For Geetha Manjunath, working as a senior director with a computer science background in a multinational organisation meant exploring latest technological advances in real-life applications was her norm.Manjunath was working with a research group to create artificial intelligence (AI)-based solutions ranging from transportation to healthcare for customers. The group also had budget for innovation from emerging markets. A part of this research meant working with doctors and hospitals. It was during this time in her career that she would receive some news that would change the course of her life.
“My cousin sister got detected with breast cancer. That was my first introduction to the disease at close quarters and I saw the kind of pain this disease can bring to the family, and this when I was trying to read up on the disease,” she said.
Soon after, Manjunath’s another relative was detected with the disease.
“Both of them were in their late 30s and their early 40s. They were not very old and had small boys. One of them was in 10th grade, giving his final exam, and that was the time I lost my cousin sister.”
Manjunath saw how the family was shattered by this. She observed how, after being bed-ridden for a year or two, when her cousin sister was finally laid to rest, it left a large void in the family.
The beginnings of Niramai
Moved by these events, Manjunath had discussions with her team members and specialists to understand why early detection of breast cancer was not the norm. This was where Manjunath believed there was a large gap between the existing testing methods and their ability to detect disease.It was around this time that Manjunath began working with a technology that involved infrared spectrum that could catch activity at a cellular level.
After working with the technology for one and a half years, Manjunath and her team came up with a solution that could differentiate between cancer and non-cancerous cells. She would work with the MNC full time on the weekdays and continue her research on the screening technology over the weekends.
It was at this time that Manjunath found herself at a crossroad. “At the time, this (the screening technology) was just a project in my lab. It really required focused activity. I decided to quit my job and begin this startup as I wanted to spend more time on this instead of other things.”
Manjunath and three of her colleagues, Nidhi, Himanshu and Shiva, left the organisation to start Non-Invasive Risk Assessment with Machine Intelligence (Niramai).
Changing the face of breast cancer screening
At the heart of Niramai’s intervention is a device that uses Thermalytix — the technology that Manjunath and her team developed by combining thermography and an artificial intelligence-based learning algorithm to search for malignant tumours.
“The process is very simple. The lady walks into a booth and there is a thermal sensor that is placed three feet from the person. She is made to cool down for 10 minutes in an air-conditioned room or by facing a cooler. After 10 minutes, we take her temperature through a process called thermal imaging. We take around five separate postures that can cover the temperature measurement of the entire chest area, and in about 10 minutes, the report would be ready,” Manjunath said.
Manjunath added that the entire procedure takes about 15 minutes of time.
“The good part is that this procedure offers complete privacy. Nobody sees, or touches the person. There is no radiation, there is no pain,” Manjunath said.
Niramai’s screening technique also does not use X-Rays, unlike mammography.
“The use of X-rays means that you cannot repeat the test more than once in two years and you need special infrastructure like a ward with thick walls, and separate section for radiation.”
Manjunath claims that Niramai’s screening can be carried out anywhere as it just measures the temperature. She has said that Niramai’s thermal screening technique, when used along with a standard clinical breast exam (CBE) — a physical exam done by a healthcare provider — could drastically improve a chances of detecting breast cancer early.
"It (CBE) is not quite effective for women to know whether the lump is malignant or cancerous. By using Niramai as an additional tool to self examination, you can see whether the lump is malignant. There are certain growths that are cancerous even before they form lumps. They, in fact, become stage three or stage four at that point. We are able to detect 4mm lesions."
The basic idea around Niramai’s scanning technique is that a tumour is a collection of cells which increases blood flow to a region, and in turn, increases its temperature. The machine uses thermography to detect that rise in temperature even when the growth is as small as 3mm or 4mm. Manjunath said that by using artificial intelligence, the scans that are made by thermography are then run through an algorithm that checks for malignant or cancerous growth by cross-examining key parameters.
She also claimed that the test is more accessible and affordable than the standard breast cancer screening techniques.
“We plan to make this test Rs 100 per scan, while a mammography is around Rs 2,500. There is no need for a doctor to administer the test as it can be done by a health worker as well.”
The test could be carried out at one-third of the cost of a mammogram test. This is because a complete mammogram report in hospitals and diagnostic centres needs the signature of the virologist, which adds to overall the cost of the test, she said.
“The device itself is 1/10th or 1/15th the cost of a mammogram. And more hospitals and diagnostic centres are able to buy the device which improves accessibility for women to go to nearby hospitals and do a mammogram test.”Manjunath asserts that the device's portability is also a key reason for improving the accessibility of the test. As a result, Niramai has managed to organise rural camps with the Karnataka Cancer Society.
When is it ideal to carry out breast cancer screening?
Early detection of breast cancer significantly improves a person’s options for treatment. When asked what would be the ideal time for women to carry out screening for the disease, Manjunath said that a person can do a quick check when they are as young as 20 or 21-years-old too.
“For those that have a family medical history of breast cancer, I suggest they start screening themselves at the age of 18 years.”
Manjunath said that women can come for more regular screenings based on the score.
“If it is low, they don’t need to get it checked for one or two years or so. If their scores are a little higher, they come back in one year or so,” said Manjunath.
It can be used to not just detect breast cancer, but other types of cancers and abnormalities.
Niramai was involved in carrying out a research project funded by the Bill and Melinda Gates Foundation, that was used to detect river blindness.
At the time of the interview, the startup had completed the first phase of this project and was securing approval for the second phase to carry out tests and collect data in Ghana.
River blindness is caused when a person is bitten by a blackfly which leaves behind a filaria worm in the body that causes nodules under the skin, intense itching and blindness if left unchecked.
“River blindness makes 50 million people go blind in Africa. Currently, the only way to detect the worm is to take a sample of the person’s skin and examine it under a microscope, which is not a great way to go about it,” Manjunath said.
Manjunath added that using thermal imaging to examine whether a parasite is living under the skin could be an alternative. “The idea of the Bill and Melinda Gates Foundation is to eradicate this disease by controlling the spread of it, and treating the patient early on,” Manjunath said. “Today, if we want to develop new drugs (to treat river blindness), and see if it works, we have to scrape off the skin. How do you give medicine and see if it is working?”
Manjunath said that thermal imaging could be used for treatment monitoring to check effectiveness of medication being administered and can be used to develop new drugs.
Aside from the research project, Niramai is also expanding its breast cancer detection techniques to other health solutions for those who do have lumps. “For example, pregnant ladies would be able to keep track of their breast health to feed their babies.”
Manjunath said that Niramai is collaborating with a partner to develop mothercare-related products. In addition, the startup has been approaching the National Health Mission to make its breast cancer screening technique a screening methodology for the disease.
Since healthcare is a state-related matter, the startup has also been approaching various states to seek approval for the breast cancer screening technique. At the time of writing this article, Niramai had received permission to screen women in over 50 hospitals under Bengaluru’s municipal corporation, the BBMP.Manjunath said that while Niramai’s proposal with many entities are in the late review stages, the startup has also been working with the Maharashtra government. It won a competition hosted by the state’s Innovation Council. It has out a paid pilot project in two districts of Maharashtra and in Bhopal, Madhya Pradesh.