Diagnosis
Research roundup: AI models independently interpret mammograms, and more
Femtech World explores the latest research and science developments in the world of women’s health.
AI models independently interpret mammograms
AI models have shown excellent performance for detecting breast cancers on mammography images.
The algorithms, submitted for a 2023 AI Challenge hosted by the Radiological Society of North America (RSNA), demonstrated increased screening sensitivity while maintaining low recall rates, according to a new study.
The goal of the Challenge was to source AI models that improve the automation of cancer detection in screening mammograms, helping radiologists work more efficiently, improving the quality and safety of patient care, and potentially reducing costs and unnecessary medical procedures.
A research team evaluated 1,537 working algorithms submitted to the Challenge, testing them on a set of 10,830 single-breast exams – completely separate from the training dataset – that were confirmed by pathology results as positive or negative for cancer.
The algorithms yielded median rates of 98.7 per cent specificity for confirming no cancer was present on mammography images, 27.6 per cent sensitivity for positively identifying cancer, and a recall rate, the percentage of the cases that AI judged positive, of 1.7 per cenr.
When the researchers combined the top three and top 10 performing algorithms, it boosted sensitivity to 60.7 per cent and 67.8 per cent, respectively.
According to the researchers, creating an ensemble of the 10 best-performing algorithms produced performance that is close to that of an average screening radiologist in Europe or Australia.
Individual algorithms showed significant differences in performance depending on factors such as the type of cancer, the manufacturer of the imaging equipment and the clinical site where the images were acquired.
Overall, the algorithms had greater sensitivity for detecting invasive cancers than for noninvasive cancers.
Since many of the participants’ AI models are open source, the results of the Challenge may contribute to the further improvement of both experimental and commercial AI tools for mammography, with the goal of improving breast cancer outcomes worldwide.
The research team plans to conduct follow-up studies to benchmark the performance of the top Challenge algorithms against commercially available products using a larger and more diverse dataset.
Cracking the cold case of endometriosis with big data
Records from millions of patients at UC health centers found correlations between endometriosis, one of the most common diseases in women, and a bounty of other diseases.
Scientists at UCSF have found that endometriosis often occurs alongside conditions like cancer, Crohn’s disease, and migraine.
The research could improve how endometriosis is diagnosed and, ultimately, how it is treated; and it paints the sharpest portrait yet of a condition that is as mysterious as it is prevalent.
The study used computational methods developed at UCSF to analyse anonymised patient records collected at the University of California’s six health centers.
Using algorithms developed for the task, researchers hunted for connections linking endometriosis with the rest of each patient’s health history.
Endometriosis patients were compared with patients who did not have it, and categorised the patients with endo into groups based on shared health histories.
The findings from the UCSF data were mapped against the rest of the UC’s health data to see if they held up across California.
The team say they found over 600 correlations between endometriosis and other conditions, ranging from infertility, autoimmune disease, and acid-reflux, to cancers, asthma, and eye-related diseases.
Some patients had migraines, bolstering previous studies suggesting that migraine drugs might help treat endometriosis.
The study supports the growing understanding of endometriosis as a “multi-system” disorder – a disease arising from dysfunction throughout the body.
Respiratory viruses can wake up breast cancer cells in lungs
Researchers have found the first direct evidence that common respiratory infections, including Covid-19 and influenza, can awaken dormant breast cancer cells that have spread to the lungs, setting the stage for new metastatic tumours.
The findings, obtained in mice, were supported by research showing increases in death and in metastatic lung disease among cancer survivors infected with SARS-CoV-2, the virus that causes Covid-19.
“Our findings indicate that individuals with a history of cancer may benefit from taking precautions against respiratory viruses, such as vaccination when available, and discussing any concerns with their healthcare providers,” said Julio Aguirre-Ghiso, a co-leader of the study and director of MECCC’s Cancer Dormancy Institute.
Prior to the study, some evidence suggested that inflammatory processes can awaken disseminated cancer cells (DCCs) – cells that have broken away from a primary tumor and spread to distant organs, often lying dormant for extended periods.
“During the COVID-19 pandemic, anecdotal reports suggested a possible increase in cancer death rates, bolstering the idea that severe inflammation might contribute to arousing dormant DCCs,” said Dr. Aguirre-Ghiso, who also serves as leader of MECCC’s Tumor Microenvironment and Metastasis Research Programme.
Researchers tested this hypothesis using Dr. Aguirre-Ghiso’s laboratory’s unique mouse models of metastatic breast cancer, which include dormant DCCs in the lungs and therefore closely resemble a key feature of the disease in humans.
The researchers exposed mice to SARS-CoV-2 or influenza virus. In both cases, the respiratory infections triggered the awakening of dormant DCCs in the lungs, leading to a massive expansion of metastatic cells within days of infection and the appearance of metastatic lesions within two weeks.
Molecular analyses revealed that the awakening of dormant DCCs is driven by interleukin-6 (IL-6), a protein that immune cells release in response to infections or injuries.
The Covid-19 pandemic offered a unique opportunity to investigate the effect of respiratory virus infections, in this case from the SARS-CoV-2 virus, on cancer progression.
The research team analysed two large databases and found support for their hypothesis that respiratory infections in cancer patients in remission are linked to cancer metastasis.
The UK Biobank is a general population cohort in which some of the more than 500,000 participants were diagnosed with cancer and other diseases prior to the Covid-19 pandemic.
Researchers from Utrecht University and Imperial College London investigated whether a Covid-19 infection increased the risk of cancer-related mortality among participants with cancer.
They focused on cancer survivors who had been diagnosed at least five years before the pandemic, ensuring they were likely in remission.
Among them, 487 individuals tested positive for COVID-19 and these were compared to 4,350 matched controls who tested negative.
After excluding those cancer patients who died from Covid-19, the researchers found that cancer patients who tested positive for Covid-19 faced an almost doubling of risk of dying from cancer compared to those patients with cancer who had tested negative.
From the second population study, the U.S. Flatiron Health database, researchers drew data pertaining to female breast cancer patients seen at 280 U.S. cancer clinics.
They compared the incidence of metastases to the lung among Covid-19-negative patients and Covid-19-positive patients (36,216 and 532 patients respectively).
During the follow-up period of approximately 52 months, those patients who came down with Covid-19 were almost 50 per cent more likely to experience metastatic progression to the lungs compared with patients with breast cancer without a diagnosis of Covid-19.
“Our findings suggest that cancer survivors may be at increased risk of metastatic relapse after common respiratory viral infections,” said Dr. Vermeulen.
Losing weight before IVF may increase chance of pregnancy
A systematic review and meta-analysis of randomised controlled trials (RCTs) has assessed whether weight loss interventions before in vitro fertilization (IVF) improved reproductive outcomes.
The review found that weight loss interventions before IVF could increase the chances of pregnancy, especially in unassisted conception, although the effect on live births was unclear.
The findings are published in Annals of Internal Medicine.
Researchers from the University of Oxford reviewed 12 RCTs comprising 1,921 patients conducted between 1980 through 27 of May 2025.
Inclusion criteria included studies conducted on women at least 18 years old with a BMI of 27 kg/m2 or greater who were seeking IVF with or without intracytoplasmic sperm injection treatment for infertility.
Outcomes of interest were the number of participants achieving pregnancy without IVF (unassisted pregnancy), with IVF (treatment-induced pregnancy), overall (unassisted plus treatment-induced) and those delivering a live infant.
The researchers found that participants were typically women in their early 30s with a median baseline BMI of 33.6 kg/m2.
Weight loss interventions studied included low-energy diets, an exercise program accompanied by healthy eating advice, and pharmacotherapy accompanied by diet and physical activity advice.
Overall, weight loss interventions before IVF were associated with greater unassisted pregnancy rates. Evidence was inconclusive on the effect of weight loss interventions on treatment-induced pregnancies.
Evidence on the association between weight loss interventions before IVF and live births was uncertain, although there was moderate certainty of no association with pregnancy loss.
The findings suggest that weight loss interventions before IVF increase total pregnancies, mainly through an increase in unassisted pregnancy rates.
However, further high-quality clinical trials testing different weight loss interventions, particularly those known to achieve greatest weight losses, such as low-energy total diet replacement programmes, are needed.
Menopause is often absent from women’s electronic health records, a study of nearly 396,000 women has found.
Researchers found menopause appeared almost seven times more often in participant surveys than in electronic health records (EHRs).
The findings suggest important reproductive health information, including age at menopause, may often be missing from health records used for research.
Audrey Hendricks, associate professor of bioinformatics at CU Anschutz and the study’s principal investigator, said: “Ultimately, we cannot study what we do not measure. We cannot treat what we do not know.
“Menopause has enormous implications for women’s health, but if we don’t consistently capture when menopause occurs and other important reproductive health information, we limit our ability to understand how this transition affects disease risk and health outcomes.”
Researchers at the University of Colorado Anschutz analysed data from women taking part in the National Institutes of Health’s All of Us Research Program.
They compared menopause information reported by participants in surveys with menopause diagnoses recorded in their electronic health records.
Around 193,000 menopause observations were identified in survey data, compared with approximately 28,000 diagnoses in EHR data.
Menopause was documented in electronic health records for only about 7 per cent of women in the dataset.
Nearly all participants with a menopause diagnosis recorded in their EHR also reported menopause in survey data. However, substantially fewer women had menopause documented in their health records.
Other important information was also frequently unavailable, including age at menopause, which researchers may use when examining links between menopause and chronic disease risk.
Menopause is a physiological transition that can affect cardiometabolic health and many other aspects of women’s health.
Researchers said relatively little is known about how factors including the timing and type of menopause influence health outcomes across diverse populations.
Large-scale programmes such as All of Us combine participant surveys, electronic health records and genomic data, but menopause-related research depends on relevant reproductive health information being available.
Missing menopause information can make it harder to investigate how the transition relates to health and disease.
The findings may also help researchers using All of Us data define menopause-related study populations, design studies and estimate how many participants are needed.
Hendricks said: “We have an enormous opportunity to use large-scale datasets to understand women’s health across the menopause transition and to identify who may be at greater risk for disease.
“But we need to make sure that the information researchers need is actually being collected.
“We must do a better job of capturing women’s health information, including reproductive health and measures related to menopause.”
Researchers said more complete and consistent collection of menopause and reproductive health information could help future studies examine factors such as age at menopause and their relationship with disease risk and health outcomes.
The FDA has granted accelerated approval to AstraZeneca drug Etcamah for certain adults with advanced breast cancer carrying an ESR1 mutation.
Etcamah, also known as camizestrant, was approved in combination with a CDK4/6 inhibitor, either abemaciclib, palbociclib or ribociclib.
The treatment is for adults with hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer when an estrogen receptor-1 (ESR1) mutation is detected during aromatase inhibitor and CDK4/6 inhibitor therapy using an FDA-authorised test.
ESR1 mutations are acquired resistance mutations that tumours may develop during treatment with aromatase inhibitors, a type of endocrine therapy commonly used as a front-line treatment for locally advanced or metastatic breast cancer.
Fewer than 5 per cent of patients have the mutation when HR-positive metastatic breast cancer is diagnosed, according to the FDA. After disease progression on an aromatase inhibitor, nearly 40 per cent have the mutation.
Acting FDA commissioner Kyle Diamantas said: “Women living with metastatic breast cancer face an uphill battle as their tumors continuously evolve to escape treatment.
“We owe them every weapon in our arsenal.
“Today’s approval delivers a win to these patients by granting them a targeted therapy designed specifically to overcome resistance, giving them more time before their disease progresses.”
The accelerated approval programme allows earlier approval of drugs that treat serious conditions and fill an unmet medical need based on surrogate or intermediate endpoints.
For Etcamah, approval was based on how long patients lived without their disease worsening, measured from when the resistance mutation was first detected in their blood.
The FDA said it has not yet been confirmed whether intervening when the mutation is detected, rather than waiting until disease progression is confirmed, results in a clinically meaningful benefit. Confirmatory studies are therefore required to verify and describe clinical benefit.
Angelo de Claro, director of the FDA’s Oncology Center of Excellence, said: “I commend both the FDA and the sponsor for their commitment to advancing cancer care and securing this accelerated approval.
“This marks the first FDA approval of a cancer therapy guided by the detection of a resistance mutation in circulating tumor DNA (ctDNA) before imaging tests show that the disease is progressing.
“But additional evidence is needed to confirm clinical benefit.”
Circulating tumour DNA, or ctDNA, consists of small pieces of tumour DNA released into the blood and can allow earlier molecular detection of resistance mutations.
The FDA also authorised the Guardant360 CDx assay as a companion diagnostic to identify patients with breast cancer who have ESR1 mutations for treatment with camizestrant.
Efficacy was assessed in a clinical trial comparing a switch to Etcamah plus a CDK4/6 inhibitor with continued treatment using an aromatase inhibitor plus a CDK4/6 inhibitor.
Estimated median progression-free survival was 16 months in the Etcamah group, compared with 9.2 months in the aromatase inhibitor group.
Etcamah’s prescribing information includes a boxed warning about the risk of irregular heart rhythm when taken with certain other medicines. It also includes warnings about an abnormally slow heart rate and potential harm to an unborn baby.
The FDA convened its Oncologic Drugs Advisory Committee for the application on 30 April 2026.
Four leading cardiovascular health groups have agreed new guidance for healthcare professionals assessing patients with suspected heart attacks.
Historically, some less common forms of heart attack, which evidence shows affect women far more than men, have been classified as less important, with treatment and care often worse as a result.
Experts said women had been receiving less effective treatments that did not always target the specific cause of their heart attack and could even make them more unwell.
The changes were announced in Munich on the opening day of the annual congress of the European Society of Cardiology (ESC).
Professor Bryan Williams, chief scientific and medical officer of the British Heart Foundation, said: “This is a landmark moment, a radical shift in how we define and diagnose heart attacks worldwide which will transform people’s care.
“For decades, women have missed out on accurate diagnoses and treatment.
“This focus on finding less common causes of heart attacks, which predominantly affect women, should help to change that. It could be life-changing for huge numbers of women in the UK and worldwide.”
The new guidance upgrades three types of heart attack that can be up to 10 times more common in women and are often caused by childbirth, exercise and emotional stress.
The most serious cases, previously known as “type 1” and now classed as “primary” heart attacks, had previously prioritised those caused by a clot blocking blood flow to the heart.
Other forms can involve reduced blood flow for different reasons, including the tightening or tearing of coronary arteries. These can be more likely to be missed or treated less urgently.
The guidance also introduces a lower diagnostic threshold for women based on levels of troponin, a protein released into the blood when the heart is injured and damaged.
Previously, women were expected to meet the same troponin threshold as men to receive a diagnosis.
Williams said the streamlined heart attack categories would also help patients understand the cause of their heart attack and what comes next.
The three upgraded types are coronary artery spasm, coronary embolism and spontaneous coronary artery dissection (SCAD).
Coronary artery spasm involves the tightening of an artery, which can deprive the heart muscle of blood and oxygen. It can be caused by emotional stress, exercise or extreme cold.
Coronary embolism occurs when a blood clot or fatty deposit travels to a coronary artery and causes a blockage.
SCAD is caused by a tear in a coronary artery. Around 80 per cent of cases occur in women, and it often happens during or soon after pregnancy.
Professor Nicholas Mills, a cardiologist at the University of Edinburgh who led the international taskforce behind the guidance, said it was “the first time that we’ve had a truly global approach to aligning how we diagnose what is probably the most important diagnosis there is”.
He said: “It kills so many people, and we’ve never got everyone together around the world to agree how we’re going to describe it, classify it, explain it to our patients.
“Our job now is to implement this as widely as possible. It’s just as relevant for the UK as it is for any other country around the world. It is a revolution. It’s going to make care better for patients.”
Mills said there had been “unintended systematic bias against women”, including through the use of the key blood test for diagnosing heart attacks at an average level, which picks up all men but misses some women.
He said: “This is used for all types of heart attack in every emergency department in the world, and we want to make sure that it’s used correctly.”
The guidance was drawn up by the ESC, the American College of Cardiology, the American Heart Association and the World Heart Federation.
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