Mental health
Interview: The race to close the gap on late-stage breast cancer diagnoses
New research suggests that one in three eligible women in the US skip recommended mammograms – leading to late-stage breast cancer diagnosis, doubling treatment costs and increasing risk. Dr. Rani Aravamudhan, senior medical director at Nomi Health, speaks to Femtech World about addressing the problem, by helping employers and healthcare providers to reach women eligible for mammograms.
As part of its Trends in Spend series, Nomi Health has examined breast cancer screening and treatment data, finding that delayed detection negatively impacts patient outcomes and significantly increases financial burden.
Key findings from the report reveal that, while screening rates among women aged 40 to 74 have improved in recent years, over one-third continue to miss mammograms screenings at the recommended frequency, leaving significant gaps in preventive care.
Nomi highlights that unscreened women with advanced-stage breast cancer face treatment costs of up to US$120,485 which is US$44,029 more than screened patients at the same stage.
They are also more than twice as likely to be diagnosed with metastatic cancer.
Improving access and awareness
Currently, women over 40 are recommended to have a mammogram screening annually or bi-annually.
However, despite the year-over-year rate slowly trending upwards, still only around 63 per cent of eligible women are receiving their mammograms.
In order to improve screening uptake, Aravamudhan emphasises the importance of increasing awareness of mammograms.
“Despite the amount of data showing that mammograms are available at no out-of-pocket cost, not all women are aware of this – and I say that sympathetically- the healthcare system can be confusing,” says Aravamudhan.
“People wonder: what’s covered under my plan? I believe the system has become unnecessarily complex over the years, and that complexity discourages people from seeking care when they should.
“Certain services like annual physicals, mammograms, and colonoscopies must be made available to everyone at zero out-of-pocket cost.
“However, whether that’s true depends on someone’s insurance – often only if they go to an in-network facility. If they go out-of-network, they might still be charged. Understanding what’s in-network and what’s not can take real effort.”
Another barrier to mammogram uptake is access to these screenings, says Aravamudhan, highlighting that even in urban areas with ample facilities, getting an appointment isn’t always easy, with long wait times pushing back diagnoses.
“Even if financial access is fine, practical access is another issue. You need somewhere close by that can see you soon,” says Aravamudhan.
“In a rural or lower-income area, someone might need to travel 30 minutes or more just to reach a facility, they may have to take half a day off work for a 20-minute procedure.
“This is a very real, very practical problem. There are currently encouraging efforts though – some organisations, whether non-profits, hospital systems, or insurers have mobile units that go out to communities. These allow women to come to the unit, get their mammogram, and go.
“This is the kind of accessibility we need to expand.”
Aravamudhan suggests that these mobile units could also visit workplaces and retail stores to improve screening accessibility and reduce time needed off work for women.
“When we talk about access, it’s multi-layered,” says Aravamudhan.
“A relationship with a primary care provider (PCP) is also vital. Studies consistently show that when patients have a strong relationship with a PCP – someone who regularly checks in and encourages them to get screened – they are more likely to follow through.
“That trusted relationship leads to better compliance. And it’s not just mammograms – the same goes for Pap smears, colonoscopies, and so on.
“The provider doesn’t need to be forceful, just clear that this matters. It helps when they explain why it’s important and follow up. That relationship with a PCP matters a lot – not only for preventative screenings but for so many aspects of healthcare.”
Effective intervention for better outcomes
Awareness and access issues are contributing to delayed diagnosis, and Nomi’s analysis reveals that delayed diagnosis leads to an increase in the severity of treatment required.
Aravamudhan says employers, health plans, and healthcare providers all have a role to play in intervening more effectively to promote early detection.
“Employers are the ones providing health insurance for their employees and their dependents, so they have a significant stake in all of this,” says Aravamudhan.
“It’s crucial that we all – collectively – promote the value and benefits of preventive care early and often.
“It’s not just about getting a test or having a screening. It’s about investing in the health of our population. As individuals, we have a responsibility to do that for ourselves too. If I don’t invest in my own health, I risk having health issues that could impact my ability to work – and that, in turn, affects my family.
“Employers and health plans can do more during annual enrollment periods – not just talk about plan options, but also highlight the importance of preventive care with clear, relatable examples.
“They can share real stories – with permission – or public examples, such as someone well known who caught cancer early through screening and is now doing well. That kind of storytelling works and makes it real.
“Just like we reassure our children before a dentist visit, we need to normalise preventive care. It’s uncomfortable, but not painful – and it only takes 20 minutes. That kind of messaging – from colleagues, managers, health champions – can make a big difference.
“Reminders also help – as long as they’re targeted. Younger people may respond better to texts or emails, older people to phone calls. Tailor the channel to the audience.”
Another tool employers could utilise are incentives, says Aravamudhan, highlighting that many employers have healthcare rewards schemes
“Data shows that only a small percentage of people maximise those benefits,” says Aravamudhan.
“So there’s a lot of room for improvement – and a lot of opportunity to drive better engagement and health outcomes.”
Preventative care as a cost containment strategy
The Nomi analysis revealed that women who did not go for their mammograms who are diagnosed with advanced-stage breast cancer face treatment costs of up to $120,485, a total of $44,029 more than screened patients at the same stage.
The average cost per breast cancer episode was $25,765 for unscreened women, 18 per cent higher than for those who received their routine screenings.
In order to prevent these costs, Aravamudhan says that investment is needed in preventive care – whether employers, individuals or the wider system.
“I’m talking about continuous preventive care – a consistent, system-wide approach,” says Aravamudhan.
“It starts with disease prevention – such as vaccinations, for example. We absolutely should be promoting vaccines. We’ve already seen the consequences – falling vaccination rates in some areas like Texas have led to outbreaks of measles. Children are being hospitalised, some placed on ventilators, and tragically, some have died. That’s the real cost – not just financial, but lives lost.
“The next level of preventive care is screening. If someone is going to develop something like breast or cervical cancer, let’s catch it early.
“Early detection means a far better chance of survival and a much lower cost of treatment.
“Preventive care evolves into monitoring. We don’t just walk away after someone’s been treated for cancer – we continue to monitor them to make sure it doesn’t return, or to catch any new risks early. That’s still preventive care – just at a different stage.
“There is also chronic condition management. That might mean lifestyle changes, medication compliance, following a low-salt diet – whatever it takes. That kind of support system is key.
“And let’s not forget mental health. People often overlook preventive care in this space, but it absolutely exists. Building strong, consistent relationships with clinicians – whether through your GP, your insurer, or a nurse care manager – really matters.
“Those ongoing connections ensure preventive care stays front and centre. It helps reduce the long-term impact of conditions, and it lowers costs over time.
“All of this leads to healthier, happier families – and ultimately, far lower costs for employers. The alternative is simply more expensive – financially, socially, and emotionally.”
Housing, work and fertility pressures are stopping many Britons growing the families they want, new research suggests.
A UK fertility report found that 79 per cent of people surveyed who had tried to conceive in the past five years would like more children than they currently have.
Among parents with one child, that figure rises to 88 per cent.
The report surveyed more than 1,000 people across the UK who had tried for a baby in the past five years.
While birth rates continue to fall, the findings suggest it is not because people no longer want children. Instead, many respondents said external pressures are making it harder to grow their families.
The findings, from wellness brand Wild Nutrition’s Fertility Disconnect report, highlight how financial pressures, fertility struggles and gaps in reproductive health knowledge are shaping modern family life in the UK.
Gail Madalena, fertility nutritional therapist at Wild Nutrition, said: “People often assume fertility begins the moment they decide to try [for a baby].
“In reality, egg and sperm health are shaped months and years earlier.
“By the time someone starts thinking about fertility, their body has already been responding to its environment for a long time.”
Among the biggest barriers, 26 per cent said career progression affected their family plans, 25 per cent cited housing affordability and lack of space, and 52 per cent said they required medical intervention during their fertility journey.
The report also found that almost a quarter of respondents had spent more than two years trying to conceive.
Trying for a baby can take a significant toll on mental health and relationships, especially for those navigating fertility treatment.
According to the research, 38 per cent of respondents said trying to conceive had negatively affected their mental health. That figure rose to 99 per cent among people undergoing fertility treatment.
Julianne Boutaleb is a perinatal psychologist.
She said: “Navigating a fertility journey is about so much more than medical appointments and procedures.
“It’s an emotional marathon that can take a huge toll on your mental wellbeing.
“Sadly, the stats show that 15 per cent of couples going through fertility treatment say their relationship has been irrevocably impaired.”
The report also highlighted the realities of secondary infertility, which affects around one in 20 people, challenging the assumption that having one child means conceiving again will be straightforward.
Researchers found many people felt under-informed about fertility, particularly younger adults.
Ten per cent of Gen Z respondents said they “know nothing” about fertility, while only one in five respondents said they know “a lot” about egg health.
The report also found that 60 per cent of women were unaware of fertility testing options, and one in five Gen Z respondents said they felt uncomfortable discussing fertility, even with their partner.
Around 40 per cent of those surveyed supported fertility education being included in schools, covering topics such as egg health, sperm health and hormonal health.
The report also explored how lifestyle and long-term health may influence fertility outcomes.
Many respondents said they only made changes once they started trying to conceive.
Some 44 per cent improved their diet when trying for a baby, while 32 per cent reduced alcohol intake at that stage.
The report also referenced emerging research that suggests ultra-processed foods and microplastics could have an impact on reproductive health.
While fertility conversations often focus on women, the findings showed male fertility issues are also affecting many families.
Seventeen per cent of respondents cited sperm health issues as a barrier to conception, while male factors contribute to around half of all fertility challenges.
Only one in four men said they would share fertility struggles with friends.
“Many causes of male infertility are entirely treatable yet so often the last resort is the first response,” said Ian Stones, co-founder at Test Him Ltd.
The findings come as UK birth rates remain below replacement level.
The report noted that the UK fertility rate is now 1.41, meaning that on average women give birth to 1.41 children over their lifetimes. The replacement rate, or rate that maintains population numbers, is 2.1.
It also said the average age of mothers has risen to 31, while birth rates are falling across most age groups except among over-40s.
“There is no single fertility story, and it is rarely a simple, linear narrative,” said Dr Zeynep Gurtin, lecturer in women’s health at UCL.
Dr Gurtin added that better fertility education, fairer access to treatment and more open conversations around infertility and pregnancy loss are needed.
Cognitive behavioural therapy (CBT) may offer short-term relief for menopause insomnia and night-time hot flushes, a pilot study suggests.
CBT is a structured, short-term talking treatment that helps people change thoughts and behaviours that can worsen sleep problems.
Researchers found the intervention was linked to meaningful short-term improvements in insomnia severity, hot flush interference, sleep self-efficacy, or confidence around sleep, and depressive symptoms.
The Menopause Society said insomnia affects an estimated 20 to 60 per cent of perimenopausal and postmenopausal women in the US.
Ongoing research is focusing on effective treatments because insomnia can have serious physical and psychological effects.
Dr Monica Christmas, associate medical director for The Menopause Society, said: “Nocturnal hot flushes (night sweats) and sleep disruption can have a significant effect on the quality of life with many women claiming extreme impairment due to symptoms that often start in early perimenopause and last 10 or more years.”
“Sleep disturbances can persist even in those using pharmacological therapy to manage hot flushes.
“The study’s findings highlight the utility of cognitive-behavioural therapy as a standalone treatment for insomnia and hot flushes, offering women an alternative or adjunct to pharmacological treatments.”
Insomnia is defined as disturbed sleep associated with distress or impaired daily functioning and is one of the most common complaints in perimenopause and postmenopause.
It can reduce quality of life and is linked to higher healthcare use and costs, disability, depression and cardiovascular disease.
Hot flushes occur in 60 to 80 per cent of women during the menopause transition and can persist for four to five years on average.
Night-time hot flushes are linked to sleep disruption, and women may respond by napping or spending longer in bed, which can help keep insomnia going.
Previous studies have shown that cognitive behavioural therapy is an effective treatment for insomnia and may also help women cope with hot flushes and other menopause symptoms.
However, few trials have looked at both insomnia and hot flushes together.
Insomnia during and after the menopause transition is complex and can have many causes, including ageing, hormone fluctuation, hot flushes, other sleep disorders, psychiatric and medical conditions and psychosocial stressors.
Because women with acute and sustained insomnia can experience greater negative health effects, effective treatment is important.
The pilot study concluded that CBT was feasible and may be a promising approach for menopause-related insomnia and nocturnal hot flushes, although the benefits appeared to lessen after three months.
By Morgan Rose, chief science officer, Ema and Erlyn Macarayan, PhD, vice president, data science at PatientsLikeMe
May is Mental Health Awareness Month.
Most of the conversation this month treats depression and anxiety as standalone conditions, things people experience independently of their physical health.
For the patients we serve through the PLM platform, that framing leaves out something important.
Mental health in chronic illness functions as an overlay on a condition that does not end. It runs alongside the disease for as long as the disease lasts.
We have been analysing anonymised, aggregated conversational data from Ema, our agentic AI for patient support, and PLM users.
One pattern stands out across the dataset: what people are reaching for when they reach out.
The single most common behavior in the data, appearing in nearly 500 unique conversations, is the search for someone with the same diagnosis.
“Can you connect me with an MS group?” “Are there other people here with fibromyalgia?” “Does anyone in my city have what I have?” “I am looking for people like me.”
That request has a name in the research literature. It is peer support, and in the context of chronic illness, it functions as a mental health intervention.
The clinical case for peer recognition
The literature on peer support in chronic illness is well-developed.
Connection with others who share your diagnosis is associated with reduced depression severity, better treatment adherence, and a measurable drop in perceived isolation.
The mechanism behind those outcomes is recognition.
Someone else has lived inside the same symptom, navigated the same medication side effect, sat with the same diagnostic delay, and that recognition closes a specific gap that conventional therapy alone often cannot reach.
Therapists matter.
So do the people who know what an MS fatigue day actually feels like, what a fibro flare does to a person’s sense of self, what it is to be 34 and on a chemo regimen your friends cannot picture.
In clinical terms, that community is part of the care infrastructure for chronic illness, alongside medications, specialists, and labs.
PLM was built around this insight.
What Ema adds is a conversational layer that can route someone toward that community at the moment of need, before they have finished learning a platform.
“The PatientsLikeMe community has made living with MS manageable and in some bizarre way, even enjoyable sometimes because I’ve garnered these friendships and I am no longer afraid because all these other people are doing it with me.”
- PLM member living with MS
Why the burden is hard to address inside a clinical visit
There is a structural reason the mental health weight of chronic illness routinely goes undertreated. The visit is consumed by the physical condition.
The provider’s task list is long, the slot is short, and there is rarely a person in the room whose role is to ask how the patient is actually doing.
Some of that weight is also biological.
Depression in MS, for example, is roughly twice as common as in the general population, and is frequently undiagnosed because fatigue, cognitive change, and social withdrawal can be read as MS symptoms.
Similar overlap exists across cancer, autoimmune disease, and chronic pain.
Two systems run in parallel, shaped in part by the same underlying biology, yet routinely treated as separate.
That gap is where unguarded conversation tends to appear, and where the PLM data gets revealing.
The disclosure pattern
When mental health is mentioned in the PLM dataset, it rarely appears at the start of a conversation.
It surfaces sideways, after trust has been established by a clinical or logistical question.
One thread opens with questions about gabapentin and how PatientsLikeMe works.
A few exchanges later, the same user asks whether Ema has crisis resources. The conversation moves to feeling anxious, then depressed, then “I don’t know how I feel.”
Another thread spends several turns on MS management, medication questions, and which groups exist on PLM. Then the user writes, “My MS is making me feel overwhelmed and like everything is just too much. I’m not sure how to go on.”
Ema’s response in moments like that one matters.
She receives what was actually said, validates its weight, offers concrete steps for support, and connects the user back to the PLM community for the kind of isolation a clinical encounter cannot address.
The conversation pivoted because the user needed it to, and Ema followed.
That arc, the one that begins with a logistical question and ends in a disclosure about feeling unable to go on, is one of the clearest pictures we have of what the untreated chronic illness mental health burden looks like from the inside.
Crisis in the middle of an ordinary conversation
In 25 separate conversations in the PLM dataset, the mental health weight rose to the level of crisis. Users disclosed suicidal ideation directly.
One wrote, “I’m thinking of suicide.” Another asked what to do “if having a crisis and feeling suicidal.”
These conversations were happening on a patient platform, amid otherwise routine exchanges about a chronic condition.
The disclosures came in mid-thread, with no triage process to queue them.
Ema’s response was immediate and grounded. Hotline numbers, emergency services, an acknowledgment of the seriousness, and a reminder that the person is not alone.
The infrastructure to capture a moment like that at any hour, with no wait time, is something the conventional care system struggles to provide at scale. People are reaching for something in those moments.
Ema is built to be the thing they reach toward, and to hand them off to the human resources they need next.
What the data points toward
Pulling the patterns together, a coherent picture emerges.
People living with chronic illness carry a real and persistent mental health burden, and the burden tends to surface in the same conversations where they are managing medications, asking about treatment, and looking for others who share their diagnosis.
The most common request across the dataset is the request for community.
For PLM, that is the platform’s foundational thesis turning up in every dataset.
The platform was built on the premise that finding others with your condition is therapeutic. The conversation data confirms this, with patients explicitly asking for the connection.
For Ema, the implication is a design constraint.
We need to recognise when a question about gabapentin is an entry point into a question about feeling overwhelmed.
The route to peer recognition has to be as accessible as the route to clinical information.
And a moment of disclosure, whenever it arrives, has to land somewhere it can be received and responded to with care.
For Mental Health Awareness Month, the implication for chronic illness patients is direct.
Mental health in this population does not require a separate appointment that most patients will not make. It requires the people who already share the diagnosis to be part of the conversation, and it requires the platform to make that connection fast.
That is the work. It is what the data is asking us to build.
About Morgan Rose
Morgan Rose is chief science officer at Ema, an AI platform for patient health engagement.
Ema partners with health platforms and life sciences organisations to deliver clinically grounded, emotionally intelligent AI support where patients already are.
Learn more about Ema at emahealth.ai
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