Artificial intelligence to detect breast cancer in the poorest women

“What all women must understand is that the arrival of breast cancer does not warn… It does not hurt, many times it is not even palpable;

That's why it's so dangerous, ”says Argentinean Silvia Verón, 45, while recreating the entire process she had to face when in 2020 the results of her first mammogram announced nodules in her right breast and microcalcifications in the left.

"The results came to me in the middle of the pandemic, without a job and without social security... And here the public hospitals give shifts for a year or even more, so I decided to let it go while I paid the most urgent debts," he confesses.

For Verón, the priorities were clear: support her children and cope with the weight of the pandemic.

A few months passed until he received a call from his family doctor, advising him that he would have free access to the surgeries to remove the benign masses from both of his breasts.

Then his life took a turn: “I saw myself with women who had to go to chemotherapy from time to time, without hair, without breasts... And that's the least of it.

I even lost one of my friends to this disease.”

According to data from the World Health Organization (WHO), in 2020 alone there were 2.2 million cases of breast cancer and 684,996 deaths worldwide due to this disease,

which has made it the most diagnosed malignant tumor on the planet and the main cause of death among women.

Although comprehensive treatment for this pathology is available in less than 15% of low-income countries, while coverage amounts to 90% in high-income countries, according to the Pan American Health Organization (PAHO).

An idea and a lot to do

Already in 2020, Argentina was positioned as the fifth country in Latin America with the highest rates of cancer patients, with figures that bordered on 130,878 new cases in both sexes.

Of these data, 73% corresponds to breast cancer.

Guillermo Pepe is the executive director and founder of Mamotest, a platform for diagnosing and accompanying patients.

Through coordinated work with local governments and social assistance foundations, he has managed to subsidize the costs of mammograms, breast ultrasounds and even treatments for more than 600,000 women at the highest risk ages, from 40 years of age.

Since 2021, when he made the leap to Mexico, he has supported 18,000 new patients.

Pepe says that in 2013, when the initiative was born, the main challenge was to talk about telemedicine.

In a country where the areas farthest from the capital lacked connectivity and efficient medical systems, the work had to start from scratch.

"Even now people believe that teleradiography is talking on the phone," he acknowledges, while explaining how this large network works.

“The patient attends the nearest radiological center in person, these X-rays are sent via the internet to our specialists and the results are ready in two days, along with a new medical appointment to analyze her health status.”

In 2020, there were 2.2 million cases of breast cancer and 684,996 deaths worldwide due to this disease

But the telematics of this system is not only the use of the Internet to send the X-rays, but also what Pepe calls "the missing link".

"We mix teleradiography with artificial intelligence that allows us to study criteria such as socioeconomic status, health history and genetics of patients," he says.

This information has become a point of interest for local governments and companies related to health to identify the needs and possible solutions for cancer prevention.

In return, the same organizations interested in these data are the ones that must subsidize the care, diagnosis and treatment of patients.

But ignorance, rejection and, above all, poverty levels have made the difference between surviving cancer or not.

Not only the disease kills: lack of resources, poverty and inequality

“Many women in a situation of poverty are postponing their check-ups because they don't have what to pay, most don't have social security and private clinics charge you an arm and a leg;

some are housewives or prefer not to miss a day of work to get their annual check-ups”, laments Agustín Fernández, medical director of Mamotest, after finishing a talk on breast cancer prevention at a school in the province of Corrientes.

“We started with my school, San Nicolás

and now we have trained 15 other centers in Buenos Aires and Corrientes on how to do a breast self-examination, risk factors and prevention methods.

You saw that the boys are the ones who generate debate at home, well you already have it

now they are also aware”, he says in a relaxed tone.

In areas far from large cities, the medical team is analog, there is a lack of specialists and legislation that requires education and prevention campaigns and payment facilities.

For Fernández, prevention makes a difference in the quality of life of a patient in the initial stage of cancer, but he does clarify that this is not so easy to achieve.

“In areas far from the big cities, the medical team is analog, there is a lack of specialists and legislation that requires education and prevention campaigns and payment facilities,” she says.

“If you

with just enough, it is difficult for you to

to spend 100 or 150 euros to get a mammogram.

This is also a question of poverty”, she sentences.

The WHO, in its latest report on the impact of this disease, has announced that breast cancer survival five years after diagnosis exceeds 90% in high-income countries, while in India it is 66% and 40% in South Africa.

Fernández says that it is not only about making patients responsible for their self-care, but that the medical system must provide regular monitoring of treatments, as well as emotional support.

"We have cases of women who refuse to undergo mammography because they are afraid of death, and what they should know is that with early detection and complete and continuous treatment, time and quality of life can be guaranteed."

From the age of 30, women should have control ultrasounds, while from 40 years onwards, hormonal changes require more detailed studies such as mammography, as recommended by international health organizations.

Now, one thing is prevention and another is when the disease is detected at an advanced level.

Fernández maintains that the key to ensuring longer life for patients living in hard-to-reach areas is to adapt radiation oncology solutions to the situation on the ground, supported by adequate security infrastructure.

From the age of 30, women should have control ultrasounds, while from 40 years onwards, hormonal changes require more detailed studies such as mammography

Pepe and Fernández agree that, although provinces such as Jujuy, Chaco, Buenos Aires, Corrientes and Santa Fe, in Argentina, and now cities such as Monterrey, Veracruz, Guadalajara, Pachuca and Metepec, in Mexico, have already reduced the standard age of review mammography from 55 to 43 years, cancer is still the leading cause of death in women.

“The problem is that this disease continues to be diagnosed at a late stage.

There is still a lot to do," says Pepe, who in 2021 was recognized by the United Nations, the World Economic Forum and the Zayeb Sustainability Award for his work to democratize health services.

“The idea is to continue building a highway where there is still no road to travel on,” concludes Pepe, who is already preparing for the new breast cancer prevention month campaign.

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