Many women dread breast cancer screening, with the anxiety-inducing trip to the clinic and the cold metal bite of the mammogram machine. In fact, some find the process so unpleasant that they avoid it altogether.
The 2023 Ontario Cancer Screening Performance Report, for example, found that 54.7 per cent of eligible women aged 50 to 74 participated in routine mammography between 2020 and 2021. This represents a decline of more than five per cent compared to pre-pandemic rates, and is well below the program’s target of at least 70 per cent.
But what if there was a way to make the experience more pleasant? What if, for instance, a general practitioner could use a contactless detection tool in the relative comfort of their office? That’s the promise of new screening technology developed by Toronto-based Linda Lifetech, which will begin a clinical trial at Toronto’s Princess Margaret Cancer Centre (PMCC) this summer.
“We believe this tool can be a game-changer for the health-care system,” says Linda’s founder, Rubens Fernando Mendrone. While the phone-enabled device isn’t meant to replace mammograms, it could make routine screening more accessible, he says. And by offering family doctors a simple preliminary detection tool, this could help them identify suspicious changes in breast tissue earlier, he says, allowing patients to seek out tests and treatment sooner.
Medical experts agree early detection is critical for the best outcomes. Caught early, many breast cancers can be treated without radiation. Additionally, most provinces encourage women to get screened for breast cancer in their 40s, and beginning this fall, women in Ontario as young as 40 will be able to refer themselves for a mammogram online. This comes after a recent study published by the University of Ottawa revealed breast cancer rates are rising among young Canadian women.
It can sometimes be difficult for general practitioners — the first line of defence against the disease — to screen for breast cancer. Lumps and other telltale symptoms like lesions don’t always appear, especially in the disease’s early stages. As a result, about 18 per cent of cases aren’t detected until they’ve spread to other parts of the body, according to the Public Health Agency of Canada’s website.
Mendrone, a tech entrepreneur who lost both his grandmother and godmother to breast cancer, says he understands how deadly the disease can be when intervention is unnecessarily delayed. He spent about two years studying breast cancer screening, and came to the conclusion that primary health-care professionals needed a tool that could detect potential indicators more easily. One year later, he developed a prototype.
“We can give women another month, another year — another life,” he says.
Using body heat to look for breast cancer
Unlike a mammogram, which uses X-ray technology to detect cancer, the Linda screening tool employs thermography by using an infrared sensor that detects heat patterns and blood flow in breast tissue. The tool itself is contactless, but patients still need to remove their shirt and bra.
As cancer cells multiply, they need more oxygen-rich blood to fuel growth; this increased blood flow to the tumour also raises the temperature around it. Linda’s sensor creates a “heat map” of the breast that highlights suspicious-looking areas. The device’s AI-assisted smartphone app analyzes that data and estimates the likelihood of cancer within seconds.
Factoring in other details, including family history, doctors can use the information to recommend a mammogram or an appointment with a specialist. Health-care practitioners can also use the assessment to triage cases more effectively. Someone with a 97 per cent likelihood of cancer, for example, might be given the earliest available appointment for a mammogram, while someone else whose scan shows no indication of cancer may be able to wait longer for their routine appointment.
This would represent a shift from a first-come, first-served model to what Mendrone calls a “first need, first served,” approach, which he says can save resource-strapped health-care systems time and money, since early treatment is almost always more cost-effective. An article published in the Current Oncology journal in 2023 shows later-stage breast cancer is often more expensive to treat.
“At the end of the day, though, doctors have the final word,” Mendrone says. “Linda doesn’t tell them what to do. It just says: ‘This looks suspicious.’”
Thermography and breast cancer screening
Thermographic technology isn’t new — it was first touted as a potential screening method in the 1950s, but has never been approved in Canada as a standalone tool. According to Health Canada’s website, “claims that thermography is useful in diagnosing breast cancer have not been proven.”
Martin Yaffe, an imaging expert with the Ontario Institute for Cancer Research, agrees there’s a need for better breast cancer detection methods. He points to a variety of techniques being explored, including tomosynthesis — also known as 3D mammography — and the use of biomarkers that can flag breast cancer.
Yaffe, who isn’t familiar with the Linda device, cites concerns about the accuracy of thermography. Thermal imaging is not necessarily a reliable predictor of cancer, he says, as hotspots can arise in the body for other reasons, such as inflammation unrelated to tumours.
But Linda’s device draws on advancements that improve its potential, Mendrone says. High-resolution digital images can display suspicious-looking tissue in greater detail, and AI-supported analysis makes predictions much more accurate, he says.
Additionally, Yaffe says he welcomes innovative ideas that could help doctors triage patients.
“Tools, possibly driven by AI that use information from images, could also be useful in prioritizing the order in which patients should be seen in terms of urgency,” he says. “This would help to use resources more effectively in a health system that is under pressure.”
A connection to artificial intelligence
Linda Lifetech provides devices that are ready for health professionals to use anywhere there is an internet connection. The AI tool was trained with a dataset of 3,000 patient records that included mammograms, ultrasounds and biopsy results. By matching these records with corresponding patient thermal images, Linda’s algorithms can identify areas that could be cancerous.
Mendrone aims to expand the dataset through new partnerships across Canada, the U.S., the U.K. and Australia to further improve the tool’s clinical outcomes.
The simplicity of the tool has helped fuel its popularity in Mendrone’s native country of Brazil, he says. In most regions of the country, people don’t have easy access to mammograms, he says, so several doctors have begun using the Linda device for screening. Each image, with accompanying analytics, costs about $10, making it relatively inexpensive for clinics.
By comparison, the Ontario Ministry of Health’s standardized guidelines put the cost of a unilateral mammogram performed on one breast at $31.95, although this cost is typically covered by the Ontario Health Insurance Plan (OHIP).
So far, the tool has been used to screen 45,000 women in Brazil — about 40 per cent of whom had never had a mammogram, Mendrone said.
The value of tech-based solutions
A 2023 study co-authored by Mendrone and published in the British Journal of Cancer Research showed that scans performed by Linda had “similar trends as mammography in suspect and non-suspect cases.”
While this study focused on refining Linda’s AI algorithm, the upcoming three-year Princess Margaret trial will be a double-blind study in which the outcomes of the Linda scan and the mammogram will be concealed from evaluators and participants to prevent bias and enable a precise comparison, says principal researcher Vivianne Freitas.
Freitas, who is a radiologist with Toronto’s University Health Network and an assistant professor at the University of Toronto, says there’s a “pressing need” for advancements in imaging technologies. While she doesn’t expect the Linda device to replace mammography, it could “streamline the diagnostic pathway, help overcome barriers to mammogram access and reduce waiting times.”
Freitas also sees another potential benefit — if Linda’s risk assessments prove accurate, they could help identify cancer in women with dense breast tissue, a significant cohort that isn’t well served by mammograms, she says. This tissue can make it challenging to detect cancer because it is similar in density to a tumour, says Freitas. An alternative imaging method like Linda’s, which isn’t affected by tissue density, could be more promising for the women in this group. According to Dense Breasts Canada, a health advocacy group, 43 per cent of women aged 40 to 74 fall into this category.
Mendrone says he hopes the device can help patients achieve better outcomes — that’s why he named his company Linda, which is Portuguese for “beautiful.” Once the clinical trial is complete, Linda will apply for Health Canada approval; following that, Mendrone hopes PMCC and other hospitals will begin using the tool. But in the meantime, he plans to make this technology available out-of-pocket to drugstore chains and clinics that want to provide early detection screening for breast cancer.
“By putting Linda at the very beginning of the line of care — the primary health-care level — we can detect earlier,” he says. “And after that happens, everything can be different.”
Carol Toller writes about technology for MaRS. CTVNews.ca has partnered with MaRS to highlight Canadian innovations in health care.