The importance of public-private partnership for an outcome-oriented approach in diagnosing and treating breast cancer in India by Anusha Ashwin, @ashwin_anusha

Breast cancer is the most common cancer among women and 80% breast cancer incidents are recorded in women above 40 years of age. This is especially worrisome because the number could be an underestimate as currently only 15% of the population is covered by cancer registries.

In India, the incidence of breast cancer is rising rapidly, and the life-threatening disease is increasingly affecting women in their 30s and 40s. The incidence of breast cancer is 25.8 per 100,000 women and is expected to rise to 35 per 100,000 women in 2026, according to the Ministry of Health and Family Welfare. Notably, in India, one woman is diagnosed with breast cancer every 4 minutes and one woman dies of breast cancer every 8 minutes.

Another study by Cancer India reveals that in 2018 breast cancer had 1,62,468 newly registered cases and 87,090 reported deaths. These numbers are expected to rise to about 200,000 a year with about 100,000 deaths a year by 2030. 

While breast cancer contributes to a sizeable percentage of morbidity in all cancer and is the second leading cause of cancer death in women, it is also one of the most treatable malignancies if detected early.

To prevent breast cancer and to save lives, it is imperative for the medical community to take all possible measures, including application of innovative technology, to improve detection and early diagnosis to limit the number of eventualities.

Also, male breast cancer accounts for fewer than 1% of all cancer diagnoses worldwide, around 40% of the affected men undergo diagnosis in stage 3 or 4, i.e. when the disease has already spread to other parts of the body. The outlook for male breast cancer is therefore considered excellent if diagnosis occurs in the early stages.

According to the American Cancer Society, when breast cancer is detected early, and is in the localized stage, the 5-year relative survival rate is 99%. Most cancers are detected at a very later stage due to the lack of routine screening. This leads to little room for trial-and-error in treating patients and ensuring disease-free survival. The odds for recovery would be much better if there was improved awareness, leading to quicker detection of the disease. On the other hand, medical equipment too requires precision diagnostic capabilities rendering ease of clinical-decision making advantages to the physician in a short time. 

Advanced Medical Imaging technology for breast cancer – an evolution for benefit 

Without any doubt, Medical Imaging plays the most important role in the early and precise diagnosis and treatment of breast cancer. Modern imaging techniques in radiology have evolved over years to provide fast, non-invasive means to study the physiologic, metabolic, and molecular conditions of any type of cancer. 

Imaging is the primary means in clinical cancer practice to facilitate diagnosis, prognosis, and treatment evaluation. And these days, Artificial intelligence (AI), which is heralded as the most disruptive technology to health services in the 21st century, has ushered the next wave of radiology AI applications in moving beyond disease diagnosis to image enhancement.

An artificial intelligence (AI) model has been shown to be as effective as human radiologists in spotting breast cancer from x-ray images and also reducing the proportion of screening errors where cancer was either incorrectly identified or where it may have been missed.

A report by CBInsights exhorts that AI in radiology will not only drive down costs, but reduce the time patients spend at imaging centers and lower their exposure to radiation and heavy metals during the process. The same report finds that one of the leading drivers of deals in healthcare AI is the use of computer vision in radiology to detect anomalies in medical scans and aid in disease diagnosis. And the impact of AI-assisted diagnosis on healthcare costs is predicted to become more pronounced in the coming months. 

Currently mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities and breast magnetic resonance imaging (MRI) has become increasingly important in the detection of breast cancer in daily practice.

And in the era of personalized and precision medicine, there is a growing interest in transforming medical images into mineable high‐dimensional data that can be used to improve clinical decision‐making.

Despite all this progress there is a looming concern. Although conventional mammography has been very successful in reducing breast cancer mortality, radiologists say that 20–26% of cancers are still missed and approximately 70% of biopsies performed to evaluate suspicious breast lesions turn out to be unnecessary. 

But significant evolution has taken place in imaging over the years. 3D breast imaging methods, digital breast tomosynthesis (DBT) and dedicated breast CT (BCT) are emerging technologies that allow for 3D visualization of breast and have shown great promise for improving the detection and diagnosis of early-stage breast cancer.

“Early diagnosis is the need of the hour and technology is making this a possibility. Mammography has moved from a film-based model to digital, with breast cancer detectors aided by technology such as CAD (Computer assisted design) and AI enabling more accurate, early diagnosis at the first point of screening. Service providers are now offering high resolution thermal sensor devices to pick up breast cancer cells and aid early detection. Such services employ cloud solutions, big data analytics, AI, and Machine Learning for reliable, early, and accurate breast cancer screening. Technology is also enabling healthcare providers to offer low cost digital mammography machines that increase the scope of early detection, especially in rural and semi-urban areas,” shares Rachel Coxon, Vice President, Healthcare, Barco APAC*. 

Barco is a company that produces an extensive line-up of high-precision display systems that is claimed to deliver accuracy and efficiency to a broad range of healthcare disciplines, including radiology, mammography, surgery, dentistry, pathology, point-of-care, and clinical review imaging.

Sharing further, Rachel Coxon says in effective diagnosis it is important for medical displays to be more than just monitors. Display screens need to certainly meet the high demands of medical imaging. The monitors have to come with special image-enhancing technologies to ensure consistent brightness over the lifetime of the display, noise-free images, ergonomic reading, and automated compliance with DICOM and other medical standards. 

Companies like Barco are also mobilizing innovative technology to improve the outlook on breast cancer diagnosis. For instance, Barco’s Coronis Uniti, says Coxon, is a display system explicitly designed for both PACS and breast imaging. “Unique in its representation of calibrated colour and grayscales and remarkable in its 2D and 3D capabilities, the Coronis Uniti is capable of both static and dynamic imaging. Coronis Uniti delivers the first unified workflow – combining PACS and breast images on one workstation. It’s a solution that replaces all display configurations, eliminating the need for a multi-head display set-up or to move to another workstation to view additional exams. Coronis Uniti was designed with ergonomics in mind, mirroring a human’s natural field of vision to optimize reading experience,” says Coxon. 

So healthcare providers like Barco are designing cutting-edge imaging technologies to aid the early detection of cancer and quick and efficient delivery of treatment. Imaging techniques such as Angiogenesis Imaging, Hypoxia Imaging, Apoptosis Imaging, etc. are seen to improve the outcome in breast cancer diagnosis. With imaging modalities becoming ever more accurate and reliable, IT and technology is seen as offering a major fillip to breast cancer diagnosis.

India’s need for awareness and early diagnosis in breast cancer

A large number of healthcare centres in India lack the basic facilities required for early diagnosis of cancer. This leads to difficulties in treatment at a later stage, particularly given any lack of adequate expertise for effective treatment. Screening in the initial point that dictates forthcoming diagnosis, treatment, and prevention and adequate screening will occur only with widespread awareness. Stringent efforts are required in rural India, from both private and public ventures, to ensure adequate awareness about the incidence of breast cancer in India. And technology is ascertained to play a major role in this aspect.

Companies like Barco believe that hospitals/clinics in rural India should have access to solutions that are designed to increase visibility of subtle details, improve focus during reading sessions, and accelerate workflow. Such technology enables healthcare providers to diagnose breast cancer in an effective and time-efficient manner. Early diagnosis ensures better prognosis and treatment, empowering women to overcome the disease in a short time. 

Coxon says her company’s SpotView display system is one innovative technology that could increase cancer detection in rural India and enable quicker diagnosis. Boosting luminance and enhancing contrast in a unique way, Barco SpotView reduces mammography radiation dose significantly without impacting diagnostic accuracy. The technology also increases radiologists’ reading accuracy by 6%, ensuring faster and better diagnosis. 

Well companies like Barco can make the products available for the betterment of the society in India, but what is needed is the support from the Government and its appropriate policy-backed intervention to make such technologies available equally for early diagnosis of breast cancer in urban, semi-urban, and rural India. 

“While the Government plays the pivotal role of framing health policies and programmes that are in line with the requirements of the country, the health sector has seen a demand supply mismatch that the private sector can correct. It has usually acted as a catalyst to ensure that services are delivered to the people in a more efficient and focused manner. The stronger management, strategy, and resource base also enable the private sector to partner with the government in facilitating early detection and diagnosis. 

Benefits of a private-public partnership include enhanced access to equipment and technology in remote areas, provision for remote ambulances and mammography centres in different states, as well as an outcome-oriented approach to diagnosing and treating cancer. Indeed, once state-wide screening programmes enable women to get screened at an early stage, treatment can be meted out in an effective and rapid manner to improve prognosis,” emphasizes Barco’s Rachel Coxon. 

*Dr Rachel Coxon is the Vice President of the Healthcare Division of Barco NV Belgium’s Asia-Pacific operations. She is a veteran business leader with over 14 years of experience in building and growing both large and medium-sized organisations in the healthcare industry. Over the course of her career, she has held key leadership positions with global healthcare leaders like GE Healthcare, Abbott Point of Care and Becton Dickinson. Prior to joining Barco, Rachel was APAC General Manager – Women’s Health, RAD/R&F & Surgery at GE Healthcare, and engaged with corporate officers for broader organisational strategic planning. Rachel has a strong technical background, with a PhD in Biomedical Engineering from the University of New South Wales, Australia, Six Sigma Black Belt accreditations and experience in IT consulting.

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Anusha Ashwin
Anusha Ashwin

While with CyberMedia, I have worked for BioSpectrum magazine, Voice&Data – India’s foremost business magazine in the telecom vertical that has been instrumental in bridging the gaps in India’s communications sector.
While being part of Voice&Data as a Consulting Editor, I also had the opportunity to cater content to the Association of Biotech Led Enterprises (ABLE).
I consider my career to take a solid shape during this phase, as I set shot to work in times of the digital era. Today, I am able to resonate on the demands of writing content tailored to meet the requirements of the new age consumer that is driven by SEO and SEM.
The blessing here is that, through the writings I am on a constant self-discovery mode. I have found a passion, which is writing in focus on digital healthcare, communication tech startups, and health-tech entrepreneurs. Somewhere down me, there is this strong educational foundation in Microbiology and Biotechnology that had to play a part!
As India becomes more Atmanirbhar, I am destined to stay focussed in aligning my content contribution passion with Digital India plans, where I interact with numerous startup entrepreneurs and other organizations that are going to be part of the ambitious Make in India and Make for India programs.

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