NHS AI test spots tiny cancers missed by doctors

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NHS AI test spots tiny cancers missed by doctors​

2 days ago

By Zoe Kleinman, Technology editor


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BBC
AI tool Mia circles two areas of concern on a mammogram scan

An AI tool tested by the NHS successfully identified tiny signs of breast cancer in 11 women which had been missed by human doctors.

The tool, called Mia, was piloted alongside NHS clinicians and analysed the mammograms of over 10,000 women.

Most of them were cancer-free, but it successfully flagged all of those with symptoms, as well as an extra 11 the doctors did not identify.

At their earliest stages, cancers can be extremely small and hard to spot.

The BBC saw Mia in action at NHS Grampian, where we were shown tumours that were practically invisible to the human eye. But, depending on their type, they can grow and spread rapidly.

Barbara was one of the 11 patients whose cancer was flagged by Mia but had not been spotted on her scan when it was studied by the hospital radiologists.

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Barbara had her tumour caught early by AI

Because her 6mm tumour was caught so early she had an operation but only needed five days of radiotherapy. Breast cancer patients with tumours which are smaller than 15mm when discovered have a 90% survival rate over the following five years.

Barbara said she was pleased the treatment was much less invasive than that of her sister and mother, who had previously also battled the disease.

She told me she met a relative who expressed sympathy that Barbara had "the Big C".

"I said, 'it's not a big C, it's a very little one'," she said.

Without the AI tool's assistance, Barbara's cancer would potentially not have been spotted until her next routine mammogram three years later. She had not experienced any noticeable symptoms.

Because it works instantly, tools like Mia also have the potential to reduce the waiting time for results from 14 days down to three, claims its developer Kheiron.

None of the cases in the trial were analysed by Mia alone - each had a human review as well. Currently two radiologists look at each individual scan, but the hope is that one of them could one day be replaced by the tool, effectively halving the workload for each pair.

Of the 10,889 women who participated in the trial, only 81 did not want the AI tool to review their scans, said Dr Gerald Lip, clinical director of breast screening in the north east of Scotland and the doctor who led the project.

AI tools are generally pretty good at spotting symptoms of a specific disease, if they are trained on enough data to enable them to be identified. This means feeding the programme with as many different anonymised images of those symptoms as possible, from as diverse a range of people as possible.

Getting hold of this data can be difficult because of patient confidentiality and privacy concerns.

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Sarah Kerruish, Chief Strategy Officer of Kheiron Medical

Sarah Kerruish, Chief Strategy Officer of Kheiron Medical, said it took six years to build and train Mia, which is run on cloud computing power from Microsoft, and it was trained on "millions" of mammograms from "women all over the world".

"I think the most important thing I've learned is that when you're developing AI for a healthcare situation, you have to build in inclusivity from day one," she said.

Breast cancer doctors look at around 5,000 breast scans per year on average, and can view 100 in a single session.

"There is an element of fatigue," said Dr Lip.

"You get disruptions, someone's coming in, someone's chatting in the background. There are lots of things that can probably throw you off your regular routine as well. And in those days when you have been distracted, you go, 'how on earth did I miss that?' It does happen."

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Dr Gerald Lip ran the evaluation of the AI tool at NHS Grampian

I asked him whether he was worried that tools like Mia might one day take away his job altogether.

He said he believed the tech could one day free him up to spend more time with patients.

"I see Mia as a friend and an augmentation to my practice," Dr Lip said.

Mia isn't perfect. It had no access to any patient history so, for example, it would flag cysts which had already been identified by previous scans and designated harmless.

Also, because of current health regulation, the machine learning element of the AI tool was disabled - so it could not learn on the job, and evolve during its use. Every time it was updated it had to undergo a new review.

The Mia trial is just one early test, by one product in one location. The University of Aberdeen independently validated the research, but the results of the evaluation have not yet been peer reviewed. The Royal College of Radiologists say the tech has potential.

"These results are encouraging and help to highlight the exciting potential AI presents for diagnostics. There is no question that real-life clinical radiologists are essential and irreplaceable, but a clinical radiologist using insights from validated AI tools will increasingly be a formidable force in patient care." said Dr Katharine Halliday, President of the Royal College of Radiologists.

Dr Julie Sharp, head of health information at Cancer Research UK said the increasing number of cancer cases diagnosed each year meant technological innovation would be "vital" to help improve NHS services and reduce pressure on its staff.

"More research will be needed to find the best ways to use this technology to improve outcomes for cancer patients," she added.

There are other healthcare-related AI trials going on around the UK, including an AI tool by a firm called Presymptom Health which is analysing blood samples looking for signs of sepsis before symptoms emerge - but many are still in early stages without published results.

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GPs use AI to boost cancer detection rates in England by 8%​

‘C the Signs’ artificial intelligence program scans medical records to increase likelihood of spotting cancers

James Tapper

Sun 21 Jul 2024 02.00 EDT

A GP with a patient: the C the Signs AI tool is used in about 15% of GP practices in England.
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A GP with a patient: the C the Signs AI tool is used in about 15% of GP practices in England. Photograph: Julian Claxton/Alamy


Artificial intelligence that scans GP records to find hidden patterns has helped doctors detect significantly more cancer cases.

The rate of cancer detection rose from 58.7% to 66.0% at GP practices using the “C the Signs” AI tool. This analyses a patient’s medical record to pull together their past medical history, test results, prescriptions and treatments, as well as other personal characteristics that might indicate cancer risk, such as their postcode, age and family history.

It also prompts GPs to ask patients about any new symptoms, and if the tool detects patterns in the data that indicate a higher risk of a particular type of cancer, then it recommends which tests or clinical pathway the patient should be referred to.

C the Signs is used in about 1,400 practices in England – about 15% – and was tested in 35 practices in the east of England in May 2021, covering a population of 420,000 patients.

The results, published in the Journal of Clinical Oncology, show that the cancer detection rate rose from 58.7% to 66.0% by 31 March 2022, while those practices not using the system remained at a similar rate.

Bea Bakshi, a GP who created the system with her colleague, Miles Payling, said: “It could be a scan, an ultrasound, or they could need to be seen by a specialist at a clinic.”

Patients are tracked through the C the Signs system to remind doctors to check test results and referrals elsewhere. “Our system has detected over 50 different types of cancers,” Bakshi said. “The key thing is that it’s not only an earlier diagnosis, but a faster diagnosis.”

Bakshi and her colleagues also sought to validate the tool by assessing 118,677 patients in a previous study, which found that 7,295 were diagnosed with cancer and 7,056 were successfully identified by the algorithm.

Where the tool came to the conclusion that it was unlikely a patient did have cancer, only 239 out of 8,453 went on to have a confirmed cancer diagnosis within six months (about 2.8%). Bakshi developed the tool after meeting a patient in hospital who had been given a late diagnosis of pancreatic cancer and died three weeks later.

“It stayed with me as a problem area,” she said. “Why are patients with cancer being diagnosed so late?”

The UK has three cancer screening programmes, for bowel, breast and cervical cancers, but there are 200 different types of cancer which may be asymptomatic or create symptoms easily confused with other conditions.

“Two-thirds of deaths are in the non-screenable cancers and the ones that we aren’t screening for,” Bakshi said. “Patients visit GPs between three and five times before they are recognised as being at risk of cancer. GPs detect an average of eight cases of cancer a year.”

GPs use guidelines from the National Institute for Health and Care Excellence to make decisions about when to make a cancer referral.

“They’re quite comprehensive guidelines, but no GP can remember them all,” said Peter Holloway, a GP who chairs the Primary Care Group for the East of England Cancer Alliances and a co-author on the study.

“We know a lot of cancers present with vague symptoms and some are difficult to define and don’t necessarily correlate with our guidelines.”

Holloway saw a patient in his early 60s who had diarrhoea and some lower abdominal pain. “Very common symptoms, and not things that would lead you to do a referral for suspected cancer,” he said. But the C the Signs tool recommended a faecal test.

“The test was positive, he was referred and he turned out to have colorectal cancer, which was diagnosed early and treated successfully,” Holloway said. “He’s fine, but if we’d followed the rigid guidelines, he may not have got referred for several months.”

The NHS England Long Term Plan for Cancer aims to have 75% of all cancers diagnosed by stage one or stage two by 2028. The NHS is also conducting research into whether the Galleri blood test, which attempts to detect DNA from more than 50 different types of tumours, is effective. The trial began in September 2021, and 140,000 people have been tested.

Holloway said that decision support systems such as C the Signs were an important part of cancer detection, alongside improving patient awareness of different types of possible symptoms of cancer, and getting better access to diagnostic technology such as CT and MRI scanners.

Prof Peter Johnson, National Clinical Director for Cancer at NHS England, said: “Despite increased demand and pressure on services, record numbers of people are being checked and treated for cancer, and we are now diagnosing a higher proportion of cancers at an early stage, increasing people’s chances of survival.

“We know we have a lot more to do to help people with cancer get the care they need, and using the most up-to-date technology is an important part of our work to reduce waits and find cancers earlier, such as ‘teledermatology’ to diagnose skin cancers, or community lung trucks, and home testing for bowel cancer.”

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