Dr Geetha Manjunath, the CEO and CTO of NIRAMAI, an Indian deep-tech startup, tells Jisha Krishnan about its pioneering breast cancer screening solution, healthcare challenges, business opportunities, need for collaboration, and more.

By Jisha Krishnan

Based on data from the Union Health Ministry of India, breast cancer ranks as the number one cancer among Indian females, with an incidence rate of 25.8 per 100,000 women and mortality of 12.7 per 100,000 women. Studies show that over 90 per cent of breast cancer cases are curable if detected early.

However, most breast cancers in India are detected at a late stage, unlike in countries that have espoused regular breast screening. Moreover, breast cancer is now increasingly common among younger women, for whom traditional methods of detection are often not be quite accurate.

Mammography, for instance, which tries to find malignant lumps in the breast using density differences, is known to have its limitations in the case of women under 40 years of age, who typically have denser breasts. Not to forget, the fear of radiation and the pain and discomfort associated with mammography.

In such a scenario, NIRAMAI, a deep-tech startup from India, has broken new ground by offering a radiation-free, non-invasive, non-touch, breast cancer screening solution. NIRAMAI – the acronym for Non-Invasive Risk Assessment with Machine Intelligence – has nine patents in the US and one in Canada to its credit.

Thermalytix, the core technology, uses a high-resolution thermal sensing device and a cloud-hosted analytics solution for analysing the thermal images. The solution is portable, accurate, privacy-aware and can be used for women of all ages to detect breast abnormalities at a much earlier stage than traditional methods or self-examination.

NIRAMAI in Sanskrit means being free from illness. And the Bengaluru-based startup, founded in 2016, is harnessing the power of big data analytics, artificial intelligence (AI) and machine learning (ML) to create a world where healthcare is accessible and affordable for all. The only Indian company listed on 2019 cohort of AI 100 startups in the world by global business data intelligence platform CB Insights, NIRAMAI recently bagged the Gold prize in Hack Osaka 2019, among 2000 startups.

“Use of point-of-care devices for early detection is the need of the day, so that we can reduce treatment cost and improve effectiveness of treatment,” says Dr Geetha Manjunath, CEO and CTO, NIRAMAI. Armed with over 25 years of experience in IT research and a PhD in Computer Science from Indian Institute of Science, she has been instrumental in designing an innovative, cost-effective solution to tackle the growing challenge of breast cancer in India.

“We have obtained regulatory clearance from Indian DCGI and have also published four clinical trial publications showing the effectiveness of the test. Hence, many hospitals have come forward to deploy our solution,” avers Dr. Geetha. “There is more visibility for femtech (or female technology) now. More female engineers are opting for technical ladder and confident in expressing their ideas. It is good to see that change,” she notes.

Edited excerpts from an interaction with the technology enthusiast who is revolutionising India’s battle against breast cancer:

What prompted you to start NIRAMAI?
I was a senior director in a corporate research lab working on multiple interesting use cases of AI with my team. The trigger to start working on this technology research problem was when I lost two of my young cousins to breast cancer due to late detection. As I researched about this issue, I found out about thermography, which had the ability to detect abnormalities in all age groups but had accuracy issues. I created a small team to explore the use of ML algorithms to address that gap, and when I started seeing early promising results, we decided to do this full time and founded NIRAMAI with my earlier team members – Nidhi, Himanshu, and Siva.

Why was the ‘experience’ aspect significant?
Women have a lot of inhibitions to take a breast screening test. There is a social stigma attached to someone going into a cancer hospital for a test. Women are reluctant to disrobe in front of others, or even allow a technician to touch them. NIRAMAI is a privacy-aware solution that addresses these concerns. During the test, no one sees or touches the person. We just create a small booth. The lady enters the booth; she is in there for about 15 minutes, and when she comes out her report is ready. This simple experience has been instrumental in getting more women to come for our test, especially in camps.

Why is early breast cancer detection such a challenge?
Early detection is critical to save lives. It reduces treatment cost, increases treatment efficacy, and enables better quality of life post-treatment. In India, women wait till there is a huge lump – stage 3 or stage 4 – before visiting a doctor. Current methods used for screening are not affordable and accessible to many women. Hence, the breast cancer survival rate in India is just about 50-60 per cent. Countries with effective implementation of regular breast screening reach over 90 per cent survival rates. Breast cancer is completely curable, as long as we detect it early.

Do you see personalised cancer diagnostics and treatment becoming a reality in the near future?
Personalised cancer diagnostics and treatment are important as every cancer is different and heterogeneous in nature. However, such treatment is affordable to very few people today. I think it will take a long time to make it a norm. In India, we are still in the age of generic medicines.

What can India do to democratise cancer care?
We must enable large-scale awareness programmes to educate people about good lifestyle; include aspects of self-examination and awareness about early symptoms in training programmes in colleges. We need to create facilities for early detection in primary healthcare centres, small and medium diagnostic centres and private clinics. Also, insurance for cancer treatment is a must.

Are there enough data-driven cancer research platforms in India?
There is definitely a lot of scope for research and innovation in the cancer care pathway. Cancer is one of the top three non-communicable diseases (NCDs) affecting mortality today. There is a huge gap in affordable and accessible tools for each sub-category of cancer, scope for data-based decision making in hospitals for diagnosis and treatment planning. There are some efforts in creating electronic medical record (EMR) or electronic health record (HER) systems, but I think this area is fragmented with too many small players catering to 10-100 centres only. It will help to have the government intervene and provide an integration platform to enable useful data-driven platforms.

Can Thermalytix technology help detect other diseases?
The technology is not just limited to breast cancer. Thermalytix can be used for many diseases, which are affected due to abnormal vascularity and have a source of pain closer to the skin. River Blindness is one such disease, mostly found in Africa, resulting in more than 50 million blind people and other significant disabilities. Using Thermalytix vascularity analysis, we are trying to detect live adult worms of Onchocerciasis, which causes the disease.

Do deep-tech innovations in healthcare take longer to realise commercial outcomes?
Innovations in healthcare, in general, have long gestation periods. Especially technique such as ours, which is a clinical decision support tool for the doctor, goes through a lot of scrutiny. Technical algorithms form just about 20 per cent of the solution. Understanding the exact customer problem and stakeholders in delivering the solution is critical to determine the right product market fit. We need innovative business models that provide good return on investment to the customer delivering the solution as well as the end-user. We need to prove the efficacy of the test through clinical trials and go through evaluation by top doctors to ensure that the solution will not adversely affect the diagnosis and treatment of patients. Health tech innovations also need to get regulatory clearances depending upon the risk category they fall into. All these take time.

You recently worked with the Bill & Melinda Gates Foundation (BMGF). How important is collaboration in the healthcare innovation space?
Collaborations and endorsement with well-known organisations like BMGF help in establishing the capabilities of startups. People now look up to us an innovative company in serious business. These endorsements are important when we are creating healthcare innovations. No hospital will work with a small startup, which can close down anytime.

Does the company have plans to expand globally?
We plan to go global in the long run. Our vision is to help every woman do a screening early and address any issue, rather than wait for a lump or another symptom. There is need to create awareness about preventative screening for women. Our single goal, for the next few years, is to spread this awareness and enable a number of women to get access to our solution across multiple cities. We would love to partner with corporate employee welfare organisations, insurance providers, hospitals and diagnostic chains, community outreach entities, NGOs and cancer societies to conduct population screening in urban as well as rural areas and enable affordable healthcare to the underprivileged.