New mammogram measures of breast cancer risk could revolutionise screening, diagnosis

World-first techniques for predicting breast cancer risk from mammograms that were developed in Melbourne could revolutionise breast screening by allowing it to be tailored to women at minimal extra cost.

Published in the International Journal of Cancer, the University of Melbourne-led study found two new mammogram-based measures of risk.

When these measures are combined, they are more effective in stratifying women in terms of their risk of breast cancer than breast density and all the known genetic risk factors.

Researchers say if successfully adopted, their new measures could substantially improve screening, make it more effective in reducing mortality and less stressful for women, and therefore encourage more to be screened. They could also help address the problem of dense breasts.

Since the late 1970s, scientists have known that women with denser breasts, which shows up on a mammogram as having more white or bright regions, are more likely to be diagnosed with breast cancer and to have it missed at the screening.

Collaborating with Cancer Council Victoria and BreastScreen Victoria, University of Melbourne researchers were the first to study other ways of investigating breast cancer risk using mammograms.

Using computer programs to analyse mammogram images of large numbers of women with and without breast cancer, they found two new measures for extracting risk information. Cirrocumulus is based on the image's brightest areas and Cirrus on its texture.

First, they used a semi-automated computer method to measure density at the usual, and successively higher levels of brightness to create Cirrocumulus.

They then used artificial intelligence (AI) and high-speed computing to learn about new aspects of the texture (not brightness) of a mammogram that predict breast cancer risk and created Cirrus.

When their new Cirrocumulus and Cirrus measures were combined, they substantially improved risk prediction beyond that of all other known risk factors.

Lead researcher and University of Melbourne Professor John Hopper said that in terms of understanding how much women differ in their risks of breast cancer, these developments could be the most significant since the breast cancer genes BRCA1 and BRCA2 were discovered 25 years ago.

"These measures could revolutionise mammographic screening at little extra cost, as they simply use computer programs. The new measures could also be combined with other risk factors collected at screening, such as family history and lifestyle factors, to provide an even stronger and holistic picture of a woman's risk," Professor Hopper said.

"Tailored screening - not 'one size fits all' - could then be based on accurately identifying women at high, as well as low, risk so that their screening can be personalised. Given mammography is now digital, and our measures are now computerised, women could be assessed for their risk at the time of screening - automatically - and given recommendations for their future screening based on their personal risk, not just their age," Hopper added.

Professor Hopper said this information could be used to ease pressure on BreastScreen, which had to close for a period during the COVID-19 pandemic and is looking for ways to best handle the backlog while continuing to provide a valuable service with limited resources.

He said the current breakthrough could not have occurred without the extraordinary support his mammogram research had received from the National Breast Cancer Foundation, starting with its first funding round more than 20 years ago.

"Only around 55 per cent of Australian women aged 50-74 currently present for screening aimed at detecting breast cancers early," he said.

"Knowing that screening could also give an accurate risk prediction could encourage more women to take up the offer of free screening. Women with high risk based on their mammogram would also benefit greatly from also knowing their genetic risk," he added.

Adjunct Associate Professor Helen Frazer, Clinical Director of St Vincent's BreastScreen Melbourne, said that improvements in assessing a woman's risk of breast cancer would be transformative for screening programs.

"Using AI developments to assess risk and personalise screening could deliver significant gains in the fight against breast cancer," Adjunct Associate Professor Frazer said.

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Coronavirus: Centre warns against use of N95 masks with valved respirators

The health ministry on Monday warned against the “inappropriate use of N95 masks, especially those that contain respiratory valves”. Director General of Health Services Rajiv Garg encouraged people to use homemade face masks.

“It is to bring to your knowledge that the use of valved respirator N95 masks is detrimental to the measures adopted for preventing the spread of coronavirus as it does not prevent the virus from escaping out of the mask,” Garg said in a letter to all states and Union Territories. “In view of the above, I request you to instruct all concerned to follow the use of face/mouth cover and prevent inappropriate use of N95 masks.”

In April, the Centre had issued an advisory on the use of homemade protective cover for face and mouth. The advisory stressed such face covers must be washed and cleaned each day. These handmade masks, however, are not meant for health workers or those working with or in contact with Covid-19 patients or those who are patients themselves as they are required to wear specified protective gear, the health ministry had said.

India’s total case count has crossed 11.55 lakh as of Tuesday and the toll is over 28,000. While more than 7 lakh people have recovered, India’s over over 4 lakh active cases.

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Pulse oximeters: How they work, may help fight COVID-19 and more

As coronavirus testing efforts continue to ramp up and face masks become part of everyday life, a tiny diagnostic tool that clips to your finger is quickly becoming a must-have gadget in the fight against COVID-19. It's called a pulse oximeter, and it checks your blood oxygen level.

The device was already beginning to surge in popularity as the public learned that people with the coronavirus often arrive at the hospital with abnormally low oxygen levels. After an op-ed piece in The New York Times on April 20 recommended that pulse oximeters be used to identify the sickest among COVID-19 patients and detect the frightening condition known as "silent hypoxia," sales of the devices skyrocketed. Right now, most are sold out in stores and online.

But questions and controversy have arisen around the at-home use of pulse oximeters, which painlessly measure heart rate and oxygen levels. It's not entirely clear if pulse oximeters can help detect a coronavirus infection or whether their widespread use can help curb the spread of COVID-19.

Whether you already have a pulse oximeter or you're thinking about buying one, here's what you need to know about what they do, how they work, what the results mean and how accurate they might be.

Pulse oximeters: Vital signs, at your fingertips

A pulse oximeter is a small medical device that measures heart rate and blood oxygen saturation. It's usually clipped to your finger, but it can also attach to your ear, nose, toe or forehead. Some are battery powered and provide real-time results on a small LED display on the device itself. Others connect with a wire to a separate vital sign monitor that records even more precise information about your heart rhythm, body temperature and blood pressure using other sensors connected to your body.

How pulse oximeters measure heart rate and oxygen

A pulse oximeter measures your blood oxygen saturation and heart rate by shining a light through your skin and detecting both the color and movement of your blood cells. Oxygenated blood cells are bright red, deoxygenated cells are dark red.

The pulse oximeter compares the number of bright red cells to dark red cells to calculate your oxygen saturation as a percentage. So, for example, a reading of 99% means only 1% of the blood cells in your bloodstream have been depleted of oxygen.

Every time your heart beats, it pushes your blood through your body in a quick pulse (which is why "pulse" is another word for "heart rate"). A pulse oximeter, using light, detects this movement and calculates your heart rate in beats per minute, or BPM.

What's a healthy oxygen level and heart rate?

According to the Mayo Clinic, a normal pulse oximeter oxygen level reading is between 95% and 100%, and anything less than 90% is considered dangerously low, or hypoxic. Some doctors have reported COVID-19 patients entering the hospital with oxygen levels at 50% or below.

A normal resting heart rate is between 60 and 100 BPM. Typically, lower is better, as a slower heart rate is usually an indication of a strong cardiovascular system.

Can a pulse oximeter detect COVID-19?

Not exactly. Although many doctors report that patients with COVID-19 are presenting with dangerously low blood oxygen levels, COVID-19 isn't the only disease that can cause such a problem. Chronic lung diseases, like COPD, asthma and other non-COVID-19 lung infections can also result in a low oxygen count.

A low oxygen reading by itself is not enough to diagnose COVID-19, but your doctor would want to know about it, especially if you notice the level decreasing over time. And if you've been diagnosed with COVID-19, your doctor may want you to monitor your oxygen level to determine whether your condition is worsening or improving.

How accurate are over-the-counter pulse oximeters?
Like with any electronic equipment, not all pulse oximeters are created equal. A 2016 study of low-cost pulse oximeters concluded several inexpensive consumer-grade devices provided highly inaccurate readings.

Some pulse oximeters have been cleared by the FDA, which means they should meet FDA standards for accuracy. Note that there is a distinction between "FDA-approved" and "FDA-cleared," with "cleared" being the less rigorous of the two. That said, Class II medical devices like pulse oximeters are usually "cleared" rather than "approved."

You can look for pulse oximeters on the FDA-cleared list by visiting the FDA's Premarket Notification website and searching for "pulse oximeter" in the Device Name field, with or without a manufacturer's name.

How much should I spend on a pulse oximeter?

In the 2016 study that found most low-cost pulse oximeters to be relatively inaccurate, "low-cost" was defined as costing less than $50. Pulse oximeters that have been cleared by the FDA tend to range in price from around $50 to $60 to well into the hundreds and even thousands of dollars.

Where can I buy a pulse oximeter?

You can still find pulse oximeters on sale online at Walmart, Amazon and eBay, but most of the name-brand devices you'll find on various best lists, like those at DigitalTrends, The Wirecutter and Consumer Reports, are either sold out completely or on backorder, with shipping estimates weeks or sometimes months away.

This week, the CDC added five more official COVID-19 symptoms for a total of seven, which are detailed here. However, symptoms, vital signs and statistics aren't the only way to track the pandemic: Memes and social media chatter are relevant data points, too. Depression and anxiety may not be symptoms of the disease itself, but as the pandemic continues, you're not the only one feeling down about it.

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AI Used to Measure Sugar in the Blood

Researchers hope this can someday replace the invasive finger prick. 

Anyone suffering from diabetes knows how important tracking sugar in the blood is. Technology has improved that process but it still requires needles and finger pricks.

Researchers at the University of Warwick in the UK are trying to change that, applying artificial intelligence to the problem.

In a paper published in journal Scientific, the scientists led by Dr. Leandro Pecchia demonstrated how they could detect sugar in the blood using ECG signals and off-the-shelf-wearable sensors. 

The AI system works just as well
Two pilot studies of healthy volunteers showed the system's average sensitivity and specificity was about 82% which is comparable with the current system used to detect hypoglycemia.  As it stands continuous glucose monitors or CGMs are available via the NHS for detecting sugar levels in the blood. They measure the glucose in fluid using a sensor with a needle. The senor sends alarms and data to a device. The devices often need to be calibrated two times a day and include fingerprick blood glucose level tests. 

Fingerpicks are never pleasant and in some circumstances are particularly cumbersome. Taking fingerpick during the night certainly is unpleasant, especially for patients in pediatric age," said Dr. Pecchia in a press release announcing the work. “Our innovation consisted in using artificial intelligence for automatic detecting hypoglycemia via few ECG beats. This is relevant because ECG can be detected in any circumstance, including sleeping.”

Subject's own data used to train the AI algorithm

What may have made the Warwick scientists' method so effective is that the AI algorithms are trained with the subject's own data. If cohort data was used the system would not give back the same results.

"Our approach enables personalised tuning of detection algorithms and emphasize how hypoglycaemic events affect ECG in individuals. Basing on this information, clinicians can adapt the therapy to each individual. Clearly more clinical research is required to confirm these results in wider populations. This is why we are looking for partners., Dr. Pecchia said.

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Smart jumpsuit to track development of infants

 In a first, researchers have come up with a smart jumpsuit that is capable of measuring the spontaneous and voluntary movement of infants starting from the age of five months.

The information which is subsequently gathered could possibly help in assessing abnormal neurological development, among other things.

The study on the smart jumpsuit and the related analysis method applied to seven-month-old infants was published in the Scientific Reports journal. In the future, the jumpsuit can also be used to study older children.

Previously, the quantitative tracking of children's spontaneous motility in the natural environment has not been possible. Instead, children have been primarily qualitatively assessed at the physician's or physiotherapist's practice, which requires taking into account the fact that the infant's behavior in the practice setting does not necessarily entirely match that seen at home.

"The smart jumpsuit provides us with the first opportunity to quantify infants' spontaneous and voluntary movements outside the laboratory. The child can be sent back home with the suit for the rest of the day. The next day, it will be returned to the hospital where the results will then be processed," explains Sampsa Vanhatalo, professor of clinical neurophysiology at the University of Helsinki.

Vanhatalo says that the new analysis method quantifies infant motility as reliably as a human being would be able to do by viewing a video recording.

After the measurement, the infant's actual movements and physical positions will be known to the second, after which computational measures can be applied to the data.

"This is a revolutionary step forward. The measurements provide a tool to detect the precise variation in motility from the age of five months, something which medical smart clothes have not been able to do until now," added Vanhatalo.

The data gleaned by the smart jumpsuit is valuable since the detection of abnormalities in the neurological development of infants at an early stage enables early support.

Brain plasticity is at its strongest in early childhood and is benefited by measures supporting development, which are targeted at recurring everyday activities.

At least 5% of Finnish children suffer from problems associated with language development, attention regulation, and motor development.

Often, such problems overlap. The pathogenic mechanisms underlying developmental disorders are complex, but preterm birth, perinatal brain damage and the lack of early care, as well as insufficient stimulation in the growth environment, aggravate the risk of developmental problems.

According to Leena Haataja, professor of pediatric neurology, developmental disorders in today's pressure-dominated world pose a considerable risk that can lead to learning difficulties and obstacles in the competition for education and jobs. Furthermore, they are a risk factor associated with exclusion from contemporary society.

In the future, smart jumpsuit can be used for the objective measurement of how various therapies and treatments affect children's development.

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