How Digital Technologies Can Support Breast Cancer Awareness – Breast Cancer Awareness Month – October, 2022

“Please get your annual mammogram. I was six months late this time. I shudder to think what might have happened if I had put it off longer. But just as importantly, please find out if you need additional screening.”

Katie Couric, Journalist
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Katie Couric was diagnosed with breast cancer over the summer and subsequently underwent surgery and radiation treatments that finished this week. In the personal essay and on her essay and on Instagram, Couric, who is 65, shared information about the prevalence of breast cancer. “Every two minutes, a woman is diagnosed with breast cancer in the United States. On June 21st, I became one of them,” she wrote in a social media post shared Wednesday morning. “As we approach #BreastCancerAwarenessMonth, I wanted to share my personal story with you all and encourage you to get screened and understand that you may fall into a category of women who needs more than a mammogram.”

Today, there are more than 3.5 million breast cancer survivors in the United States, with 268,600 new cases expected to be diagnosed this year alone. With an estimated 89% of United States online and 72% owning smartphones, digital health technologies are uniquely situated to bridge the gap in breast cancer care through detection, intervention, and management. As we begin Breast Cancer Awareness Month, I wanted to dig deeper into the current developments and highlight some of the most promising digital health solutions to promote early detection and improve patient care for breast cancer patients and survivors.

Breast Cancer Apps – One of the most stabilizing things you can do with a breast cancer diagnosis is to get the correct information. In addition to your doctor, the right app can be a great place to find answers to all your questions. It can also offer access to a supportive community that understands what you’re navigating. Here are some of the most highly recommended apps based on their quality content, reliability, and user recommendations:

Breast Cancer Healthline – Those who are newly diagnosed, receiving treatment, or in remission will find support and camaraderie in the app’s one-on-one chats and group discussions. This is a place to find and receive advice, access current news and research, and connect with people who genuinely get it.

Cancer Therapy Advisor – An app designed for oncology professionals, Cancer Therapy Advisor compiles the latest in oncology news and trends, cancer treatment regimens, full-length features, slideshows, case studies, and drug information for various cancer types.

BELONG Beating Cancer Together – This free app helps get you access to the best care without a high cost of entry. You can directly communicate with researchers, experts, and other medical professionals who can give you quick, accurate responses to your pressing questions about breast cancer. You can also keep all your records within the app and share them with your doctor and your loved ones, too. You can browse and sign up for clinical trials and access leading oncologists, radiologists, researchers & nurses to answer your questions.

OWise Breast CancerOWise is an accredited mobile app and website that helps you regain control of your life from the first day of a breast cancer diagnosis. OWise provides safe, reliable, and credible information and practical support and guidance. You can monitor and share changes in your day-to-day well-being with your care team or other trusted individuals. This way, you can help your doctors to make timely and informed decisions on how to give you more personalized care.

Mammosphere – Life Image is the creator of Mammosphere. This breast imaging and cancer prevention application lets patients digitally transfer records to and from health care providers at the click of a button. 1 in 4 patients fails to gather their records promptly, skyrocketing the risk of being called back for additional testing or receiving a false positive. Life Image, based in Newton, MA, reduces the number of false positives for breast cancer by up to 60% and drives up patients’ chances of receiving an efficient and accurate diagnosis.

UntireUntire, founded by Door Vonk, is an app that provides cancer patients and survivors with the tools to cope with extreme fatigue. As a result of cancer, its medical treatments, and the emotional and social impact of such a severe illness causes patients to suffer from severe fatigue. Developed by psychologists with the contributions of patients and researchers, Untire uses scientifically proven theories and mindfulness-based techniques to increase cancer patients’ energy and improve their lives. With less fatigue, cancer patients can fight cancer without sacrificing their enjoyment of life.

Savor Health – By leveraging a team of oncology nutrition experts and the latest technology, Savor Health—founded by Susan Bratton—designs individually personalized nutrition solutions to meet the unique needs of cancer patients at every step along their journey. This innovative technology utilizes deep learning models to promote algorithm-driven meal, content recommendations and nutritional counseling through a team of oncology credentialed registered dietitians and nurses.

A.I. and Clinical Decision Support

PathAIPath AI, founded in Boston, MA, utilizes artificial intelligence and machine learning technologies to improve the accuracy and speed of pathologist diagnoses and ensure patients get the correct diagnosis and the most effective treatment.

MIT Computer Science and AI LabMassachusetts Institute of Technology’s Computer Science and Artificial Intelligence Lab developed a new deep learning-based AI prediction model that can anticipate the development of breast cancer up to five years in advance. This innovative technology, trained on over 90,000 mammograms and 600,000 patient outcomes, can accurately predict over 30% of all cancer patients in the highest-risk category compared to the 18% detected by current models. In developing its technique, MIT sought to address disparities in detection inequality among minorities; Black women are more than 42% more likely than white women to die from breast cancer, a statistic primarily driven by the lack of minority representation in current early detection techniques.

Kheiron – London-based Kheiron has developed a machine learning platform dubbed Mia. Mia analyzes standard mammography images to help radiologists decide whether or not a woman requires further evaluation. The company says the software has already shown success in a multi-center clinical study

Google/Hologic – Global medical device company Hologic is another early adopter of the imaging suite. The company is using Google Cloud’s offering to strengthen its diagnostic platform that screens women for cervical cancer. Hologic will store its images using the suite, and it will develop an AI model with Google Cloud to improve diagnostic accuracy for those cancer images.

Digital technologies in breast health – Some critical ideas for scaling up from pilot programs to full-scale implementation:

  • Technology is an enabler, but feedback from the people at the forefront of providing care, particularly nurses, is essential to scaling up pilot projects.
  • Equally important is making sure that the people using the technology are properly trained.
  • Implement quality monitoring protocols
  • Set up public-private collaborations
  • Identify and scale-up high-potential solutions: who’s out there working on new ideas?
  • Find people who know how to analyse data.
  • Build into projects the questions that will help provide the answers to scaling up a project: who do we need to talk to; what data will be needed to convince governments, investors, organisations to participate?
  • Scale isn’t just about reach: it’s showing that the technology can be adapted to the local environment.
  • Scaling up successfully means being able to convince investors that the environment you’re working in is viable.
  • Understand the local digital regulatory environment.
  • And finally: never lose sight of the patient’s needs throughout the process of scaling up a pilot project.

Innovations in mobile health and social media applications are occurring across the cancer spectrum, from primary prevention to screening, early diagnosis, treatment, survivorship, and end-of-life care. Thousands of health-oriented mobile sites and apps have already been developed with the advantages of low- or no-cost, high scalability, self-tracking, tailored feedback functionalities, use of images and video for enhanced health literacy, broad reach, and data sharing for large-scale analytics. More and more research demonstrates that digital health interventions can support and improve patient experiences and outcomes. For breast cancer patients and survivors, digital health technology can ultimately increase their chances of a good quality of life and positive health outcomes.

We Need To Invest More In Women’s Health Research & Technology Can Help

“….much of modern medicine is built on research performed exclusively on male bodies, and the effects of this research gap are serious–sometimes even deadly.”

Prianka Jain and Laine Bruzek, Fortune Magazine article June 10, 2022
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In almost every aspect of the world, male bodies have always been the default–from office air conditioning to crash test dummies. But nowhere is that default more dangerous than in medical research. Women are diagnosed significantly later than men on average across over 700 diseases, sometimes waiting up to 10 years for the proper diagnosis.

I’m ashamed that I was completely unaware of this disparity in research funding and focus until two articles hit my inbox in the same week. One was from Dr. Bertalan Mesko and his team at The Medical Futurist Institute, and the other was a Fortune Magazine article quoted above. The reasons for the “gender gap” in health research and its funding are historical. And we don’t even need to go back centuries, only a few decades, to find some interesting things. In the United States, women were not required to be included in clinical research until June 10, 1993, when Congress passed the NIH Revitalization Act. That means that much of modern medicine is built on research performed exclusively on male bodies, and the effects of this research gap are serious–sometimes even deadly.

Centuries of unconscious bias and lack of research have created a public health crisis where women are often dismissed, misdiagnosed, or prescribed the wrong treatment. It’s a perfect storm of implicit bias in clinical settings, a shortage of women’s health research, and a lack of funding for female-focused solutions. Only 4% of healthcare R&D spending in the US goes directly towards women’s health.

The drug dose gender gap is one clear example. Research published in 2020 from UC Berkeley and the University of Chicago analyzed data from several thousand medical journal articles and found clear evidence of a drug-dose gender gap for 86 different medications approved by the FDA (including antidepressants, cardiovascular and anti-seizure drugs, and painkillers). The study found that medications are routinely overprescribed to women because the clinical trials were conducted only on cisgender men, and women also experienced worse side effects in 90% of cases. The study also concluded that sex differences in body weight did not explain this “sex difference.” Some 80% of all drugs removed from the US market between 1997 and 2000 were withdrawn because their side effects occurred mainly or exclusively in women. And the trend continued. Between 2004 and 2013, women suffered more than 2 million drug-related adverse events, compared with 1.3 million men in the United States.

Cardiovascular disease is another example – Even in 2015, only about a third of participants in clinical trials for new treatments for cardiovascular disease were female, despite cardiovascular diseases’ being the number one cause of death in American women.

But the list goes on and on. Endometriosis, Alzheimer’s, Crohn’s disease, rheumatoid arthritis, and autoimmune conditions are just a few of the diseases that are affecting women significantly more and receive only a moderate amount of research funding. Researchers examined what would happen if the budget for Alzheimer’s research into women went from $288 million to $576 million. In these simulations, they conservatively assumed that this budgetary increase would deliver just 0.01 percent of health improvements for Alzheimer’s and coronary artery disease, and 0.1 percent for rheumatoid arthritis, over 30 years. But, this is a critical point; even these slivers of improvement produced a shockingly high return on investment. By doubling the NIH budget for research on coronary artery disease in women from its current $20 million, we could expect an ROI of 9,500 percent. Studies focused on rheumatoid arthritis in women receive just $6 million annually. Doubling that would deliver an ROI of 174,000 percent and add $10.5 billion to our economy over the 30-year timespan.

So if these returns are so significant, what’s stopping this research funding increase from happening? Female health-related startups are gaining momentum – and funding – over the past decade. The sheer amount of available health data from both genders will also contribute to a better understanding of the biological differences between how men and women react to drugs, treatments, and aging. In recent years, femtech has evolved from a niche market sector into one predicted to exceed $60 billion worldwide by 2027. The global femtech industry comprises over 200 startups 92% of which are founded and led by women), most of them born out of the frustration around a lack of care for female health issues–from menstrual health to menopause.

Image Credit: CB Insights

I’ve written previously on Femtech as the next big growth opportunity in health care. And I see even bigger things on the horizon. Technology applied intelligently can help narrow the gap in research studies, increase panel sizes, increase the amount of data collected and analyzed, and outcomes reported. The sheer amount of available health data from both genders will also contribute to a better understanding of the biological differences between how men and women react to drugs, treatments, and aging. Improving healthcare outcomes for 50% of the world’s population is a huge business opportunity–and it’s time for the venture industry to start treating it that way. The upside is simply too significant to continue ignoring.

Is Femtech the Next Big Growth Opportunity in Health Care?

“The market potential is huge. There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”

Michelle Tempest, Partner, Candesic
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Women’s healthcare enables better outcomes for women patients and consumers. Although women represent half of the planet’s population, tech companies catering to their specific health needs represent a minute share of the global technology market. This disparity is staggering, especially since women spend an estimated $500 billion a year on medical expenses, according to PitchBook. Tapping into that spending power, many apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility and offering solutions for pregnancy, breastfeeding, and menopause.

The term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In the course of just a few years, it has grown to encompass a wide range of technology-enabled, consumer-centric products and solutions, including maternal health, menstrual health, pelvic and sexual health, fertility, menopause, and contraception, as well as several general health conditions that affect women disproportionately or differently (such as osteoporosis or cardiovascular disease).

In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company.

According to McKinsey, depending on scope, estimates for FemTech’s current market size range from $500 million to $1 billion. Forecasts suggest opportunities for double-digit revenue growth. In analyzing the current market, they found concentration in maternal health patient support, consumer menstrual products, gynecological devices, and solutions in fertility. Yet this is clearly, and promisingly, only the beginning of what FemTech can address. As they show in the graphic below, there’s still a lot of “white space” available for companies to develop more solutions to fill current gaps in the global market.

Image Credit: McKinsey, February 14, 2022

Another company, FemTech Analytics, estimates that the global FemTech Market Size accounted for $40.2 billion in 2020 and is projected to grow at an average CAGR of 13.3% from 2020 till 2025 to reach $75.1 billion. Despite increasing interest in recent years, the industry remains underestimated and has high growth potential. They show the market segmentation and distribution across the various segments in the graphic below:

Image Credit: FemTech Analytics

And within those various segments, FemTech Analytics has identified the product types as seen in the graphic below:

Image Credit: FemTech Analytics

What I love about FemTech Analytics’ market research reporting is that they’ve created a MindMap of all the companies that make up the FemTech market as of the end of 2021. You can access that MindMap here.

Some examples of companies developing products in the FemTech market include Clue, Elvie, MobileODT, Lattice Medical, and EndoDiag. Here’s a brief look at each company.

Clue – I mentioned Clue and its founder earlier. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet. Clue allows women to do exactly that with a few taps on their smartphones.

Image Credit: Clue

Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Pelvic floor/kegel exercises have had known benefits for women for decades, especially post-childbirth, for strengthening bladder muscles, reducing the risk of pelvic prolapse, and improving sex. It’s the same core strength promise of popular activities such as pilates and yoga but without the easy availability of motivating group exercise classes. The wearable — for indeed, when in use, it’s ‘worn’ inside the body — has a companion iOS app that offers five-minute workouts to help the user learn how to exercise their pelvic floor muscle correctly and build up its strength, tracking progress within the app via a personal LV score.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence identifies normal or abnormal cervical findings. A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.)

Image Credit: MobileODT

Lattice Medical has developed a 3-D printed hollow breast implant that allows for tissue regeneration and is absorbed by the body over time. Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant and eventually fills it out. In the meantime, the 3-D-printed shell disappears altogether 18 months later. This product is in the very early stage of development, however. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025.

Image Credit: Lattice Medical

EndoDiag is a French medical technology company that allows early diagnosis of endometriosis and better management of the condition. Despite significant advances in non-invasive diagnostic methods, including imaging techniques such as ultrasound, MRI, or CT scans, currently only the removal of endometriotic lesions via laparoscopy under general anesthesia and their histological analysis enables the diagnosis of endometriosis with certainty. The average delay between disease onset and its effective diagnosis is estimated between 7 to 11 years. This significant delay due to the lack of a non-invasive diagnostic test leads to frequent misdiagnosis and associated unsuitable treatments, as well as to more severe cases as the disease may progress and damage other organs. They’ve developed a test called EndoDTect®, a blood test based on the analysis of a combination of biomarkers. Changes in their expression levels indicate if a subject has endometriosis or not. Combining high sensitivity and specificity, EndoDTect® has the potential to reduce diagnosis delays dramatically. Endodiag is currently conducting validation studies to confirm the predictive value of EndoDTect® for disease detection.

My take – Companies have a tremendous opportunity to develop products and services in this space and a willing audience ready to take advantage of them. Early movers can stake out opportunities in prominent white spaces identified in the McKinsey research, including by leveraging technology to address women’s health issues beyond reproduction and by helping to meet the needs of underserved populations such as low-income or minority communities. I think there are multiple use cases where FemTech will play an increasingly important role in the future. These include:

  • Improving care delivery: Virtual clinics such as Tia, innovative brick-and-mortar clinics such as Kindbody, and direct-to-consumer prescription delivery services like those of The Pill Club all enable women to access care in a more convenient, consumer-centric manner.
  • Enabling and supporting self-care: Trackers and wearables offered by companies such as Bloomlife, and at-home diagnostics like those provided by Modern Fertility, are among the FemTech solutions that are helping women take greater charge of their health and health-related data.
  • Improving diagnoses: Clinical diagnostics companies are pushing the scientific frontier to address unmet medical needs in areas such as endometriosis (DotLab) and preterm birth (Sera Prognostics).
  • Addressing areas that are often stigmatized: Companies are addressing what had been considered to be stigmatized topics head-on, such as menstrual health (Thinx), sexual health (Rosy Wellness), pelvic care (Elvie), and menopause (Elektra Health).
  • Delivering tailored care to underserved populations and culturally sensitive care: Solutions tailored for subpopulations are emerging for Black women (such as Health in Her HUE), LGBTQ+ populations (FOLX Health), and women in low- and middle-income countries (Kasha).

“Women Buy, Women Rule” – So says business guru Tom Peters. I couldn’t agree more. Because women are not just consumers but the primary healthcare decision-makers for themselves and their families, better health outcomes for women can lead to better outcomes for society. As women’s healthcare becomes an increasing priority, FemTech is rising to meet the challenge as it matches capital and talent with unmet needs. In a short period of time, FemTech has already demonstrated impressive early wins. And the actual disruption in the market lies ahead.