FemTech forerunners- Episode 2 with Dr. Geetha Manjunath
Founder & CEO of Niramai Health Analytix
Edited by Aishwarya Viswamitra
(Transcript by Otter.ai)
As we all know, breast cancer is the most common cancer among women in India. Niramai Health Analytix is a Bangalore-based company that has developed a unique technology comparable to traditional screening and is creating a buzz around the world. Miyara’s Dr. Gayatri Muthukrishnan sat down with Dr. Geetha Manjunath, the CEO of Niramai, to learn about how Geetha became an entrepreneur, the status of breast cancer diagnosis and awareness in India, the advantages of using their breast screening method, and how you can get tested in the convenience of your own home.
Here is the full interview:
Gayatri: Can you tell us a little about yourself and what led you down the path of starting this project, this company?
Geeta: I'm basically a techie! I did my Computers Bachelors and Masters from the Indian Institute of Science. Then I joined a research group, which worked on the first supercomputer developer. It was a very good learning experience. After that, I joined Hewlett Packard research labs and was the first member from India, back in ‘97. Through all of this, I was trying to look at innovation, trying to come up with new ideas with my team, and trying to make a difference on the ground. Of course, we continue to publish, we continue to patent but how does it change right now? That has always been a passion for me.
After about 17 years at HP, I joined Xerox research to head analytics research for India where very interesting AI work was being done. I was in techno-managerial roles so I used to interact with a lot of customers, including hospitals, doctors, and so on. We were innovating with artificial intelligence because, let's say, for example: detecting if a person can or will go into an ICU tomorrow. We can then take care of them earlier before they become worse! Around this time, a cousin sister was diagnosed with breast cancer. She was just a year older than me and it was very shocking because it was detected in a late-stage and she had only a few months left. I started reading up about breast cancer. Coincidentally, I met an imaging specialist and casually mentioned that we should work in this area. He started looking at different types of imaging, those used for something else but mentioned that thermal imaging had been used for breast cancer detection. We set up a project to try it out and after a year I decided that I wanted to spend the rest of my life on this because I felt like it had an opportunity to save many lives. I quit my job and started Niramai. So I call myself an accidental entrepreneur. I really think we've been able to create something that can help so many women detect cancer much earlier in an accessible and affordable manner.
Gayatri: Could you explain the breast cancer screening process?
Geetha: Did you know that last year 680,000 women were diagnosed with breast cancer? But what is interesting, and probably the positive angle is that breast cancer is not a death sentence, it is completely curable! So what is the gap? Though it is the largest cancer killer, many women can be saved, the only thing that is needed is early detection.
Mammography uses X-rays to detect whether or not there are small lumps in the breast by compressing the breasts between two plates and passing X rays through it. But it does not work on women under 45 years of age. It may not even work on women above 45 years of age as well. Let's say we take an X-ray of my hand: the skeleton appears white, right? Because anything that is hard is stopped by the X-ray and appears white. That is the principle behind finding small lumps in the breast. But in younger women, there's a lot of fiber glandular tissue and hormonal activities going on so the whole breast appears white normally. How do you find a white spot in a white zone? So that is the reason why even radiologists find it very difficult to find cancer in dense places using mammography. This means that the lump is only seen when it is big and when it is staged. The efficacy of treatment at later stages is costlier and more uncertain. The treatment may or may not work.
There are alternatives like you can go get an MRI done, but an MRI is not an annual screening machine. Some of the gaps exist closer to home in India, it is not even affordable. With the mentality that all of us feel like we will not get cancer, you know that mentality, why spend 3500 rupees? So that's also an issue. And so all of that will result in only 50% of breast cancer in India being detected. In the UK there is government funding and more women get regular mammograms but younger women are still finding it late. That is also the reason why I lost my cousin sister. What we have done is instead of using X-ray, we use thermal sensing. Especially right now, when you enter any building, there's somebody holding a gun to take your temperature. This is exactly that temperature measuring instrument, but with a high resolution and high sensitivity. A small thing is kept in front of the lady. In minutes the whole body's temperature is quickly measured after some preparation. That's about it! This temperature variation is analysed using a smart, artificial intelligence software that we've developed. That generates a report, which states whether there is an abnormality, the likelihood that it is actually cancer, and where a follow up diagnostic test can be done? So all this can be done automatically using one solution.
Gayatri: The reason that thermography detects cancer is that there's more activity, blood activity there, right?
Geetha: And also, there's more activity. So in general, the cancer cells are dividing at a much faster rate compared to the rest. And they're also dividing irregularly, which results in an increase in temperature. Because of the high metabolism, nitrogen oxide is generated. So the cancer cell itself is at a much higher temperature when compared to the rest. As you said, the surrounding areas’ blood vessel activity, vascular activity increases too. And both of these are very important to identify early cancer because the lesion can be very, very small, a few pixels, so it may get missed. But because the activity around it is more active than the other breast, usually people get breast cancer in one breast first, the different thermal signatures are clear.
Gayatri: What is the difference between thermography and Niramai's Thermalytix technology?
Geetha: Oh, that’s an excellent question! Thermography measures the temperature variation on the chest area, but thermography requires an expert to visually analyse temperature variations because of the lack of temperature points. How can a human being understand the difference between temperature points at 22.5 22.6 22.7, or 36.7, and do the analysis? There are a lot of errors. We use the thermal camera, but the rest is completely different. We use the measured temperature, and model it using sophisticated statistics and probability-based models, which is like machine-learning based models. We are able to detect 117 different types of abnormal patterns or a combination of all of them in two minutes. That is a major difference in the smart software, whereas thermography is error-prone and requires you to come twice.
Gayatri: Could you tell me the advantages of using Niramai over other screening methods?
Geetha: Mammography does not work on dense tissue and younger women. So thermal imaging does not depend on the density of the tissue, it looks at the temperature of the tissue or the abnormal tissue activity. It is irrespective of the density and irrespective of age. We've done work on women of all ages. Mammography detects at two centimeters, while our test is able to detect at four millimetres. It's less than five times smaller! And so it's much much earlier than what a hand test can detect. Early detection means a very simple procedure to solve it and people can go back home. That's another major advantage. The third advantage is that there's no radiation. We're just measuring temperature like a thermometer. I can even do this test as often as necessary. Especially if it's a doctor who treats cancer patients, her risk of cancer is slightly higher. It's good to get the test done every six months just to be on the safer side. The cost is also a major advantage, the device itself is less than 1/10 the cost of a mammogram. In fact, we are now working on a mobile phone attachment. This is very important for countries like India, where you want to address the price.
It's a really small device. So you can do it in a hospital for sure. Because we have proven that it actually works as well as, or even better than mammography you can also take it out to do screenings in rural areas. We started home screening because of its portability and accessibility.
It is non-radiation, affordable and accessible. And most importantly, the last one, and not definitely not least, is that it is privacy-aware. Nobody touches you, or nobody sees you without clothes during the process. And that is never heard of for breast cancer detection. The lady enters the booth, sits in front of the device, and even the technician is outside the room. It's like a changing room experience, you just close the door and sit inside and nobody sees you without clothes. This Privacy Awareness has made a huge difference because people feel comfortable. It’s important for it to not feel like a disease when this test is done. It’s like doing a regular glucose test.
Read related: Inspiring Journeys Episode 3 with Tithi Pandya, a breast cancer survivor
Gayatri: What does Niramai mean to a woman sitting at home?
Geetha: Due to COVID, all of us had decided to not go to a hospital for non-emergency reasons. So that's why we launched the home screening last year. They can just come to our website and register for the screening. Our team will come home and do the screening at your place. Our test is also available in multiple hospitals. So you can check on our website if you are living close to a clinic that has it: you can just walk in or make an appointment and get the test done. It hardly takes 15-20 minutes. Some women want to conduct camps in their own apartments and receive discounts. All of that can be accessed from our website too. For Europe, we've just got the regulatory clearance and we are working in multiple countries with doctors to make this available. And if there is a specific interest, they can write to us, and we will connect them to the doctor in that country who can provide it right now.
Gayatri: As this screening can be done for younger women, what age should one start thinking about breast cancer screening?
Geetha: Any person above 25 years of age should get at least one screening done. Mammography is not recommended unless there's a high risk, so, I suggest my test. Getting a screening done at the age of 25 generates a score. Based on the score, you can decide whether you want to do it once in a year or two years from then. In addition to that, what we all recommend, is to do a self examination at least once a month. You can fix the date as five days after the menstrual period is done for the month, stand in front of the mirror and then do the self-examination to look for any lumps or any discharge from the nipple.
Learn how to do a breast self examination
Gayatri: What is next for Niramai?
Geetha: I think we are fairly established in India. We are still working with the government for the government adoption which takes time. So while that is happening, we've got like one of the largest hospital chains, Apollo, fully adopting our solution in multiple society clinics, maybe 25 clinics! Apollo already has this, and also HCG, which is a cancer specialist.
Now, recently, we got approval for Europe, Africa and some parts of Asia. So, we've started testing in Africa and we have now started exploring multiple partnerships in Europe. In fact, some of the doctors have already started using it for evaluation. So we will be expanding to Europe. Our US clearances are halfway through, and we have got a favorable response already. So we just have to produce some more documentation and we're hoping to have that cleared in a few months now as well. So expanding is one thing.
The second thing is we want to reduce the costs and make it more affordable and portable for villages. Every village should have it. So we're working on a very simple, nice model which can be used along with the phone. And in fact, if everything goes well, it can become a screening device that can be bought and kept at home. Instead of doing a hand examination, they can do a quick scan themselves in the bathroom. There's a lot of innovation, nobody else has done this. There have been such efforts in pockets, but doing it at a systematic level at this production quality is why we're unique. So we want to leverage that leadership position.
Gayatri: That will be great. We're looking forward to it! So any advice to women about their health?
Geetha: I want to thank you for giving me an opportunity to talk to your audience. But what I want to really mention is that, usually, women keep the priority of their health, much, much lower than their children. Just think about a day when you had a fever and how the whole family was around you feeling messed up and didn't know what to do. That tells you how important your health is to your family and, of course, to yourself as well. So I think one piece of advice is to prioritize your health.
I think it's absolutely critical particularly for women to make health more preventative in nature. Don't wait for the car to actually break down. The annual maintenance required for your car is similarly required for your body. So go for preventive screening every year, like general annual health checkups: BP, sugar, breast cancer screening. It takes 15 minutes of your time in the year!
Stay safe, stay healthy. Please take care of your health. And of course, do about 20 minutes of walking at least as some kind of physical exercise to keep healthy and if possible, do some yoga meditation to keep your mind healthy.
We have partnered with Niramai and are offering at-home Breast Cancer screening, which you can sign up for through this form.
In the series "FemTech forerunners" we speak to pioneering men and women in the FemTech field. FemTech is defined as software, diagnostics, products and services aimed at bettering women's lives.
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About the author:
Aishwarya Viswamitra is a science communicator with experience in science writing, podcast hosting and social media marketing. When she's not furiously typing a new article, you can find her curled up in a spot of sunlight.