In 2016, when Geetha Manjunath wound up her high-flying career at a multinational giant and stepped into the unfamiliar territory of breast cancer, it raised a few eyebrows. Her sole aim in life then was to innovate a technology for the early-stage detection of the disease that silenced two of her young cousins and continues to kill a million Indian women every year. What drove her was her sheer grit and tenacity.
Apart from the acuity and astuteness that Manjunath acquired during her stints at MNCs spread over 25 years, she had barely changed in her outlook. She was as steadfast as she was in 1991 when she joined the government-owned Centre for Development of Advanced Computing (C-DAC) soon after her Ph.D. in data mining and semantic web. During her stint at C-DAC, she was part of the proud team that developed India’s first supercomputer. Subsequently, she worked with Hewlett-Packard Laboratories (research scientist and chief lab architect for 16 years) and Xerox Research Centre India (as head of its Data Analytics Research Laboratory for nearly four years).
“I started my chase for the new technology in 2016 after one of my cousins was detected with breast cancer. Niramai came into being in 2017. We developed a novel solution for detecting early-stage breast cancer using artificial intelligence and machine learning. We started selling installations in 2018. In 2020, we won the national startup award by the Startup India initiative,” Manjunath, who founded the startup and is its CEO and CTO, tells Fortune India.
The A.I.-enabled tool developed by Niramai uses thermal analytics. The core of the solution is Thermalytix, an automated diagnostic tool, which combines thermal imaging with A.I. The A.I. within Niramai analyses 400,000 temperature points per person.
“Our efficacy rate is 100% for screening population,” she claims.
Women in India are generally diagnosed at a later, more advanced stage, with poor prognosis. According to Javaid Iqbal Sofi, a global fellow at Brandeis University, breast cancer is likely to cause more death among women in India than any other malady, by 2030. At present, one woman gets diagnosed with breast cancer every four minutes in India and one woman dies every 13 minutes, making it the most prevalent cancer among Indian women.
The health tech company, which was picked by Google to be part of its Launchpad Accelerator programme and had received a grant from the Bill & Melinda Gates Foundation, is on a long trek. It has a small but growing team of 60 employees, half of them being women.
For breast cancer screening, Niramai has received several patents. “The machine learning techniques used in Niramai’s solution have led to it winning 10 U.S.-granted patents. We got three patents from India, two each from Singapore and China, and one from Canada. The U.S. FDA has already given its nod for Niramai’s hardware, but we are awaiting the clearance for the software,” says Manjunath.
“The core innovation is in the software which is able to analyse thermal images and generate a diagnostic report which determines whether there is anything malignant or not. It is non-contact, non-invasive, and private. What the tool is looking for is an abnormal tissue activity which is five-six years before the lump is formed. Since the detection is at a very early stage, it has the potential to save many lives,” she says.
According to her, Niramai has over 70 installations at hospitals and diagnostic centres in India, with Apollo Clinic being their marquee partner.
Apollo Clinic has implemented Niramai’s systems at five of their 72 clinics. “We have been using it as a pilot project for the last four months. On the precision and efficacy of the technology, we have seen very good results. Once the pandemic subsides, we will expand the service to other clinics as well,” says Nihal Elli Kathodika, programme manager, primary care, at Apollo Clinic.
He says the pandemic has taken a toll on footfall since Niramai is in the preventive care space.
The founder agrees that Niramai’s growth has slowed in the pandemic year. “We are 60 people now, and expanding. The fact is that there are only eight salespeople now. We need a bigger sales team,” says Manjunath.
How different is Niramai’s technology from mammography and sonomammography?
For years, breast check-ups in the country have depended on mammography to examine the human breast for diagnosis and screening. It helps in early detection of breast cancer, typically through detection of characteristic masses or microcalcifications. A mammogram uses a low dose of radiation to take an image of the breast. The tissue is compressed between two plates for the best image to be taken.
In sonomammography, an ultrasound uses high-frequency sound waves and converts them to an image. An ultrasound is generally not used as the primary screening tool for breast cancer. However, when used in conjunction with mammography, it can complement other breast cancer screening tools. Often, an ultrasound will be ordered when an abnormality is detected on a mammogram.
But a lot of women hesitate to undergo mammographic screening because it primarily uses radiation.
“The mammography is painful, and many women are not comfortable with it. And it may not work on women under 45 years,” says Manjunath.
Experts suggest that sonomammography is not so precise. Moreover, while some radiologists are able to figure out breast abnormalities easily from sonomammography, some are not able to do so.
In stark comparison, Niramai’s technology uses absolutely no radiation and makes patients extremely comfortable. Given that it is portable and low-cost, the solution makes cancer screening more accessible and affordable to all. Niramai’s thermal device, which is placed three feet in front of the patient, captures five thermal images of the region. Niramai’s software tool automatically analyses these images and sends the analysis report that is certified by a senior radiologist.
“Privacy issues are well taken care of. No see, no touch. Thermal analytics works with thermal cameras measuring 400,000 temperature points per person and generates a breast health report with multiple scores,” says Manjunath. The solution is accurate, automated, and works on women of all age groups.
“The cost is another important factor. A 2D mammography machine costs around ₹80 lakh while a 3D machine costs above ₹2 crore. Our machine, which comprises several thermal sensors and the software, costs only ₹8 lakh,” she says.
“Our equipment is easily portable. We have already done several outreach camps in partnership with clinics, companies, and non-governmental organisations,” she says.
The revenue model is simple: hospitals and clinics will levy a screening charge from each patient. For bulk users like hospitals and big clinics, Niramai has a different pricing strategy depending on their volume. In general, hospitals charge patients ₹1,500 per screening.
Niramai recently received the CE mark approval, ISO 13485 and MDSAP (Medical Device Single Audit Programme) International Certifications. The CE mark approval indicates that the product may be sold freely in any part of the European Economic Area.
Manish Singhal, founding partner of pi Ventures and lead investor of Niramai, argues that the technology is a game changer on how lives can be saved from breast cancer. “With the ISO and CE certification, now Thermalytix can be made available to women beyond India especially in entire Europe, Middle East and several countries in Southeast Asia leading to global impact,” he said in a statement.
Munehiko Eto, another board member and investor from the Japanese VC Firm Dream Incubator, said, “There is a strong global need for Niramai’s breakthrough solution for breast cancer.”
Niramai has also developed a similar tool to screen Covid-19 patients. It has installed it at two railway stations in Bengaluru.
What is next on Niramai’s mind? “At present, research is on for similar A.I.-enabled tools to detect all kinds of cancers as well as river blindness.” So far, Niramai has raised $7 million in funding. But Manjunath knows it still has a long road ahead.