For women, their gender is the strongest breast cancer risk factor, as approximately less than 1% of ... [+]
In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally. And as of the end of 2020, World Health Organization estimated that there were 7.8 million women alive who were diagnosed with breast cancer in the past five years, making it the world’s most prevalent cancer. There are more lost disability-adjusted life years (DALYs) by women to breast cancer globally than any other type of cancer.
Unlike some cancers that have infection-related causes, such as human papillomavirus (HPV) infection and cervical cancer, as well as liver and stomach cancer, there are no known viral or bacterial infections linked to the development of breast cancer. For women, in particular, increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use, and postmenopausal hormone therapy, are all factors that increase the risk of breast cancer at some point in their lives. Unfortunately, for women, their gender is the strongest breast cancer risk factor, as approximately less than 1% of breast cancers occur in men.
Vara, a startup building an intelligent platform that infuses state-of-the-art artificial intelligence into routine breast screenings, is on a mission to find every deadly breast cancer early.
Today, the company has announced its Series A extension in the amount of $4.4 million which was led by VI Partners and included impact investor, EQT Foundation, as well as the family office behind one of Germany's largest radiology provider groups, Med360, which particularly invested after seeing the impact Vara had on its own workflows. Its latest investors join OMERS Ventures, Merantix (Europe’s first AI venture studio which is backed by limited partners such as SoftBank), Think.Health, Soleria Capital, and Plug and Play in backing the cancer screening company.
Jonas Muff and Stefan Bunk, cofounders of Vara
Arnd Kaltofen-Ehmann, the Managing Partner at Vi Partners, is a strong supporter of Vara’s mission. “Vara continues to break ground in how AI and machine learning can transform the screening workflow. From its unique tech and AI approach to its deep integration with German centers, and its strong partnerships with international providers, Vara is an innovative startup with great purpose. It’s already underpinned by a growing body of peer-reviewed evidence and backed by clinical and health experts, and through its groundbreaking prospective study coupled with this latest investment, Vara is in a strong position to achieve its life-saving mission.”
Founded in Germany, Vara is already operating in Germany and Greece and has recently announced two major partnerships in Greece and Mexico, which will make its technology available to over 30 million women. In Greece, the company has partnered with MITERA, the largest Private Hospital in Greece, and in Mexico, large employers, such as the automobile company JAC or Latin American food company GAT are purchasing screenings offered by Mamotest and Vara, as are large NGO organizations such as ProMujer.
Better Cancer Screening For 1 Billion Women Worldwide
The platform has also tripled the number of mammograms screened on its platform and is on a mission to provide 1 billion women worldwide with access to better screening, particularly in underfunded areas, in order to catch breast cancer earlier. At the moment, more than 80,000 mammography examinations per month are assessed through Vara.
“800 million women are currently at risk of developing breast cancer, many of which will not get access to suitable screening. We envision a world where cancer screening is accessible for everyone, regardless of geography or background,” shares Jonas Muff, founder of Vara, with me.
To accomplish that, Muff and the team have developed a breast cancer screening platform with artificial intelligence at its core. It allows local radiology clinics to make better use of their existing mammography scanners to provide high-quality and reliable breast cancer screening at much lower costs - proven by leading and globally accepted clinical evidence.
Vara is an intelligent platform that infuses state-of-the-art artificial intelligence into routine ... [+]
The initial aim for Vara’s team was to approach the problem holistically - which is required to establish breast cancer screening in a cost-effective and scalable way: they do this by helping their partners raise awareness and provide education to more women and remove the barriers that prevent them from accessing effective screening, while Vara’s platform navigates the entire screening workflow, from appointments to the follow-up after screening (incl. real-world evidence monitoring).
A Collaborative AI–Radiologist Approach
On top of that, their AI decision referral pathway (published in Lancet Digital Health and developed in Germany, as well as the European Journal of Radiology) supports their partners’ radiologists, such that they can screen more women and achieve better efficacy. The study conducted (results published in Lancet in July 2022) aimed to propose a solution for the safe clinical adoption of AI systems in breast cancer screening, “namely, adopting a collaborative AI–radiologist approach that combines triage and cancer detection with high accuracy and forgoes a standalone AI approach that aims to replace the radiologist, but at the risk of degrading sensitivity”. This two-part system incorporates both “triaging of exams and a safety net to predict cancer-positive exams to maintain a high degree of sensitivity for cancer detection, improves the screening accuracy of radiologists, is adaptive to screening requirements, and allows for the reduction of the workload of radiologists without discarding their final oversight”.
Vara’s main customers are women at risk of breast cancer who require a mammogram at least once every second year but (in most parts of the world) do not yet have access.
“In Germany, we work with 30% of all screening centers and were able to show that we can find 42% of all missed interval cancers and reduce workload by 73%. In Mexico, we work with a mission-driven strategic partner like Mamotest to deliver the platform faster and to more women, and we have already launched five mammography screening clinics,” adds Muff.
Muff highlights that many health systems today want to implement population-based breast cancer screening programs, but implementing such programs based on European guidelines is very costly, and requires sub-specialized screening experts which are very scarce worldwide. He also highlighted how many radiology clinics often have mammography scanners (for women with symptoms) which aren’t frequently used and thus aren’t profitable. Those clinics lack the radiologists and the processes to ramp up their screening business and aren’t effectively driving awareness in their communities.
On top of that, women’s insurance plans often do not cover preventative mammography screening, which results in high costs for screening, which must be paid by the individual. “Many women also lack trust in the healthcare system and haven’t received enough education on the importance of regular breast cancer screening.”
Supporting More Women In Low And Middle-Income Countries
Ultimately, the company’s vision is that breast cancer screening is provided to every woman at risk. “For this, we’ll need to bring the health systems and bodies that fund screening (e.g. insurance companies) on board which will help us to roll out breast cancer screening at a wide scale. We will also need to be able to demonstrate the economic return on investment we’re able to deliver to healthcare systems - which requires prospective, real-world evidence,” explains Muff.
In Germany - where he and his team already work with 30% of the screening market - Vara has launched the PRAIM study, in partnership with the University of Lübeck, the first of its kind worldwide and by far the largest-ever prospective study conducted, with the aim of evaluating the use of an AI application and workflow software to support breast cancer-screening radiologists. By June 2023, they’ll have included 400,000 women.
“The second north star right now for us is to continue reaching more women in Mexico, where hundreds of women are screened every week and we are very focused on launching further clinics and growing the ecosystem in Mexico, which was joined by large corporations and NGOs such as ProMujer. We launched in Mexico only this year but already see exciting interest and support coming from large international corporations,” shares Muff.
The goal for 2023 is to launch in Egypt and India, as well as expand its AI technology to other modalities, starting with 3D mammography (tomosynthesis) to provide the best possible screening quality to women with dense breast tissue.
This international expansion is key to Vara’s mission because, despite the fact that breast cancer could be treated very well if detected in its earliest stages, millions are being left behind by a lack of effective, organized programs. Of the 700,000 global deaths caused by breast cancer each year, ~70% occur in low and middle-income countries, in part due to the inability to diagnose early caused by a lack of technology, awareness, and of specialized screening radiologists. Ultimately, if breast cancer could be detected early, (1) survival rates would increase by more than 60% when diagnosed at stage I compared to later stages (2) treatment costs would be lower, and less invasive, and (3) life quality would increase significantly.
“Today’s funding announcement, in which we welcome such esteemed investors in the healthtech, radiology, and impact-focused sectors to Vara, speaks to both the success we’ve seen in recent months, as well as to our ambition. We’re on a mission to make data-driven breast cancer screening accessible to everyone, everywhere, and catch cancer early and this funding extension helps make this mission a reality,” concludes Muff.
