A New Zealand medical technology company that has enjoyed wide success in the United States is shunned at home – and its chief executive, Teri Thomas, says she must speak out “on behalf of
New Zealand women”.
Thomas says Volpara’s measurement of breast density — an accepted measure of cancer risk in the United States and Europe — would help identify those at risk overall and help set priorities at a time when BreastScreen Aotearoa has a backlog of some 30,000 mammograms to reach pre-Covid levels.
But the Ministry of Health stands by its decision not to adopt the Kiwi company’s software.
Volpara Health’s software for early detection of breast cancer is used by more than 2,000 facilities, including top cancer screening centers in the United States, the Wellington-based company says.
Tech giant Microsoft is an R&D partner on Volpara’s artificial intelligence (AI) technology, used to analyze mammograms. Volpara also manufactures software for managing radiology clinics and managing patient communications.
Accelerating adoption of Volpara’s products overseas led to a 32% increase in revenue to $26.1 million in the year ending March.
But its home market was almost completely excluded, with 98.4% of the company’s revenue coming from the United States and Australia.
“We would like to continue to grow in New Zealand, but we don’t have a lot of activity here at the moment,” Thomas told the Herald.
“The focus is on getting women for mammograms. BreastScreen Aotearoa is working with systems integrators on a custom solution which I believe lacks AI, communication to women about their density and has no risk calculation. We hope that our New Zealand market will evolve and we will eventually find more customers interested in our level of sophistication.”
BreastScreen Aotearoa (BSA) is a free nationwide breast cancer screening program for women aged 45-69. He is part of the National Screening Unit within Te Whatu Ora – Health New Zealand.
Women with dense breasts – or low fatty tissue – have a higher risk of developing breast cancer.
The Herald put the criticism of Thomas to the Ministry of Health.
A spokesperson responded that there were no plans to mandate breast density testing for radiologists who assess mammograms for BreastScreen Aotearoa.
“There is a high threshold for introducing changes to population health screening programs to ensure that any changes will benefit the screening population and that potential risks to participants are minimized,” the gatekeeper said. -word.
“There are difficulties in assessing breast density and a lack of evidence that additional monitoring of women with dense breasts will reduce deaths from breast cancer. There are also disadvantages to consider, such as the anxiety, unnecessary needle biopsies, overdiagnosis and cost.”
Overall, the harms are likely to outweigh the benefits, the ministry spokesperson said.
He added, “Currently, there is insufficient evidence to demonstrate the effectiveness of using artificial intelligence in organized breast screening mammograms.”
The Department of Health and Te Whatu Ora are involved in research undertaken by Victoria University of Wellington to explore the use of AI in reading mammograms and continue to monitor new evidence as it emerges, said the spokesperson.
Need to aim higher
“I find it difficult to answer because I think BreastScreen Aotearoa is doing an incredible job of saving lives through screening and the work they are doing is incredibly important to our wāhine,” Thomas said.
“I don’t want to criticize them. But I find myself in a situation where I have to speak out on behalf of our New Zealand women.
“Frankly, I think they can aim higher and tackle this really important and complex challenge by making better use of modern tools and knowledge available around the world.”
Thirty-eight of 50 U.S. states require women to be told about their breast density, Thomas said.
“I’ve worked in healthcare in Europe, the US and the Middle East – in addition to New Zealand and Australia – and I find it strange/frustrating to hear the BSA say that she is waiting for more research before providing important information to her populations. I don’t know what they are waiting for. The United States has been reporting and acting on breast density for about 10 years now using the standard reporting framework BI-RADS [which includes an assessment of breast density].”
Just being informed about their breast density would motivate women to get screened regularly, Thomas said. It is estimated that some 271,000 women have not taken advantage of the free mammogram every two years offered by BreastScreen Aotearoa.
“I believe in empowering and informing women rather than not even giving them the opportunity to know information – which could be very important – about their bodies. For my personal breasts and mammograms, I really want to know my density .”
The Volpara boss also said the ministry had the wrong end of the stick with its comments on artificial intelligence, which her company currently does not do directly, although it has an R&D collaboration with Microsoft. which may see AI for computer-aided detection added in the future.
“While the latest AI for computer-assisted detection looks promising, I agree that we could use larger scale prospective trials to show the benefit of population screening programs such as BreastScreen Aotearoa. is an area that Volpara continues to monitor given the sheer scale of the unique data we collect, and it is an exciting future opportunity for us due to the global shortage of radiologists,” she says.
Thomas says some of the National Screening Unit guidelines date from 2013.
“The evidence has changed since then and is simply outdated.”
She mentions the 10-year DENSE trial in the Netherlands, saying the 10-year randomized controlled trial showed that using Volpara to select women with extremely dense breasts, then performing a breast MRI, resulted in a significant drop in interval cancers (cancers that appear between screenings and tend to be more aggressive).
And she notes a March recommendation from the European Society for Breast Imaging for MRI screening of women with dense breasts.
“Some women with dense breasts will have a higher risk of breast cancer than women with a first-degree relative diagnosed before menopause.”
The United States, Western Australia and various European countries are all successfully reporting and acting on breast density through population screening programs, Thomas said.
The new European guidelines “indicate that breast density increases the risk of breast cancer, but if women request this information from BreastScreen Aotearoa, they cannot access it because it is not currently registered,” says Thomas.
Covid accentuates the need to prioritize
Last month it was revealed that around 30,000 Kiwi women were overdue for breast cancer checks under the BSA scheme, due to a pandemic disruption.
“With the backlog of Covid-related screening mammograms, looking at density and risk factors and prioritizing women most at risk makes a lot of sense to me. Unfortunately, this appears to be postponed to an unknown future date.”
Thomas, who worked in the healthcare industry in the United States before moving to New Zealand where she worked as Vice President of Global Sales, Marketing and Strategy for Orion Health in 2017, sees a tendency for the New Zealand healthcare system not to evolve over time.
“During my work for Orion Health, I was shocked by Kiwis’ tolerance for low-tech technology,” she said.
“The healthcare system in New Zealand is good overall, but there is one big gap, which is the use of technology. Our leadership lacks appreciation of what is possible and what is being rolled out in Europe and the U.S. Most of the first world hospitals I’ve worked with had withdrawn its pen and paper prescriptions, for example, and for very good reasons.”
View from the trenches
In 2020, after being disbarred from Orion, Thomas made the unusual decision to give up his business career to pursue a nursing degree.
“I thought I could retire here. However, I’m too young and I want my life to have a positive impact on the world. I’m grateful for all the opportunities I’ve had in my life and wanted to give back in some way.”
His career change led to frontline experience which reinforced his view that New Zealand are behind the game.
“Getting a Masters in Nursing gave me a much deeper understanding of New Zealand healthcare. I trained in three different DHBs and was able to gain an intimate knowledge New Zealand healthcare workflows.
“My intent was to be a nurse and look for ways to support national technology efforts and probably move into nursing informatics and help nationally.”
Ultimately, working part-time for Volpara at the same time led to his current full-time role.
But before that, “I did nursing in Whakarongorau Aotearoa as a Covid nurse, monitoring high-risk people diagnosed with coronavirus. My assessment of New Zealand’s use of health technology remains the even: we have a huge opportunity to do better and we are not on par with other first world nations.
High rate of breast cancer
New Zealand is one of the countries with the highest prevalence of breast cancer. About 650 New Zealand women die from breast cancer every year.
“What is really sad for me is that almost 10% of breast cancers are diagnosed before the age of 50, and these are often more aggressive and/or discovered at more advanced stages”, says Thomas.
“I think we can do better for women, and as the first cancer diagnosed in women, that’s so important. Heck, even educating women about the risks of breast cancer can improve the percentage of people who pass mammograms, which I know is a goal for BreastScreen Aotearoa.”
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