The reluctance to go for a screening is what often impedes early detection of breast cancer, which can make an enormous difference to the prognosis. Healthcare startup NIRAMAI (Non-Invasive Risk Assessment with Machine Intelligence), an innovative technology with its no-touch, no-see, no-pain and radiation-free solution, is encouraging women to not only become aware of regular screening but also take steps to seek immediate treatment if there’s an alarm. 

The startup, which recently bagged the gold prize at the Hack Osaka event in Japan, also raised $6 million in a Series A round of funding led by Dream Incubator, a Japanese VC firm. Taking another step forward, NIRAMAI will also be developing an AI-based software for detecting River Blindness.

NIRAMAI, which in Sanskrit means ‘being free from illness’, detects breast cancer at a much earlier stage than traditional methods or self-examination. Dr Geetha Manjunath and Dr Nidhi Mathur together created and co-founded NIRAMAI in 2016. In 2017, they raised seed funding led by multiple top-notch firms. Named as one of the top 50 NASSCOM IT Innovators in 2009, Dr Manjunath is responsible for the development and application of technology at the startup. 

SheThePeople speaks to Dr Manjunath, about NIRAMAI’s unique features, its reach among the rural and urban population, and why regular screening of breast health should be a priority for every woman. 

What led to NIRAMAI?

Before starting NIRAMAI, I was a Research Lab Director at a corporate research lab developing multiple interesting AI-based solutions to problems in smart cities, customer care and also healthcare. Around the same time, two close relatives of mine were detected with breast cancer and I saw the suffering and the impact it can have on a family. I thought we should solve this problem by using technology and try to save many women from breast cancer. I put up a proposal and started an exploratory research project. After about two years of research, I felt it needed full focus to try the solution on the ground. I partnered with Nidhi and two smart engineers, Himanshu and Siva, to create NIRAMAI.

NIRAMAI Geetha Manjunath
Geetha Manjunath and Nidhi Mathur

A lot of women don’t go for breast cancer screening because of the fear of pain and discomfort using current screening methods. What does NIRAMAI offer differently?

The standard method to detect the cancer is by mammography which compresses the patient breast between 2 plates and uses a light dose of X-rays through it. Women aren’t comfortable with the technician touching their breasts and handling the same to make it work through the above procedure. The test is also expensive and advised for women over 45 years of age. 

Our test is a no-touch, no-pain, no-radiation and no-see solution. The privacy experience is almost like getting into the trial room in a mall when you go to purchase clothes. Women just enter into a small booth, sit there for 15 minutes and come out, their test will be done. No one would have touched or even seen them without clothes.

How does NIRAMAI use Artificial Intelligence and Machine Learning to detect breast cancer and how does it benefit women?

The core of NIRAMAI solution is a technology we have built called Thermalytix© which uses artificial intelligence and machine learning over thermal images. Using a thermal sensor, we capture over 400,000 temperature points on the chest per person in a non-contact way. In order to detect breast abnormalities, we need to analyse those points, which is a huge cognitive task for a radiologist and hence error-prone. We use novel computer vision and machine learning and provide an automated interpretation of these thermal images with a quantitative report that can be used by medical professionals for cancer care.   

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NIRAMAI is radiation-free and privacy-aware. It works on women of all age groups and is also more affordable and accessible than current methods.

NIRAMAI Geetha Manjunath
Screening sketch

You believe it’s not just the technology, but the cultural aspect that drives your initiative. How does it make women more aware of the need for screening?

Being a no-touch, no-see solution, the test addresses the socio-cultural issues in cancer screening and has now become quite sought after being tested by Indian women, particularly for rural women given the cultural discomfort of disrobing in front of a stranger just for routine screening. The procedure is very simple and comfortable for women. They just have to walk into a small booth with a thermal sensor placed three feet from them. The thermal sensor measures the temperature variations on the chest, and NIRAMAI software analyses these thermal signatures to generate a breast health report automatically, which is reviewed by an expert radiologist.

The test can be used in hospitals and diagnostic centres for a preventive health check-up. In addition, the portable nature of this solution makes it suitable for on-site corporate health check-ups, as well as mass screening in rural or remote areas with limited infrastructure.

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Is NIRAMAI also cost-effective compared to other solutions? 

Our solution in commercially available to hospital and diagnostic centres at an upfront cost of one-tenth that of a mammography machine. Also, the skill set required to perform the screening test using Thermalytix isn’t very high. Nurses and paramedics with a little training can perform the test, while the expert radiologist can review the automated report through teleradiology. This lowers the full-time staffing costs for hospitals too. This cost-saving for the hospital can be passed on to the end-user. 

Due to reduced Capex (capital expenditure), many more diagnostic centres and hospital hubs even in tier two, tier three cities can provide the service to women, making it more accessible and affordable to women.  

Coming to rural inclusion, how do you aim to reach out to women who are in rural corners of the country – the women who don’t have access to technology and information?

We work with outreach partners focused on rural screenings to provide our breast health test to rural women. We also provide a real-time triaging report, so that we can quickly identify people who need a follow-up test. With higher volumes, the solution cost per screening can come down to as low as Rs 100 for rural area focused programs.

We’re looking to partner with NGOs and government bodies to conduct large scale camps in rural areas. We’re working towards partnering with the National Health Mission, NITI Aayog and State Health Departments to provide the solution in rural hospitals, primary health centres and in mobile vans that can go to rural corners of the country. Recently, the Mayor of Bengaluru approved free breast cancer screening for underprivileged women at all Bruhat Bengaluru Mahanagara Palike (BBMP) hospitals to be conducted by NIRAMAI.

The overall vision is to take Niramai solution to every land in India and beyond.

NIRAMAI Geetha Manjunath
The team behind NIRAMAI

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How has this technology evolved since 2016 and how does it benefit our future?

We have developed many innovative algorithms over the last few years to enhance the accuracy of the analysis. We have also enhanced the usability of the product so that low skilled workers can be used for conducting the test, without affecting the performance of the solution. In order to create this technology, we have collaborated with multiple reputed hospitals and expert radiologists, collected a database of annotated thermal images.

The several novel features of our machine learning models have resulted in nine granted US patents so far. It has received clinical acceptance by reputed doctors and acceptance from international forums including the largest breast cancer research forum called SABCS. Presently, we have about 25 installations across hospitals and diagnostics centres in ten cities including Bengaluru, Mysore, Hyderabad, Chennai, Pune, Mumbai, Delhi, Dehradun, Vadodara and Bhubaneswar. We want to expand and make it accessible for every woman in India.

We have screened more than 7000 women till now and detected cancer early-on in some of them. This number is important because the innovative method used by us is not just to find lumps, it has accuracy levels of detection that is better than the best-known method of detecting cancer.

What are the challenges you face when dealing in the Indian market?

As this is a new test to detect cancer, doctors are first skeptical whether the test works. Many doctors want to evaluate it before full installation. So, every deployment takes time, with multiple rounds of reviews, pilots and evaluation before they eventually agree to install. This is expected since the use of AI-based tool is not in wide adoption today, especially when we talk about a critical disease like cancer.

How did you manage to make it all-age friendly?

Breast cancer is a leading cause among cancer deaths of women in India, particularly among the urban population. Statistics show that the mean age of Indian women who get affected with breast cancer is much lower compared to western countries. We strive to provide a simple, safe and accurate tool for women of all age groups. Our solution just measures the temperature distribution on the chest, and hence is radiation-free and has no side effects. The breast tissue of younger women is more fibroglandular in nature called dense breasts. Many tests available today do not work on dense tissue as they are based on X-rays. 

Unlike these methods which analyse density differences to detect an abnormality, NIRAMAI solution is based on physiology, vascular flow and cell metabolism which does not depend upon the age of the person. So NIRAMAI solution works on women of all age groups. In fact, we have been able to find cancer in a seventeen-year-old.

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How is its acceptance among women? What have been the major challenges? 

Women really love our solution due to its simplicity and privacy awareness. We realised early on how important privacy awareness was for a screening test after seeing clear willingness and acceptance from women to take the test. However, creating awareness among even working women has been a challenge. We get many inward requests asking for a screening test for their women employees, themselves, family members, etc. However, that is not sufficient. A lot more women need to make it a habit to do an annual breast screening.

One of the reasons that make breast cancer so unpredictable and lethal is the fact that the victim is often unaware that they are suffering from cancer and by the time the symptoms appear, cancer has most likely metastasized. This is the most common problem for people in India or even other parts of the world wherein there is a lack of regular preventive screening method.

NIRAMAI Geetha Manjunath
NIRAMAI

Early diagnosis is very critical. How can we get the conversation going when it comes to regular preventive health checkups for women? What is your advice to them?

Breast Cancer is completely curable. No one needs to die of breast cancer. All we need is early detection and early treatment. For early detection, regular screening of breast health is important

Women need to go for breast cancer check-up even if they have no symptoms. If they find any lump, discharge or continuous pain, they should see a doctor immediately.

If they come clear, then they will be happy. If an issue is found, they should still be satisfied as it got detected it early. The earlier the detection, diagnosis and intervention, the more are the chances of a full recovery.

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