Invention Notebook
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Invention Notebook

Meet the Woman Who is Transforming Early Breast Cancer Detection in India

Through her novel thermal imaging device, Indian entrepreneur Geetha Manjunath is making breast cancer screening more accessible to more women.

Indian entrepreneur Geetha Manjunath, founder of Niramai.

What compels a PhD in computer science to become a pioneer in cancer detection? In the case of Indian entrepreneur Geetha Manjunath, the answer is heartbreak, combined with a passion for helping people in need.

After losing two family members to late-stage breast cancer, Manjunath left her career in IT to develop a product that would catch the disease earlier, potentially saving countless lives, particularly in India, where each year breast cancer kills 50 percent of the women who are diagnosed with it.

“Every alternate lady detected with breast cancer is dying,” says Manjunath. “And that is what we have to stop.”

Since 2016, Manjunath has been working in pursuit of that goal. Her Bangalore-based company, Niramai, centers on a novel, software-based medical device that detects breast cancer through thermal imaging. Called the Smile 100, the portable, low-cost tool enables doctors and technicians to screen for cancer in a variety of settings, from urban hospitals to rural clinics — and it recently became the first Indian company to get a U.S. FDA clearance for a medical device for women’s health.

We spoke with Manjunath about her inspiration for and journey since creating Niramai, a name that’s both an acronym (for Non-Invasive Risk Assessment with Machine Intelligence) and a word derived from a fitting Sanskrit phrase: “Let everyone be healthy.”

This interview has been edited for length and clarity.

What prompted your interest in breast cancer?

When my cousin was in her 40s she was diagnosed with breast cancer. It was very shocking — this is a person who I spent my childhood summers with. She stayed with us for a year. After that she was no more. And it triggered a turning point for me. She was the first person I’m close with who I saw affected by breast cancer. Within six months, one of my husband’s cousins, another close family member, also was affected. She was younger, and both of these women had small kids.

So I started reading up about it, and learning about different imaging methods. And that’s when I came to know about thermal imaging.

How did you make the switch from computer scientist to entrepreneur? What was your thought process?

Personally, I have always found satisfaction in serving somebody, in social causes. I used to spend my summer holidays going to orphanages, for example. Healthcare is a field where you have that feeling of saving somebody’s life, helping somebody live longer.

As a computer scientist, I’ve always enjoyed research and innovation — doing something that nobody else has done before. You know, the thrill of doing and solving things in a different way, and making it better in some form — faster, cheaper, more useful.

So when I saw two people suffering, I was thinking a lot about how I could help, and I hit upon a potential solution. And I thought that if I didn’t use this opportunity to serve people, that someday looking back, I would regret it.

What are some of the barriers for women in India to detect breast cancer earlier?

I discussed this with the doctors I was working with, and they emphasized the fact that when a lady comes to their hospital, they come in really late-stage. That’s because of lack of awareness and also lack of tools for screening. In the U.S., for example, or the UK or other European countries, there’s regular mammographic screening. It’s not like that in India and many other countries. The lady has to pay for that screening, and first of all, they don’t even know that everybody needs to get a mammogram. Because fewer numbers of people are coming, the price per mammography screening also increases, because hospitals need to get a return on their investment on the machine. And many don’t even have the machine, so access itself is also an issue.

And there is a physics limitation. Mammography does not always work on women younger than 45, roughly, because they have dense breasts. Now in India, statistics show that the mean age for breast cancer is 10 years younger than the rest of the world. So that means there are more younger women who are getting affected in India.

Tell us about your invention. How does it work?

The idea was to create something that was more effective, affordable, and accessible than mammography. And maybe even safer, without radiation exposure. I had looked into thermal imaging and found that there were no hospitals using it. So we developed a software that basically converts thermal distribution on the chest into a breast cancer report. It does this through an analysis that uses multiple artificial intelligence algorithms. It’s AI over thermal imaging, and we call this technology Thermalytics.

Called the Smile 100, the portable, low-cost tool enables doctors and technicians to screen for cancer in a variety of settings.

What was your research and testing process like?

I Googled a lot. And I talked to surgeons and doctors using thermal imaging to better understand how it works. We started doing clinical studies and it took almost one-and-a-half years to get 256 people tested in a very systematic manner. Hospital acceptance was tough, but once we started publishing in top journals, actually doing this clinical research and scientific method, it really helped with adoption.

Were there moments when you knew you were onto something impactful?

I’ll never forget a phone call I got from the now-president of the Karnataka Cancer Society. He called me one day and I was really nervous because we had a free breast health screening camp happening and I was worried something went wrong. But instead, he said, “I’ve been doing cancer screening programs for the last 50 years, and every time I use the word ‘cancer’ women run away. I don’t know what you have done, but there are 100 people standing in line at your camp fighting to go next. And they’re not letting you close until they’ve been screened.” I get goosebumps when I remember that call.

Another time, a woman came to our clinic for a regular checkup, and her test revealed abnormalities. She was the hospital’s marketing manager, and because she took our test, she was able to be treated early and is now completely fine.

Now in multiple hospitals in 27 Indian cities, 60,000 women have already benefitted from Geetha’s technology.

And finally, there was a radiologist, who, when I asked him to try our test, said, “It’s not going to work.” But because I’d gotten the appropriate permissions, he agreed to let me use it on his patients. Today, that radiologist works for Niramai as a consultant — he told me, “I’m so happy you proved me wrong.”

What were some early challenges? Did you feel any barriers because of your gender?

I think whenever we are developing a novel medical device that nobody else in this world has done before, it takes time for it to be adopted. And especially for a disease like cancer, where the device is saying yes, or no. So the top challenge that I’ve always had is to initially get the support and acceptance from doctors. Some will say, “You’re not even a medical doctor.”

To them I say, “Okay, fine, you don’t like it, but tell me what I should be doing? First to improve, and next to prove to you that it’s accurate. And, I want to work with you to make this happen.” This kind of collaborative, constructive feedback-seeking approach really helped us figure out that scientifically proving with clinical studies is the only way to prove to doctors that it actually works.

And as a lady, yes, I have found that sometimes if I have another male team member with me, there is more acceptance. So many times I do take one of my team members just for them to feel comfortable.

One of your products now has FDA approval.

The FDA is very particular about what we call a product and how we talk about the product, and we designed our Thermalytics technology to automatically decide whether somebody has a malignancy or benign. So when we went to the FDA, basically they said, if there is a machine saying cancer or no cancer, it’s a very, very risky device.

So we said okay, what if we don’t tell them it’s cancer or not, but we just help the doctor mark the area of likely malignancy. And so we put up that proposal, that is what is called Smile 100. So the doctor — not the tool — makes the decision.

How has Niramai grown in the last few years?

We started as a small group and now we have 50 full-time and part-time staff, plus 30 or so technicians who do on-the-ground screening.

To date, we have 28 granted patents, and we are the most awarded Indian startup. We also have been able to raise seven million U.S. dollars, which is a good amount of funding for an early-stage idea. But I think the real success is the number of screenings that we do — the end users are really using it.

We’ve now seen 60,000 women. And in general, from an expansion standpoint, we are now in multiple hospitals in 27 cities in India, and we are operational. We’ve also signed contracts with the Philippines and UAE, so a lot of requests from other emerging markets because with the regulatory clearance, the test can be used in any country in the world, with different levels of adoption possibilities.

What kind of support have you received, and how important has it been?

Honestly, I didn’t know what it is to become an entrepreneur. I was never finance savvy, never worked for money, and so it was very difficult. All I knew was, I really want to build the solution. And make many people happy. The rest, I think, has been like serendipity — I have got advice and mentorship from so many people, and a huge number of supporters within the ecosystem.

Ankur Capital has always been a super supporter of Niramai. I remember I met one of the founders over a cup of coffee in Bangalore and I was so impressed by their investment in deep tech. And I know I can pick up the phone and call them anytime and say, okay, this is a problem, can you connect me to somebody who can help me. That’s something they’ve always done. They have given me a lot of connections and networking in the government, in the life sciences area. And they’ve recently helped me identify investors to go and talk to for our next round of funding. But they also ask hard questions and give constructive — and critical — feedback so we can balance risk versus optimism.

For young and aspiring inventors, especially girls and women from lower- and middle-income countries, what is your advice?

The first thing I would say is, do not fear. Especially with ladies, I have seen them question and doubt themselves more. To them I would say, you are on a path to make a difference in the world. Passion and perseverance are very, very important.

There will always be hurdles, but you cannot get disheartened. You have to feel strongly towards solving the problem. Make sure that you’re willing to put your life to it, and you will succeed. Because the world will align to help you.

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