• Cancer
  • There’s lots of projects to improve breast cancer diagnoses

     WHO has a report showing breast cancer as the most common cancer in women, both in developed and under developed countries. The breast cancer mortality rate was estimated at 508,000 in 2011. Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries. Incidence rates vary greatly worldwide, from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 in Western Europe. In most developing regions, incidence rates are below 40 per 100,000. Africa has the lowest e rates,  but here, breast cancer incidence rates are increasing.

    An article in FierceBiotech says Philips,  the  Dutch technology company, is partnering with PathAI, a company that develops artificial intelligence (AI) for pathology, to develop solutions that improve the precision and accuracy of routine breast cancer diagnosis. A report by Tissue Pathology says the two companies are developing deep-learning algorithms that will detect and diagnose several diseases, with the first being breast cancer. The outcome’ll be an app that automatically identifies cancerous lesions in breast tissue.

    Tumour analysis is essential to diagnosis, but conducting it manually is time consuming and laborious for pathologists. The app will ease the burden on pathologists.

    Philips’ Illumeo platform uses adaptive intelligence to help radiologists work more efficiently. Its IntelliSite Pathology Solution is an automated digital pathology system that includes a slide scanner, image management system and software tools. Last June, the company bought PathXL, a Northern Ireland company focusing on image analysis and digital pathology.

    There’s plenty of similar research underway. Samsung is another company that’s applying AI to diagnose breast cancer from medical imaging. It uses deep-learning algorithms too to detect breast cancer lesions in ultrasound images.

    Breast Cancer News has reported that researchers from Houston Methodist Hospital have developed software to predict breast cancer risk from patient charts and mammograms. Harvard Health Publications has reported that a Harvard-MIT team has used AI to diagnose breast cancer from slides of lymph node cells.

    These developments are a step into the future of disease diagnosis. How far behind do developing nations lag in implementing these innovations?

  • Kenya’s cancer screening app ETiCCS’s now available

    Cervical cancer is the second most common cause of death for women worldwide. In Kenya, it’s the leading cause of death for women of reproductive age.  Kenyan Network of Cancer Organizations says there are approximately 39,000 new cases of cancer each year in Kenya, leading to more than 27,000 deaths. The star has a report estimating increases in cervical cancers cases from 3,000 to 4,200 by 2025. It’s largely due to lack of access to healthcare resources and treatments.

    To address this gap and improve the quality of life among women in Africa, and particularly Kenya, the SAP’s Design and Co-Innovation Center together with Heidelberg University Hospital has optimised a cervical cancer screening test that combines practical medical research with cloud technology from SAP. The digitised screening test, called Emerging Technologies in Cervical Cancer Screening (ETiCCS) strives to support the fight against cancer in developing countries.

    An article in IT online reports that ETiCCS was piloted during a one-year study, which tested 800 women at the Moi Teaching and Referral Hospital in Eldoret, Kenya. The program is ongoing and SAP East Africa plans to include the countrywide self-sampling and IoT scenarios, deep learning, pattern recognition, remote diagnostics support and validation into the program. SAP East Africa will collaborate with technology including SAP HANA Cloud Platform, as development continues SAP HANA Cloud allows seamless communication between healthcare providers including those in remote areas and environments with unstable Internet connectivity.

    The technology will allow the healthcare screening services to:

    1. Keep medical records safely stored in the cloud providing instant access to results. Enabling labs to accelerate the screening process and empower medical staff through improved quality control embedded in the screening process
    2.  Enforce compliance with data privacy and security requirements, meaning labs can make informed diagnoses regardless of location or region
    3. Enable healthcare professionals to uncover critical patient insights and adapt the solution to other screening processes and field research.

    The ETiCCS program has already enabled hundreds of women in Kenya access to screening for cervical cancer.

  • AI’s good at diagnosing skin cancer

    Conventionally, skin cancer’s primarily diagnosed visually. It starts with a clinical screenings, then, if needed, followed by dermoscopic analyses, a biopsies and histopathological examinations. A team mainly from Stanford University, California, has reported in Nature that mHealth can provide an alternative. It’s a technological step up for Africa’s mHealth.

    Classifying skin lesions using images is challenging, owing to fine-grained variabilities in their appearance. Convolutional Neural Networks (CNN) offer potential for dealing with fine-grained object categories. The team demonstrates skin lesion classifications using a single CNN, trained end-to-end directly from images using only pixels and disease labels as inputs. Trained CNN used a dataset of 129,450 clinical images and 2,000 skin lesions.

    Its performance was tested against 21 dermatologists using proven clinical images from biopsies in two use cases:

    1. Keratinocyte carcinomas versus benign seborrheic keratosis, identifying the most common cancers
    2. Malignant melanomas versus benign nevi, identifying deadliest skin cancer.

    CNN achieved performance in both use cases that matched all tested experts. It shows that the algorithms in Artificial Intelligence (AI) can classify skin cancer as well as dermatologists. Equipped with CNN, mHealth can potentially extend dermatologists’ reach beyond their clinics. An impact is lower-cost universal access to vital diagnostic services.

    As healthcare researcher teams extend AI across other conditions, it offers Africa’s mHealth initiatives a much wider role and impact. It seems that mHealth can have much more to offer.

  • IHE wants comments on endoscopy

    Four aspects of endoscopy can be seen as the instrument, the technique, a diagnostic tool and minimally invasive surgery. It’s a very valuable medical technology. Looking inside people is a clever way to avoid cutting them open.

    Endoscope’s aren’t a modern idea. Primed Canada says its inventor identified by most medical historians is Philip Bozzini. In 1805, he used a tube, lichtleiter, a light guiding instrument, he created, to examine urinary tracts. Antoine Jean Desormeaux, a French surgeon renamed it the endoscope. It’s claimed that in 1868, Adolph Kussmaul was the first person to use an endoscope to see the inside of a stomach of a living person. In 1878, two doctors, Max Nitze and Josef Leiter, invented an endoscope to inspect the urinary tract and bladder.

    None of these men concerned themselves with the informatics or eHealth standards and interoperability of their innovations. Integrating the Healthcare Enterprise (IHE) does. It’s released for consultation two supplements:

    Endoscopy Image Archiving (EIA)

    Endoscopy Ordering Workflow (EWF).

    The IHE Endoscopy Technical Committee wanted comments on these by 18 January 2017. They will now complete the supplements as part of the planned IHE Endoscopy Technical Framework.

  • eHealth can help Africa's cancer care

    Cancers are on the march, but disproportionately affect developing countries. India’s using Medic Mobile. It’s part of the British Council's Global Innovation Initiative and partnerships with University of Edinburgh, Weill Cornell Medical College, New York and Christian Medical College Vellore, India.

    Medic Mobile says more than 60% of world's new annual cancer cases occur in Africa, Asia and Central and South America. They account for 70% of the world's cancer deaths. Cancer’s become a serious public health issue in India. It has only eleven health workers for every 10,000 citizens, and rural and urban populations experience vastly different healthcare.

    World Health Rankings for all cancers in 2014 show India’s death rate as about 70 per 100,000. Africa’s average’s about 87. Ten African countries have a death rate lower than India’s. Gabon’s the lowest at about 51. Gambia, Namibia and Niger are all below 60 too. Zimbabwe’s the highest at about 210 per 100,000. It’s an outlier. Burundi’s second highest at about 130. If India sees cancers as a public health priority, Africa’s facing challenges too. 

    Cancers in rural parts of India are rarely diagnosed due to lack of public awareness and healthcare. The delays in diagnoses pose treatment challenges. Leveraging low-cost, low-technology mHealth can improve healthcare access, reduce costs, and strengthen health systems to meet cancer care challenges in remote communities. A study’s analysing the impact that the mHealth tools have on cancer outcomes in low-resource settings as health workers and nurses us it to screen high-risk people, refer some of them to facilities for care and follow them up for treatment.

    Three sites are Padhar, Vellore and Mungeli. Only Vellore's Rural Unit for Health and Social Affairs (RUHSA) currently has a paper-based early cancer detection system. Padhar and Mungeli have no early cancer screening or detection system and only provide cancer care in facilities. The lack of early detection at these two sites means that many late-stage oral and cervical cancer patients have low chances of successful treatment. The project will train health workers, nurses, dental assistants and project coordinators to use mHealth to screen, record, and refer patients.

    Health workers are being trained to identify oral cancer lesions and refer the patients with precancerous lesions to the hospital. The health workers will use mHealth to create a profile for each new patient and generate a unique patient ID. Cervical cancer screening requires a Visual Inspection with Acetic acid (VIA), so nurses will screen women for cervical cancer by visiting community centres in the villages. Women who test VIA positive are counselled by nurses to visit the hospital’s gynaecology department where they’ll have a second VIA test, and a biopsy if needed, then appropriate medical treatment. Nurses will use mHealth to report on the second test results and treatment confirmation.

    This’s a simple, effective mHealth model that Africa’s health systems can adopt. A small start leading to a steady roll out with adjustments from learning has much to commend it.


    Image from Kera News

  • Top healthcare solutions in the Innovation Prize for Africa

    The African Innovation Foundation (AIF) has announced the top ten nominees for its landmark programme, the Innovation Prize for Africa (IPA). Now celebrating its fifth year under the theme Made in Africa, IPA offers a grand share prize of $150 000 to spur growth and prosperity in Africa through home-grown solutions, an article in IT-Online says.

    The IPA has seen considerable growth in applications and increasing interest from both innovators and innovation enablers over the years. IPA 2016 attracted a record of over 3,600 innovators and received 985 successful submissions from 46 African countries. African ingenuity this year showcases new breakthroughs in public health, including malaria, HIV/AIDS and cancer, smart solutions for farmers and dynamic energy initiatives. 

    AIF will host the IPA 2016: Made in Africa awards ceremony on 22 and 23 June 2016 in Gaborone, Botswana. Collaborating partners include the Ministry of Infrastructure, Science and Technology (MIST), and the Botswana Innovation Hub (BIH). 

    The healthcare solutions in the top 10 IPA 2016 nominees include:

    Urine Test for Malaria (UMT)

    Dr Eddy Agbo from Nigeria developed the UMT, a rapid non-blood diagnostic medical device that can diagnose malaria in less than 25 minutes. Africa has the highest number of malaria cases worldwide. The inability to quickly diagnose and commence malaria treatment can lead to various complications including kidney failure, build-up of lung fluid, aplastic anaemia and even death. UMT uses a dip-stick to get accurate results within half an hour. The technology detects malaria parasite proteins in urine of patients with fever due to malaria. UMT’is simple and affordable, and a potential game changer in managing malaria across Africa. 


    Valentin Agon from Benin also developed a solution to curb the spread of malaria. Api-Palu is an anti-malaria drug treatment developed out of natural plant extract. It is significantly cheaper than available anti-malarial drugs, and has great inhibitory effects on 3D7 strains of plasmodium falciparum the causative agent of malaria. According to the WHO, Sub-Saharan Africa is home to 88% of malaria cases and 90% of malaria deaths reported globally with some African governments spending up to 40% of their public health budgets on malaria treatment. Api-Palu manifests as a fast rate of malaria parasite clearance from the blood following short term treatment, with relatively lower doses. It is available in tablets, capsules or syrup. The drug has been approved in Benin, Burkina Faso, Tchad, and Central Africa Republic because of its therapeutic and non-toxic effects.


    Dr Imogen Wright, South Africa, solution addresses a different healthcare issue facing many African countries, HIV/AIDS. Exatype’s a software solution that enables healthcare workers to determine HIV positive patients’ responsiveness to Antiretroviral Drugs (ARV) drug treatment. According to WHO, 71% of people living with HIV/AIDS reside in Africa. 

    A growing number of people on ARVs are resistant to drug regimens, leading to treatment failure, further exacerbating the continent’s HIV/AIDS burden. Exatype processes the highly complex data produced by the advanced next generation of DNA sequencing of HIV DNA in patients’ blood. A simple report detects drugs resistant to patients, then highlights the need to avoid these to ensure successful treatment. Exatype has the potential to contribute towards effectively managing HIV/AIDS in Africa, and also holds promise in helping detect drug resistance for other disease burdens such as Tuberculosis (TB) and malaria.


    Dr Kit Vaughan, also from South Africa, created an imaging technology, capable of performing full-field digital mammography and automated breast ultrasound at the same time, dramatically improving breast cancer detection. Annually, there are more than half a million cancer deaths in Africa and these numbers are expected to double in the next three decades. If diagnosed early enough, the chances of treating the cancer successfully increases dramatically. However, because 40% of women have dense tissue, their cancers cannot be seen on X-ray. Furthermore, a false negative finding can have devastating consequences. Aceso is a single device that can acquire dual-modality images, full-field digital mammography and automated breast ultrasound at the same time. This world first system’s protected by international patents and has been successfully tested in two separate clinical trials with 120 women.

    Having four healthcare solutions emerging from the top ten Innovative solutions across the different sectors is very encouraging. All four address critical healthcare issues facing African health systems and have the potential to have a real impact and save lives across the continent.

  • Molecular scissors cut through a leukaemia barrier

    Layla was a healthy baby. Her story's that at after 14 weeks, she was diagnosed with Infant Acute Lymphoblastic Leukaemia (ALL) and admitted to the world-famous Great Ormond Street Hospital (GOSH). She had one of the most aggressive forms of the disease the GOSH’s doctors had seen. Chemotherapy was started without delay, then a bone marrow transplant (BMT) to replace her damaged blood cells. It didn’t work. A second round of treatment wasn’t an option. Neither was an experimental treatment at another hospital. Layla was a year old then.

    Profs Waseem Qasim and Paul Veys described Layla’s story at the Royal Society of Medicine’s 12th Innovation Summit in April. They were able to offer a very recent and experimental treatment only trialled in mice. Prof Qasim was developing the molecular scissores, and only one vial was available for Prof Veys to use. There were no guarantees. Layla’s parents agreed. GOSH’s ethics committee promptly agreed it was right to try it.

    Treatment used molecular scissors to edit genes and create designer immune cells programmed to seek and kill drug-resistant leukaemia. Leyla was given a small 1ml infusion of genetically engineered cells, Universal Chimeric Antigene Receptor T-cells (UCART19).

    It took a couple of minutes, followed by a five minute flush. She was bouncing around her cot during the process. Leyla’s now cancer-free, and doing well. The breakthrough from GOSH and UCL Institute of Child Health’s (ICH) pioneering research teams supported by the National Institute for Health Research (NIHR) Great Ormond Street Biomedical Research Centre.

    The doctors expected an immune response within a fortnight, usually a rash or a fever. A rash emerged after two weeks. It worsened, then, faded. A second child has now had successful molecular scissor treatment, and didn’t have a rash.

    When doctors were confident that Leyla’s leukaemia cells had been removed, she was given a bone marrow transplant to replace her entire blood and immune system which had been wiped out by the treatment. She returns to GOSH regularly to check that her bone marrow cells are healthy and blood counts continue to normalise.

    Molecular scissors works by adding new genes to healthy donor T-cells, arming them against leukaemia. Molecular tools, TALEN, act like accurate scissors to cut specific genes to make the T-cells behave in two ways. First, cells become invisible to a powerful leukaemia drug that usually kill them. Next, they’re reprogrammed to target and fight leukaemia cells.

  • Smartphones improve cervical cancer screening in Madagascar

    mHealth keeps expanding its potential. A study in Ambanja, a city in Madagascar, published in PLOS One, found that using smartphones for on-site diagnosis offer the same information as off-site diagnosis, and it takes much less time. 

    The team, mostly from Geneva University Hospitals, sought to test the use of smartphones to improve the screening technique of visual inspection of the cervix after applying 5% acetic acid (VIA). It’s a technique used widely in Low and Middle-Income Countries (LMIC). Women were recruited from a screening campaign, 332 in total. Each one completed a human papillomavirus (HPV) self-sample as a primary screen. PV is a group of viruses that affect skin and moist membranes lining bodies, so they can affect the cervix.

    Women testing positive for HPV went on to VIA followed by D-VIA, a cervical biopsy and endocervical curettage, a procedure where the mucous membrane of the cervical canal is scraped with a curette, a spoon-shaped instrument. The D-VIA was emailed to a tertiary care centre for immediate assessment. Results were either D-VIA normal or D-VIA abnormal, requiring immediate therapy or referral to a tertiary centre.

    About 41%, 137 women, were HPV-positive and recalled for VIA triage. About 69%, 95 women, complied. Cervical intraepithelial neoplasia, an indication of premalignant transformation and abnormal growth, was detected in digital images by 18% on-site and 22% off-site physicians. After adjusting for sensitivity, the team concluded that using smartphone images for off-site diagnosis of cervical intraepithelial neoplasia achieves a similar diagnostic performance to on-site diagnosis.

    While smartphone images can improve cervical cancer screening, the study didn’t extend to testing the efficiency of using smartphones in LMICs. While these results are awaited, it’s encouraging to confirm another valuable role for mHealth in Africa.

  • GENOMES and GENIE offer more hope for cancer patients

    Research into health matters is increasingly a global endeavour. Its scale and value’s illustrated by the American Association for Cancer Research (AACR) launch of AACR Project Genomics, Evidence, Neoplasia, Information, Exchange (GENIE). It’s an international collaborative and initiative that aims to now power clinical decision making and advance clinical and translational research. The project will aggregate participants’ clinical-grade sequencing data to improve patient treatment decisions and be a catalyst for clinical and translational research. 

    Phase one’s being conducted in partnership with seven global leaders in genomic sequencing for clinical utility and two informatics partners. The seven founding members of the consortium and phase 1 are:

    • The Center for Personalized Cancer Treatment, Utrecht, Netherlands
    • Dana-Farber Cancer Institute, Boston
    • Institut Gustave Roussy, Villejuif, France
    • Johns Hopkins University's Sidney Kimmel Comprehensive Cancer Center, Baltimore
    • Memorial Sloan Kettering Cancer Center, New York
    • Princess Margaret Cancer Centre, Toronto
    • Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. 

    The two informatics partners are:

    • Sage Bionetworks, Seattle
    • cBioPortal, New York.

    Charles L. Sawyers, MD, AACR is the chair of the Project GENIE Steering Committee. He says that despite an increase in the amount of genomic data available for analysis, “These data are typically insufficient in number or lack the necessary clinical outcomes data to be clinically meaningful. Thus, to effectively benefit patients, the genomic and clinical outcomes data from as many institutions as is practical should be combined through a data-sharing initiative, such as AACR Project GENIE.”

    GENIE will achieve its goals by pooling Clinical Laboratory Improvement Amendments (CLIA) and International Organization for Standardization (ISO)-certified sequencing data from the members’ institutions into a single registry and linking these data with selected longitudinal clinical outcomes. All project data will be made open-access following defined periods of project exclusivity, and the initial genomic data set will be publicly available on Nov. 6, 2016.

    There are already over 17,000 genomic records in GENIE’s registry, which is unique in that it’s enriched in late-stage cancers and contains only clinical-grade sequencing data used for clinical decisions. The number of genomic records in GENIE’s registry will continue to grow as new patients are seen at each institution are added. Each of the seven members can keep working how it sees fit, while simultaneously contributing its data to the project. This will ensure that future participants can easily be added after the pilot phase project is completed.

    The GENIE registry is a tool that can be used to solve many clinical and research challenges. There are numerous ways that it can benefit patients. They include:

    • Validating gene signatures of drug response or prognosis
    • Identifying new patient populations for previously US. Food and Drug Administration (FDA)-approved drugs
    • Expanding patient populations that benefit from existing drugs
    • Identifying new drug targets and biomarkers.

    It’s a project that Africa’s health systems should follow closely. They should also invest in the eHealth that enables them to participate and thrive from the benefits GENIE offers to patients and communities.

  • e-Driver algorithm can detect protein changes in genes

    DNA carries genetic information. It’s the chemical instructions that tell our cells what to do. When DNA’s damaged and cells mutate, it can cause cancer. Exploring and learning more about the relationships between genes and cancers are high-priority research activities. Many people want to know more about the genetic risks they’re facing. In 2005, Eduard Porta-Pardo and Adam Godzik from Sanford-Burnham Medical Research Institute, California, described their e-Driver algorithm in e-Driver: A novel method to identify protein regions driving cancer. It can analyse the effect of proteins on different parts of a gene they affect. It added to the approach that focuses on a gene as an entire entity.

    Porta-Pardo and Godzik are part of the team that used e-Driver to produce A Pan-Cancer Catalogue of Cancer Driver Protein Interaction Interfaces. It’s published by PLOS Computational Biology. It starts from the position that some ten years after their e-Driver paper, the role of mutations on Protein-Protein Interaction (PPI) interfaces as cancer drivers hasn’t been studied systematically. 

    The team included Luz Garcia-Alonso from the European Bioinformatics Institute in Cambridge, UK and Thomas Hrabe, Joaquin Dopazo from Computational Genomics Department, Centro de Investigación Príncipe Felipe (CIPF) in Valenica, Spain. They used e-Driver to analyse the mutation patterns of the PPI interfaces from 10,028 proteins in a pan-cancer cohort of 5,989 tumours from 23 projects of The Cancer Genome Atlas (TCGA) to find interfaces enriched in missense mutations which can inhibit a protein’s function. The result was 103 PPI interfaces enriched in somatic cancer mutations, with 32 of them found in proteins coded by known cancer driver genes. The other 71 interfaces are found in proteins that weren’t identified as cancer drivers even though in most cases there’s extensive literature, suggesting they play an important role in cancer. 

    The study shows that algorithms and the considerable skills and knowledge to develop and use them can have an enormous impact in advancing healthcare’s knowledge research. Africa’s health systems should find a place for these activities as part their eHealth strategies. While it may only be a small part to begin with, it’ll increase in scale and importance.