Mammography screening supported by artificial intelligence is a safe alternative to today’s conventional double reading by radiologists, a new study has shown.
The potential of AI to support mammography screening has attracted much attention, but how this is to be optimally conducted and what the clinical consequences will be remains unclear.
Female breast cancer has now surpassed lung cancer as the most commonly diagnosed cancer worldwide, with an estimated two million new cases registered in 2020.
The Mammography Screening with Artificial Intelligence (MASAI) trial is the first randomised controlled trial evaluating the effect of AI-supported screening.
The study, led by researchers from Lund University in Sweden, addressed the clinical safety of using AI in mammography screening and found that AI screening is as good as two radiologists working together, without increasing false positives.
“In our trial, we used AI to identify screening examinations with a high risk of breast cancer, which underwent double reading by radiologists,” said Kristina Lång, researcher and associate professor in diagnostic radiology at Lund University and consultant at Skåne University Hospital, who led the study.
“The remaining examinations were classified as low risk and were read only by one radiologist. In the screen reading, radiologists used AI as detection support, in which it highlighted suspicious findings on the images.”
The 80,033 women included in the safety analysis were randomly allocated into two groups: 40,003 women in the intervention group that underwent AI-supported screening and 40,030 in the control group that underwent standard double reading without AI support.
“We found that using AI resulted in the detection of 20 per cent more cancers compared with standard screening, without affecting false positives. A false positive in screening occurs when a woman is recalled but cleared of suspicion of cancer after workup,” Lång added.
The screen-reading workload for radiologists was reduced by 44 per cent. The number of screen readings with AI-supported screening was 46,345 compared with 83,231 with standard screening.
Lång said the time aspect is incredibly important, as one radiologist reads only an average of 50 screening examinations per hour.
“We estimated that it took approximately five months less of a radiologist’s time to read the roughly 40,000 screening examinations in the AI group,” she explained.
“However, we need to see whether these promising results hold up under other conditions, for example with other radiologists or other AI algorithms.
“There may be other ways to use AI in mammography screening, but these should preferably also need to be investigated in a prospective setting,” the researcher added.
A total of 100,000 women have now been enrolled in the MASAI trial. The research team’s next step is to investigate which cancer types that were detected with and without AI support.
The primary endpoint of the trial is interval-cancer rate. An interval cancer is a cancer diagnosed between screenings and generally have poorer prognosis than screen-detected cancers. The interval-cancer rate will be assessed after the 100,000 women in the trial have had at least a two-year follow up.
“Screening is complex,” Lång said. “The balance between benefit and harm must always be taken into account. Just because a screening method finds more cancers does not necessarily mean it’s a better method.
“What’s important is to find a method that can identify clinically significant cancers at an early stage. However, this has to be balanced with the harm of false positives and the overdiagnosis of indolent cancers.
“The results from our first analysis shows that AI-supported screening is safe since the cancer detection rate did not decline despite a substantial reduction in the screen-reading workload.
“The planned analysis of interval cancers will show whether AI-supported screening also leads to a more accurate and effective screening programme.”
Lawyers warn of discrimination risks around lack of menstrual health support in the workplace
Employers should consider proactively supporting women in managing menstruation at work, lawyers have argued
Employers should consider the potential discrimination risks around menstrual health in the workplace, lawyers have warned, as research shows that most women in the UK feel unsupported.
According to the Chartered Institute of Personnel and Development (CIPD), the majority of women in the UK do not feel a strong sense of support in their organisation in relation to their menstrual cycle.
Figures show women are more likely to feel supported by colleagues than by their employer or manager, with only one in 10 reporting that their organisation provides support for menstruation and menstrual health.
Annisa Khan, employment lawyer at Farrer & Co who has previously raised the alarm over the lack of practical measures to support women with their periods, told Femtech World that employers should be mindful of the legal risks related to managing menstruation.
“Under the Equality Act 2010, it is unlawful to discriminate against employees based on sex, age, or disability,” she said.
“Employers should therefore consider the potential discrimination risks in relation to managing mensuration in the workplace and implement measures to reduce these risks.”
A lack of workplace period policies has been estimated to cost businesses over £6bn per year, as menstrual symptoms cause women to miss an average of 8.4 days per year due to lower productivity.
Khan said organisations should consider proactively supporting employees in managing menstruation at work by reviewing existing policies, including sickness absence and health and wellbeing policies, to ensure they effectively address menstrual-related concerns.
“Creating an open and supportive environment is crucial for employees to feel comfortable discussing periods at work,” she explained.
“This involves raising awareness among all staff, including senior-level managers and male colleagues, to foster an understanding of how colleagues may be affected by menstruation, the relevant policies and how to have open and empathetic conversations.
“Implementing practical measures is also essential to create a supportive environment. Practical steps can include having accessible bathroom facilities with sanitary bins, providing free period products to employees, offering additional breaks and providing a quiet space for rest.”
In line with CIPD’s findings, Khan said workplaces should also consider implementing more flexible working practices and giving women more breaks when needed.
“Employers should be open to employees adjusting their work pattern on the days they are experiencing menstruation symptoms by, for example, offering employees the opportunity to work from home.
“Additionally, they should consider the needs of employees with disabilities or those with medical conditions, and how they may be affected by managing mensuration at work.”
Heidi Watson, employment partner at Clyde & Co, said employers should ensure they avoid breaching discrimination laws when approaching issues like menstrual health.
“As awareness of menstrual issues such as endometriosis grows and as employees are more willing to discuss their symptoms at work, employers will need to consider whether employees are disabled under the legal definition and therefore entitled to protection from less favourable treatment and subject to the duty of the employer to make reasonable adjustments for them,” she told Femtech World.
“Employees may also be able to establish sex or age discrimination claims. We can expect more claims to come before the Employment Tribunal in the not too distant future, in a similar way as we have seen with cases involving menopause in recent years.
“Adopting a flexible approach to managing those with menstrual symptoms which are impacting their work, and creating an open and supportive culture around the issue, will help to reduce the risk of such claims being brought,” she added.
OB/GYN-founded vitamin company pledges US$10m to improve women’s health research
Perelel aims to close the divide on women’s reproductive health research and improve access to nutritional support
The US OB/GYN-founded vitamin company Perelel has pledged US$10m to Magee-Womens Research Institute and Good+ Foundation to fund women’s health research and address gaps in maternal healthcare.
The vitamin company said the US$10m would be distributed as both in-kind product donations and funding grants through 2027 focused on advancing women’s reproductive health.
Magee-Womens Research Institute is the largest US research foundation focused exclusively on women’s health, reproductive biology and infant research and care.
Good+Foundation is a national nonprofit working to dismantle multi-generational poverty by pairing tangible goods with innovative services for under-resourced individuals.
“As the only female OB/GYN-founded women’s vitamin company, Perelel is committed to ensuring that all women have access to medically backed care,” said Victoria Thain Gioia, co-founder and co-CEO of Perelel.
“This is why we are devoted to furthering women’s research in partnership with Magee-Womens Research Institute and creating more equity in the way underserved communities receive critical prenatal micronutrients that would otherwise be inaccessible thanks to Good+Foundation.”
Research shows that medical studies have historically excluded female participants and data have been collected from males and generalised to females.
The exclusion of women of “childbearing potential” from clinical research studies has meant that women’s diseases are often missed, misdiagnosed or remain a total mystery.
Alex Taylor, co-founder and co-CEO and of Perelel, said: “We recognise how wildly complex women’s bodies are — bodies that have historically been oversimplified, objectified and shamefully under-researched in medicine.
“Unfortunately, it’s not as simple as ’12 essential nutrients.’ In founding Perelel, we hope to shine a light on how dynamic our bodies are by supporting them with targeted solutions made by the doctors and experts who know best.
“Core to what we stand for is the need to keep fighting for our fundamental rights and help close the women’s health research gap and improve body literacy.”
Perelel’s pledge comes at a time of intensified focus on women’s health as efforts start to reach new levels, including the White House, after President Joe Biden announced the first-ever initiative on Women’s Health Research in 2023.
“It is critical that there is more in-depth medical research done to support women at every hormonal life stage,” said Michael Annichine, CEO at Magee-Womens Research Institute and Foundation.
“Perelel has committed to a cash donation to further advance research into women’s reproductive health and to ensure that this research is made more accessible to doctors everywhere.”
New treatment could ‘disrupt’ growth of breast cancer tumours
A new type of immunotherapy could lead to pioneering treatment for breast cancer
A breakthrough injection could “disrupt” the growth of breast cancer tumours, paving the way for a pioneering new treatment.
Breast cancer is the most common cancer in the UK with one woman diagnosed every 10 minutes. Around 55,000 women in the UK are diagnosed with breast cancer every year and 11,500 die from the disease each year.
Researchers from the Institute of Cancer Research have found that a new type of immunotherapy that targets non-cancer cells could help prevent the growth and spread of breast cancer tumours.
The discovery, published in The Journal for ImmunoTherapy of Cancer, has found that an immunotherapy approach targeting a protein, called endosialin, disrupts the tumour’s blood supply and, as a result, can hinder its growth and spread.
Unlike most cancer treatments, this innovative treatment does not target cancer cells directly but attacks the cells that support the disease instead.
Researchers used a type of immunotherapy called CAR-T therapy, which involves removing a patient’s healthy immune cells and genetically modifying them to attack specific targets.
CAR-T therapies are already being used to treat some blood cancers, and scientists are trying to find ways to make them effective for other types of cancer, including breast cancer.
However, CAR-T cell therapy does not always work on tumours because their environment suppresses the immune response, and it can also be challenging to find specific features on the breast cancer cells to target.
To work around these challenges, the team directed the CAR-T cells to cells surrounding the tumour’s blood supply that make the endosialin protein, rather than actual cancer cells. In experiments in mice, scientists found that targeting endosialin successfully reduced the breast cancer’s growth and spread.
The team, based at the Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research (ICR), also tested the treatment on lung cancer tumours in mice and saw similarly successful results, suggesting patients with other types of cancer could benefit from this new treatment too.
In addition, researchers found that the CAR-T therapy did not affect cells without endosialin, indicating this could work as a cancer-specific treatment with potentially fewer side effects for patients.
“This is the very first study that demonstrates the effectiveness of using endosialin-directed CAR-T cells to reduce breast cancer tumour growth and spread,” said Dr Frances Turrell, study co-leader and postdoctoral training fellow in the division of breast cancer research at the Institute of Cancer Research.
“Immunotherapy has had limited success in treating breast cancer but by targeting the cells that support the tumour and help it to survive, rather than the cancer cells directly, we’ve found a promising way to overcome the challenges posed by the tumour environment and develop a more effective and targeted treatment for breast cancer.
“We could not have done this project without funding to the Molecular Cell Biology group from Breast Cancer Now and we hope that further research will help translate these findings into targeted therapies for breast cancer patients.”
Dr Simon Vincent, director of research, support and influencing at Breast Cancer Now, said: “This exciting research could lead to much-needed targeted treatments for people with breast cancer, and with one person dying from breast cancer every 45 minutes in the UK, new treatments like these are urgently needed.
“Now we know that the treatment works in principle in mice, Breast Cancer Now researchers can continue to develop this immunotherapy to make it suitable for people, as well as to understand the full effect it could have and who it may benefit the most.”
- Lawyers warn of discrimination risks around lack of menstrual health support in the workplace
- OB/GYN-founded vitamin company pledges US$10m to improve women’s health research
- New treatment could ‘disrupt’ growth of breast cancer tumours
- The slippery slope of presumed consent in post-humous reproductive health cases
- Women’s health content censored and blocked on social media
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