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.”
Young women are more likely than young men to get health and wellness information from social media influencers, a US survey has found.
Among adults aged 18 to 29, 57 per cent of women said they received health and wellness information from influencers, compared with 47 per cent of men.
The Pew Research Center study surveyed 5,023 US adults and examined how young people consume health and wellness content online.
Local university students said influencer content frequently appeared in their social media feeds.
Kabija Koroma, a local university student, said: “It’s more exercise stuff, more like protein and like meals and like how to get ready and like the outfits of the day of videos on TikTok or lately. My favourite ones.”
About 51 per cent of women under 30 said they often consumed influencer content focused on beauty and personal appearance, compared with 18 per cent of men.
The study also found that 21 per cent of women often saw content about therapies outside mainstream medicine, compared with 10 per cent of men.
At least one-third of both young women and young men often encountered influencer content about mental health and weight loss. Around half or more of both groups regularly saw fitness-related content.
Another local university student, Ania Davis, said: “I see a lot like how to meal prep and how to get your morning started. Affirmations stuff. But I do also ask the adults around me because sometimes the internet is not right.”
Researchers also looked at why young adults sought health and wellness information from influencers.
About 51 per cent of young women said they watched the content because they wanted to change their health or lifestyle.
Women were also more likely than men to say they enjoyed hearing from people who shared their background or beliefs, at 23 per cent compared with 14 per cent.
Nineteen per cent of young women said they used influencer content to learn about topics they did not want to ask their doctors about, compared with 10 per cent of young men.
Despite regularly using social media, some students said they did not rely solely on influencer content when making decisions about their health and wellness.
Koroma said: “I’m always on TikTok 24/7 and Instagram, but I also like to ask people older than me because I don’t know everything.”
A new UK study aims to improve maternity care for pregnant women living with multiple long-term health conditions.
The three-year project, led by the University of Aberdeen and Birmingham City University, brings together experts from academia and the NHS, including King’s College London, the University of Birmingham, Manchester University, Barts Health NHS Trust, Newcastle-upon-Tyne NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust.
The research is supported by a £1.3m award from the National Institute for Health and Care Research (NIHR), with £70,000 of the funding going to King’s College London.
Recent figures show that more than 80 women die each year in the UK due to complications arising from pregnancy, while more than one in six pregnant women are living with multiple long-term conditions such as diabetes, high blood pressure, heart disease and mental health disorders.
These conditions are becoming increasingly common and are considered an important contributor to poor maternal outcomes.
There are currently no defined care requirements for pregnant women living with more than one long-term health condition.
Women living with multiple conditions can face changes to medication, disjointed care from multiple teams, conflicting advice between healthcare professionals and a lack of appropriate follow-up for their health conditions after birth.
Pregnant women with multiple long-term health conditions are at twice the risk of preterm birth and nine times more likely to die during pregnancy than those without these health complications.
Researchers will develop a “care bundle”, a package of evidence-led care designed to guide safe maternity care for women living with multiple long-term health conditions throughout pregnancy, birth and the postnatal period.
At King’s, Professor Krishnarajah Nirantharakumar and Professor Jane Sandall will be co-investigators on the project, contributing expertise in implementation research and continuity of maternity models of care. Zoe Vowles, an NIHR-funded midwife PhD student, will contribute expertise from her research into the contribution of midwifery to care for women with multiple long-term health conditions.
Sandall, professor of social science and women’s health at King’s College London, said: “Too many women living with more than one long-term health condition are falling through the gaps between different parts of the health system during pregnancy, when they most need coordinated support. This research will bring together expertise from across maternity and specialist care to build a care bundle that gives women and health professionals clear, consistent guidance, before, during and after birth.”
Nirantharakumar, clinical professor of public health and health data science at King’s College London, said: “Our MRC-funded MuM-PreDiCT programme worked directly with women living with multiple long-term conditions and with maternity clinicians to identify the elements of care that matter most in pregnancy. This award takes those elements and builds them into a care bundle that can be tested and delivered in the NHS.”
Over three years, the team will be led by Dr Mairead Black, clinical reader in obstetrics at the University of Aberdeen and honorary consultant obstetrician at NHS Grampian. It will address the challenges these women face and create a package of care aimed at reducing the risks they encounter in pregnancy.
The care bundle will include guidance on medication management, communication between healthcare teams, midwifery care and postnatal handovers. Researchers will also work with people with lived experience of maternity care to help shape and test it.
The researchers hope the project will provide an evidence-led care bundle specifically designed for women living with multiple long-term health conditions and, for the first time, clear guidance to support their complex needs throughout pregnancy and beyond.
Prepared for Femtech World by Dr Emilė Radytė, neuroscientist and co-founder and CEO of Samphire Neuroscience
The short answer
Premenstrual dysphoric disorder (PMDD) does not usually result from abnormal hormone levels.
Research suggests that the brain can respond differently to expected changes in estrogen, progesterone, and the progesterone metabolite allopregnanolone.
This helps explain why blood tests can look typical while a person’s experiences remain severe. It also gives researchers a clear reason to study nervous-system treatments alongside selective serotonin reuptake inhibitors (SSRIs), hormonal treatment, and psychological care.
Why can expected hormone changes cause severe PMDD experiences?
Hormones act as signals. They interact with receptors throughout the brain and influence networks involved in mood, stress, sleep, and emotional regulation.
Two people can have similar hormonal patterns and experience those signals in different ways.
Hantsoo and Epperson (2020) reviewed evidence that PMDD involves an altered response to changing levels of allopregnanolone, which modulates gamma-aminobutyric acid type A (GABA-A) receptors. GABA helps regulate neural activity and the stress response.
In PMDD, the issue may lie in the brain’s adaptation to allopregnanolone fluctuations across the menstrual cycle.
Experimental research supports this sensitivity model. Suppressing ovarian hormone fluctuations can reduce PMDD experiences in susceptible participants, while reintroducing physiologic concentrations can bring them back.
Researchers therefore describe PMDD as a disorder of sensitivity to hormonal change, while recognizing that no single pathway explains every case.
Do normal hormone test results rule out PMDD?
No. A blood test shows whether a hormone concentration falls within an expected range at one point in time.
It cannot show how a person’s brain responds to that signal across the cycle.
Clinicians diagnose PMDD by its timing and impact, using prospective daily ratings across menstrual cycles.
The American College of Obstetricians and Gynecologists (ACOG) recognises PMDD as part of a spectrum of premenstrual disorders and recommends an individualised, multimodal approach.
Which treatments have evidence for PMDD?
ACOG’s 2023 clinical practice guideline includes hormonal and nonhormonal medicines, psychological counseling, exercise, nutritional approaches, patient education, and surgery for selected cases.
SSRIs can work faster in PMDD than they often do in major depression. Hormonal approaches can suppress ovulation or stabilize fluctuations for some patients.
No treatment works for every person. Some patients do not improve, cannot tolerate side effects, have contraindications, or prefer another route.
When that happens, clinicians and researchers need to ask which part of the biological pathway still drives the condition.
Could brain stimulation treat PMDD?
Noninvasive brain stimulation offers a plausible research direction because it can influence neural networks involved in mood regulation.
Evidence from depression cannot establish that it works for PMDD.
Researchers need PMDD-specific randomised trials that measure experiences across the cycle and report safety, adherence, and clinically meaningful outcomes.
The distinction matters. A coherent mechanism creates a hypothesis. Only indication-specific clinical evidence can establish efficacy.
Key takeaways
- PMDD can occur with hormone levels that fall within expected ranges.
- Research points to altered brain sensitivity to hormonal change, including allopregnanolone fluctuations.
- SSRIs and hormonal approaches remain evidence-based options, often as part of multimodal care.
- Brain stimulation is a research target for PMDD, not a conclusion that can be borrowed from depression studies.
Learn more at https://www.samphireneuro.com/en-us/pmdd
Sources:
Hantsoo and Epperson (2020), Allopregnanolone in premenstrual dysphoric disorder.
American College of Obstetricians and Gynecologists (2023), Management of premenstrual disorders.
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