Researchers experimenting with artificial intelligence have found that these tools seem to reliably detect breast cancer, while also reducing a demanding workload for radiologists.
Breast cancer is the most common cancer among adults, with more than 2.3 million cases diagnosed each year, according to the World Health Organization. In most countries, the illness is one of the top two leading causes of cancer deaths in women.
But research shows that early detection and treatment can save lives.
To increase screening capacity and better identify high and low risk breast cancer, two recent studies show that specific applications of artificial intelligence (AI) performed similarly to highly trained radiologists.
“I think that breast imaging, especially mammography, [is] one of the front runners when it comes to the maturity of these AI tools,” said Kristina Lång, lead author on one of the studies.
Preliminary results of the Swedish trial show that AI detected more cancer, while keeping false positives to a minimum.
“The results were actually [above] our expectations,” said Lång, a breast radiologist and associate professor at Lund University in Sweden.
Kristina Lång is the lead author on a randomized control trial out of Sweden that compares the results from at an AI-supported screening group and one with two radiologists. (Jennifer La Grassa/CBC)
Another smaller study, published earlier this week in the journal Radiology, found that radiologists and AI came to similar conclusions after reviewing the same mammograms.
These recent studies are practical examples of the way AI could be used in healthcare to relieve a strained workforce, while ensuring more accurate diagnoses, say experts like Lång.
But other experts warn that the technology is still being refined to ensure it doesn’t over diagnose or miss the cancer.
AI reduced radiologist workload
Radiologists are placing extra significance on Lång’s research as it randomly assigned mammograms from more than 80,000 women to two groups.
One group involved AI-supported screening and the other followed double reading — a standard practice in Europe where two radiologists independently review each mammogram.
In the AI-supported group, the software triaged the scans by determining which ones were of low risk and needed only one radiologist to look at them, or high risk, requiring two radiologists.
Results found that the AI-supported screening group detected about 20 per cent more cancers. It also had a similar number of false positives and women recalled for further analysis as the standard group.
Due to the triaging, the radiologists in the AI-supported screening group read about 44 per cent fewer mammograms than those in the standard group.
“It’s a difficult task to read large volumes of screening examinations in order to detect these small subtle cancers,” said Lång. “You have to be alert.”
AI can over diagnose, have trouble with dense breasts
“We should be embracing this technology as a really helpful tool to do better and try and diagnose more cancers at an early stage,” said Jean Seely, who heads the breast imaging section at the Ottawa Hospital.
But she said there are still some issues that need to be refined.
Dr. Jean Seely is a professor of radiology at the University of Ottawa and also head of the breast imaging section at the Ottawa Hospital. (CBC News)
In particular, Lång’s study found that AI can over diagnose cancers that might not end up being harmful to the patient.
“We want to call only those patients that really have cancer, but there’s a fine line that we have to balance,” said Seely, who is also a radiology professor at the University of Ottawa.
She also said that, at this point, AI doesn’t compare the current mammogram it’s reading to past ones, nor does it know that the patient might have already had a biopsy for a certain abnormality.
“So to rely on the AI only is really impossible,” said Seely, adding that radiologists are also legally responsible for the mammogram interpretation.
“You have to have a trained person, radiologist, to be able to read those cases and say, ‘yeah this is an appropriate recall, but this is not.'”
Dr. Mojola Omole, a breast oncologist and surgeon in Ontario’s Scarborough Health Network, also thinks AI shows promise for the future, but she’s concerned with the technology’s ability to detect breast cancer in women with more dense tissue.
Dr. Mojola Omole is a breast surgical oncologist and a general surgeon with the Scarborough Health Network. She’s also a member of the Black Physicians’ Association of Ontario. (Submitted by Mojola Omole)
Typically, she said, Black and Asian women can have more dense breast tissue, which hides the cancer.
“What I worry about sometimes, when we talk about AI medicine, is that populations such as racialized people, when it comes to breast cancer, are not necessarily going to be represented in that sample,” she said.
Omole noted that in the Swedish trial, the race and ethnicity of the women wasn’t recorded.
If women of all backgrounds aren’t included in research like this, said Omole, then it might mean that AI could misdiagnose them or miss the cancer completely.
Dr. Martin Yaffe, a professor and senior scientist at Sunnybrook Research Institute in Toronto, said his team is working on AI that can detect breast density and calculate the chances of a hidden cancer.
“We’re stepping carefully to try and avoid doing anything foolish to get this new technology so that it’s ready for prime time and that involves a lot of testing, and testing under a wide variety of circumstances,” he said.
More research needed to determine tool’s success
Unlike in Europe, mammograms aren’t screened by two radiologists in Canada.
As a result, Ottawa-based radiologist Seely said more research is needed to know how AI would work in the Canadian context.
She notes that it shouldn’t “replace a human,” but that it “adds more value.”
Martin Yaffe is senior scientist at Sunnybrook Health Sciences Centre in Toronto. (Keith Whelan/CBC)
And that’s what breast cancer survivor Marilyn Jordan also thinks about it.
“I feel positive about AI facilitating quicker diagnosis and catching more cancers than at the current time,” said the 68-year-old Vancouver resident.
Jordan completed her breast cancer treatment last September after she pushed to get a mammogram a year before her regularly scheduled screening appointment.
Even though AI can over diagnose, Jordan said she’d rather the tool be “extra cautious” and catch everything.
“Maybe it’ll find a cyst that needs to be monitored annually, ” she said.
The Swedish trial is still ongoing and looks to better evaluate AI-supported screening by finding out whether it reduces the rate of interval cancer.
Interval cancer is when a person is diagnosed with cancer after a normal result and before their next screening appointment.
The interval cancer rate will be determined after the participants have a follow-up two years from their screening in December 2024.
Lång said they’re also interested to know whether the use of AI is cost effective.
“I think the synergistic effect, when humans work together with this AI tool, to use them in a safe and smart way, we can really … improve both the efficiency and the quality of healthcare.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
