were in this particular dilemma, which is not a small group,” Rhodes says. Most women in their 40s have dense breast tissue, and 30 to 40 percent of women overall have dense breasts, she says.
A colleague suggested she meet with O’Connor, who had just returned from Israel with a semiconductor gamma detector that was being developed for cardiac imaging. O’Connor thought this new type of detector could overcome some of the limitations of conventional gamma detectors that had previously been shown to be ineffective in breast imaging. He built a molecular breast imaging (MBI) prototype machine, and he and Rhodes have been partners and collaborators ever since.
Over the last decade, Rhodes has been researching the effectiveness of the tool, using skills she developed during her days as a Clinical Scholar. “If I hadn’t had the skillset I learned at the Robert Wood Johnson Foundation program, there’s no way I could have jumped into writing research proposals and managing large clinical protocols,” Rhodes says.
It took more than five years to complete and publish the first study of MBI as a screening tool. But the findings were dramatic; the study showed that MBI found three times as many cancers as mammography in women with dense breasts. The team’s subsequent work has focused on lowering the radiation dose associated with MBI so that it is comparable to mammography.
Rhodes is now leading a 2,400-patient study comparing low radiation-dose MBI to mammography in women with dense breasts. Among the first 600 women who participated, Rhodes and her team found nine cancers. Eight were identified by molecular breast imaging and one was found after a patient underwent a prophylactic mastectomy. None of the nine were found by mammography.
It will take at least another year to complete the study, but Rhodes is very encouraged by these early results. “We’re not just finding small tumors,” she says. “In a few cases, MBI has found large tumors that were simply not visible on the mammogram because of the surrounding dense breast tissue.”
Despite her successes, Rhodes acknowledges that it has been a difficult road. Few internists conduct research in breast imaging, and she found it difficult initially to get support and funding for the research and acceptance from the radiology community. But having an outsider’s perspective can sometimes be an advantage, she says, particularly when challenging the status quo of a tool as entrenched as mammography.
Because she has focused her research on a single issue, spending five years, for example, on one study, she lacks the stack of publications needed for promotion. Now nearing age 50, Rhodes has not yet advanced beyond assistant professor. In academia, she says, quantity of publications is an easier metric to assess than impact. “But if I can ultimately measure my work in terms of lives saved rather than papers published,” Rhodes says, “I will be satisfied.”
Still, she concedes, “It would certainly have been a lot easier if I had gone into a fully established lab with mentors and solid funding and a clear research trajectory.” Despite these challenges, she plans to soldier on. And opening up her inbox to find a message like the one from the teacher in Iran “makes it all worthwhile,” Rhodes says.
For more than three decades, the Robert Wood Johnson Foundation Clinical Scholars® program has fostered the development of physicians who are leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles. Through the program, future leaders learn to conduct innovative research and work with communities, organizations, practitioners and policy-makers on issues important to the health and well-being of all Americans.