Diagnosis
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.”
A new reporting tool built specifically for obstetrics and maternal-fetal medicine has launched, aimed at teams managing increasingly complex pregnancies with limited time and resources.
Trice Imaging has released Trice Workspace Reporting, which connects imaging, reporting and longitudinal patient data in a single workflow to support faster clinical decision making.
Birth rates are falling worldwide, but pregnancies are getting more complicated. Advanced maternal age, IVF-assisted pregnancies, rising obesity rates and a higher prevalence of hypertension and diabetes mean more cases now require specialist monitoring, advanced imaging and multidisciplinary care.
At the same time, clinical teams are stretched and facing growing administrative demands.
Trice Workspace Reporting brings together customisable reporting, dynamic pregnancy dating and longitudinal patient history with an AI-ready, EHR-interoperable infrastructure, all inside the company’s Tricefy image management platform.
The company says it aims to accelerate standardised and synchronised report turnaround, support timely clinical decisions and improve operational efficiency for fetal medicine services.
“Maternal fetal medicine teams are managing increasingly complex pregnancies while being asked to do more with limited time and resources,” said Mark A. Samii, chief revenue officer at Trice Imaging.
“Trice Workspace Reporting is designed to remove unnecessary friction from reporting by creating a structured digital foundation that supports today’s need for connected clinical workflows.
“It also provides a digital foundation as practices prepare for tomorrow and the evolution of AI-enabled fetal assessment, anomaly detection and outcome prediction technologies.”
Trice Imaging describes its mission as transforming the women’s health journey by connecting physicians, patients and healthcare systems. From independent practices to large hospital ecosystems, it aims to reach the entire women’s health continuum, spanning IVF and reproductive health, maternal-fetal medicine and OB/GYN, and onwards to lifelong women’s health.
For more than 17 years the firm has worked on cloud-based storage, retrieval, display, organisation and exchange of ultrasound medical images and associated information across health environments.
Its wider platform now extends to dynamic clinical reporting, AI-driven workflow optimisation, data analytics and secure patient engagement.
Trice Imaging holds regulatory and data protection clearances in 40 countries. It has offices in Miami and Stockholm, alongside a growing network of global distributors.
Two endometriosis tests could cut years from diagnosis after NICE backed their temporary NHS use in England and Wales.
EndoSure and Endotest have been recommended in draft guidance, with one able to provide results in 45 minutes.
Endometriosis affects around one in 10 women of reproductive age. It occurs when tissue similar to the womb lining grows elsewhere, including around the ovaries and fallopian tubes.
Symptoms can include painful periods, painful bowel movements, pain when urinating and pain during or after sex.
Diagnosis can involve ultrasound scans, magnetic resonance imaging (MRI) or laparoscopy. A laparoscopy is keyhole surgery in which a camera is inserted through a small cut in the abdomen.
Despite the effect the condition can have on physical and mental health, women can wait years for a diagnosis.
The average wait in the UK is nine years and four months, rising to 11 years for women from ethnically diverse communities, according to the National Institute for Health and Care Excellence (NICE).
Long waits can increase suffering, prolong poor health and allow the condition to progress, making it more difficult to treat.
Dr Anastasia Chalkidou, NICE’s healthtech programme director, said: “A diagnosis of endometriosis can for some women take the best part of a decade, with the UK average standing at nine years and four months, and rising to 11 years for those from ethnically diverse communities.”
She said delays could lead to chronic pain affecting daily life, relationships and work.
She added: “These technologies have the potential to change that by giving primary care professionals better non-invasive tools to identify endometriosis earlier, allowing earlier and better treatment.
“Our draft guidance reflects our commitment to getting promising innovations to patients quickly, while making sure the evidence to support their wider use is built in a rigorous way.”
Endotest examines a saliva sample for microRNAs, tiny biological markers that can indicate the presence of endometriosis.
The sample is sent to a laboratory and the result returned to a GP or another healthcare professional to inform the next steps in diagnosis and care.
EndoSure uses sensor pads placed on the abdomen to measure electrical signals in the gut.
Women must fast for between six and eight hours before the 45-minute test. During the procedure, they drink water until they feel full, helping the device record gut activity accurately.
Results are available as soon as the test is complete.
The draft recommendation, published on Tuesday, approves both technologies for three years while further evidence is collected on how well they work.
NICE will then decide whether to approve them permanently for NHS use.
NICE said a third test, DotEndo, needs more research before it can be recommended.
EndoSure and Endotest are not designed to diagnose the condition on their own.
They are intended for women whose symptoms still suggest endometriosis after a normal clinical examination and negative or inconclusive imaging results, or when imaging has not been carried out.
Dr Gail Busby, a consultant gynaecologist at Manchester University NHS Foundation Trust, said: “These tests are a gamechanger because they give us answers much earlier, without the need for invasive surgery, and that means we can start the right treatment sooner.
“An earlier diagnosis doesn’t just change one person’s life, it frees up appointments and surgical slots for everyone waiting for care.”
Emma Cox, of Endometriosis UK, welcomed the tests.
She said their introduction should be supported by education for GPs and nurses to ensure prompt access and prevent symptoms from going unrecognised.
Xella Health has launched what it calls the first AI precision health platform built for the XX chromosome.
The company says it aims to address a lack of diagnostic precision and clinical research focused on female biology.
Women make up half of the population and account for 80 per cent of consumer healthcare decisions, but research into women’s health has historically received less funding than male-focused studies.
Kelly Lacob, Xella Health co-founder and chief executive, said: “Women have been trapped in a diagnostic dark age experiencing debilitating symptoms like severe period pain, bloating and GI issues, exhaustion, and brain fog, routinely dismissed by the healthcare system.
“This dismissal results in women being diagnosed four years later than men, on average, for the same conditions, and a seven-to-10-year delay for women to receive an accurate diagnosis for conditions like endometriosis.
Stalling necessary care and treatment results in prolonged suffering with chronic pain, heightened infertility risks, and declining mental health.
Xella is here to replace the systemic medical gaslighting women have endured for generations.
We are handing women the evidence and information they need to advocate for themselves and secure faster, accurate diagnoses before early-stage conditions spiral.”
Xella says its AI examines billions of data points from clinical information and multi-omic biomarkers to assess the probability of more than 130 conditions specific to female biology.
Multi-omic data combines information from several biological areas, including genes, proteins and hormones.
The conditions assessed include polyendocrine metabolic ovarian syndrome, or PMOS, formerly known as polycystic ovary syndrome, as well as perimenopause and endometriosis.
Xella was founded by Lacob, Adriana Dantas and Dr Jesus Ching, who developed the concept while working together on molecular diagnostics at Mammoth Biosciences.
The founders say the platform is designed to provide information about possible underlying causes through advanced testing and long-term care of a kind often available only through expensive concierge services.
They drew on personal experiences to build a service intended to identify small changes in a woman’s biological baseline.
Members complete an initial health questionnaire before having blood taken at a local partner laboratory such as Quest or Labcorp.
A phlebotomist can also visit a member’s home for an additional charge.
The company’s AI analyses biomarker data from genomics, proteins and hormones alongside symptoms, lifestyle risks and medical history.
Xella says this information is used to screen for more than 130 female-specific conditions, including PMOS, Hashimoto’s disease, premenstrual dysphoric disorder, endometriosis and perimenopause timelines.
Hashimoto’s disease is an autoimmune condition in which the immune system attacks the thyroid gland.
Premenstrual dysphoric disorder, or PMDD, is a severe form of premenstrual syndrome that can cause significant emotional and physical symptoms.
The results are processed through Xella’s own dry laboratory, which the company says is certified under the US Clinical Laboratory Improvement Amendments and accredited by the College of American Pathologists.
A dry laboratory analyses data using computing and other non-experimental methods rather than carrying out traditional laboratory procedures.
The findings are turned into a personalised healthcare plan and reviewed with a certified telehealth doctor.
The doctor may recommend immediate clinical action, including personalised hormone therapy or referrals to genetic counsellors, pelvic floor physiotherapists and reproductive endocrinologists.
Reproductive endocrinologists are doctors who specialise in hormones, fertility and reproductive health conditions.
Dantas, co-founder and chief operating officer, said: “Women’s health data has historically been treated in isolated silos – a hormone test here, an ultrasound there – but no one was connecting the dots across the entire biology.
“By tracking unique biological patterns longitudinally across cycles and life stages, we aren’t just providing data, but a clear path forward.”
Xella’s clinical advisers include Dr Allison Kurian, director of Stanford Women’s Clinical Cancer Genetics Program and professor of medicine, epidemiology and population health at Stanford.
They also include Dr Lynn Westphal, a reproductive endocrinology and infertility specialist and chief medical officer of Kindbody.
Xella has received US$4.7m in angel and pre-seed funding from Precursor Ventures, Capital F, Ulu Ventures and Swizzle Ventures.
Other funds and angel investors from healthcare, diagnostics and consumer technology also participated.
Margaret Coblentz, co-founder and general partner of Capital F, said: “Women’s health is one of the highest-momentum categories in the market today, driven by a US$15tn female economy.
“Xella represents exactly how Capital F sees women’s health evolving: deep clinical expertise paired with a consumer-first mindset, and a genuine opportunity to unlock the next generation of healthcare.”
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