Web-Based Breast Self Exam

This project increases accessibility to breast cancer
examination procedure by creating a web-based educational tool.

The goal is to produce a vivid learning experience via a truly
educational web site. The site will use not only text and
static imagery but also animation and audio to communicate the
importance of conducting a monthly self-examination. The site
will illustrate how to do a clinical breast exam and a breast
self-exam. It will cover the anatomy of the breast, risk
factors, signs and symptoms, mammography, pathophysiology, and
treatment of breast cancer.

The specific aims of this project are:

1. Broad Reach: Anyone, Anywhere, Anytime
Deploying cancer education material in a web-based format
extends that material¹s accessibility. Anyone, anywhere,
anytime can access the material. While the website is geared
toward healthcare professionals, anyone with access to a
computer and the internet can visit the site. For example,
someone visiting a library could use a library computer to visit
the site. This would enhance the information the Komen
Foundation has already provided in libraries around Arkansas.

2. Rapid Updating with Self Revising Content
Information on the web site can be quickly updated as advances
are made in the fight against breast cancer. Directed searches
allow users to pursue deep lines of questioning by integrated
access to cancer search engines. The technique of using
directed searches to produce self-revising content first
developed here in our cancer pain web module will be extended in
scope here.

3. Links To Other Advancing Content
Health care providers and patients would have access to the
latest information available on the world wide web through links
to other sites and self-updating searches.

Background and rational

In recent years, the availability of self-directed learning
materials on CD-ROM has increased. Unfortunately, the time
available to primary care providers, residents, and medical
students to participate in self-directed learning activities is
limited. Teachable moments that occur during the day are often
lost. Cancer education via the world wide web reduces this

An effective example of cancer education material translated to
the web is the UAMS Cancer Pain Module:
This site combines carefully produced static images, animations,
and interactivity to provide the user with a rich learning

Web access offers several advantages over the previous CD-ROM
format. The module will be available to a wider audience -
anyone with Internet access will be able to use the program at
any time that they choose. Furthermore, learners will be able to
link to additional information. Computer compatibility or
specific software platforms no longer are showstopping issues.
Since web-posting is instantaneous, updates can be provided
quickly and easily.


A brief satisfaction survey consisting of five questions will
be used to rate the program . This information will be collected
electronically and analyzed. Each question will be assigned an
appropriate rating scale.

1. Was the information accessible and easy to understand?

2. Was it informative?

3. Did you encounter any problem while viewing the information?

4. Would you recommend the site to a colleague?

5. How would you rate the site overall?
excellent very good good fair

Accessibility will be determined by comparing the number of
times someone has visited the website to the number of people
who use the CD-ROM version of the material.


Target Population:
The target population for the breast cancer exam site are
healthcare providers, patients and supportive members of the
public at large. Providers include professionals such as
primary care physicians, advanced practice nurses, nurse
practitioners, residents, and medical students. Patients and the
general public include anyone who has access to a computer and
the internet.

Number of People
The statistics for the number of women affected with breast
cancer are staggering. The breast cancer exam site will begin
to deliver the message to larger numbers of people than could be
reached by existing media channels alone.

Timeline for Proposed Activities
The date for demonstration of capability is 4 months from the
date at which the funding commences.

Fast computers and up to date software working together with
information content of high quality will reach wider audiences
than ever before possible. This work has potentially world wide
scope and reach, far beyond traditional leaflets or handouts.
It will continue to establish Arkansas as a significant player
in the breast cancer effort.

While many Arkansans may not be connected to the internet, free
computer access is available through public libraries. In
addition, computers in the Ottenheimer Cancer Education Center
at the ACRC will be available for patients who would like to
access this information.

Health care professionals will discover the site through
notices in publications including: The Journal of Arkansas
Medical Society, the Arkansas Academy of Family Physicians
newsletter, the Arkansas Cancer Research Center Review, the CIS
mid-south six-state quarterly newsletter and the Ask the CIS
monthly column which appears in 45 newspapers in Arkansas, and
other professional newsletters

It is estimated that the project will take 324 hours to


Total amount requested is $18000 and is broken into the overall

Salary $16,200
Software/Hardware upgrades $1,800
Total $18,000

Coordinating the technical efforts is Ms. Marilyn Fulper-Smith
whose media background includes theatre, radio, and cancer
education CD-ROM¹s. Her multitalented efforts insure a polished
and complete final product.

The salary portion of the funds will be used to procure the
services of information system engineer Van Warren, a nine year
veteran of NASA¹s Jet Propulsion Laboratory, technical director
of the GeoSphere project, and author of numerous cancer related
works on the world wide web.

Van Warren¹s training in took place at one of the birthplaces
of computer graphics, the University of Utah. His long term
participation in image processing, realistic image synthesis,
image compression techniques and artistic flair make him
uniquely qualified for this work. For background on him see: or the attached vitae.

Moore¹s Law states that computers double in speed and halve in
cost every 18 months. Our work in cancer education on the web
has borne this out, and a small maintenance fee for software and
hardware upgrades such as memory, storage and data archiving is

Developing appropriate graphics and animations for web sites is
extremely labor intensive. Komen funds enable the acquisition of
top of the line computer graphics for enhanced web page
development. The above amount is based on the Cancer Pain
Management web site. That site took approximately 1080 hours to

Background on the Arkansas Cancer Research Center (ACRC)

The Arkansas Cancer Research Center (ACRC) is a nonprofit center
that serves as the central focus for all cancer-related
activities to improve the prevention and management of cancer in
the region served by UAMS.

The major goals of ACRC are
(1) provide state-of-the-art cancer treatment
(2) provide education to physicians, nurses, students,
patients, families, and the public, and
(3) conduct clinical and basic research.

Cancer screening and prevention via community outreach and
health education programs are emphasized by the ACRC cancer
education program. Education about breast cancer is delivered to
medically and economically limited areas of eastern Arkansas.
Hats Off for Health was developed in cooperation with and funded
by the American Cancer Society and the Arkansas Department of
Health. This program, which emphasizes breast self-examination
and mammography, has been presented to more than 2,500 rural,
elderly women by a community volunteer and a lay health
educator. Another breast cancer education research program, The
Witness Project®, is designed to reach African American women in
churches and community centers across Arkansas. This
national-award winning program is currently supported by the
Susan G. Komen Breast Cancer Foundation, an NCI R25 cancer
education grant, and a supplemental grant through the Centers
for Disease Control and Prevention.


Thanks for your inquiry of yesterday. You asked some questions
and Iwanted to get back to you with an answer right away. I hope
the following answers any questions that you might have about
the Komen Foundation grant request.

We have asked for a total of $18,000 ($18K). Most of that money
($16.2 K) would be used to procure high-level technical support
in the area of graphics development. This figure is based on
the time and effort it took to develop the Cancer Pain
Management website, our showcase educational prototype on the
world wide web. Since this is for development of a specific
item, it is a one-time cost.

Graphics development is a very specialized, labor-intensive,
time consuming process. There is a definite shortage of this
kind of expertise particularly in Arkansas. Creating vivid
technical illustrations for the internet requires training and
skill which are long in the making. It is access to this skill
that the $16.2K will enable. The right image in the right
location can communicate much more efffectively than words. A
picture is worth a thousand words, but a picture doesn¹t cost a
thousand times what the words would cost. An animation is worth
a million words, and animations, which consist of a sequence of
pictures require patience, diligence and effort to produce.
Animations are used to clearly illustrate complicated
processes. Good graphics are an effective way to communicate
and one must to communicate in order to educate.
Last week, the Cancer Pain Management site was displayed at the
American Association for Cancer Education meeting in Cleveland
and drew numerous comments on the high quality and effectivness
of our internet based computer graphics. One doctor from the
Ukraine was particularly impressed and asked how he might go
about getting a copy of our work. He was quite pleased when he
was informed that he could access this site from his home in
the Ukraine.

The estimated time to complete this module is 324 hours or
about 8 person-weeks (based on a 40-hour week). My role as
project director will be to coordinate and contribute to the
work, despite this I will not draw salary from this grant. I am
funded through the state. We spent the entire summer working
evenings and weekends to produce the cancer pain module which
contained 30 animations, over 80 web pages and approximately 400
images and numerous chemical structures and several simulations.
The1028 hours that you mentioned on the phone was for this
effort, the Pain module, a sophisticated example of what is
possible with new internet technology.


We have asked for $1,800 to cover software tools, graphics
support services, media costs scanning, duplication, memory
upgrades, and the miscellaneous upgrades to hardware and
software that occur in the course of the project that are not
obvious at the outset.