New tool to detect early-stage breast cancer

Back in 2021, Carolyn Holland was taking a shower when she first discovered two lumps — one in each of her breasts. Her doctor gave her a requisition for a mammogram and an ultrasound, but she soon discovered it was nearly impossible to book an appointment.

“I phoned every single imaging clinic in Ottawa; there was nothing available for months and months,” recalled Ms. Holland, who was 43 years old at the time. “I was reaching the point where I thought, ‘Maybe I’ll pay out of pocket, maybe I’ll go elsewhere to get the imaging.’ I waited a very long time. Granted, it was the tail end of the pandemic, but this is ongoing now. Everyone says there’s a huge delay for preventative screening.”

Four months after she found the lumps, she was diagnosed with Stage IIB synchronous bilateral breast cancer. Following chemotherapy, she had a bilateral mastectomy and a lymph node biopsy. The biopsy found three malignant nodes, prompting an axillary lymph node dissection to check for more growths. Since then, it’s been a rocky road to recovery.

At the University of Waterloo, a three-person research team is working to change the landscape of breast cancer screening for women like Ms. Holland. The researchers are pioneering a technology that is non-invasive, more accurate and much cheaper to manufacture than today’s most common diagnostic tools, such as mammography, computed tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasound.

“We want something that is effective for women across the board, something that’s inexpensive, and something that has no adverse health effects,” said Omar Ramahi, lead researcher and a professor in U of Waterloo’s department of electrical and computer engineering.

“We’re at the stage where we really believe it can be a viable product.”

Less energy than a smartphone

The device they are developing works by emitting low-frequency electromagnetic energy from an antenna — like the one found in a smartphone.

“The system uses low frequency radio waves; that was the key physical underpinning,” explained Dr. Ramahi. “In fact, our device uses energy way lower than a smartphone.”

During a breast cancer screening, the energy would penetrate the breast and then get picked up by a pixelated, printed circuit board.

“Each pixel picks up the energy that falls upon it; each console will pick up a certain power level,” said Dr. Ramahi. “You record that, and you have an image.”

Dr. Ramahi has been researching a solution for breast cancer screening since 2001. A breakthrough moment in the team’s research was their discovery that very low electro-magnetic frequencies travel in straight lines, mimicking an X-ray, but without the potentially harmful risks of radiation. He said his research team aims to address the existing issues with current breast cancer screening technologies.

“The cost of a mammography machine is $100,000 to $300,000, and then you have the radiologist that needs to interpret the results,” he said, adding that mammograms can be a painful procedure and are not effective for women with dense breasts. Since mammography is an X-ray based system, it’s also not recommended for frequent use.

“Women will only be recommended to have [a mammogram] every one to two years, because X-ray is potentially ionizing,” he added.

Likewise, CT scans are expensive and use a heavy dosage of X-rays, noted Dr. Ramahi. An MRI machine is expensive, but not dangerous. Finally, ultrasound is sometimes used for breast cancer screening — “but it’s not very effective.”

Dr. Ramahi said his team’s prototype will also work more effectively in scanning dense breasts. Women’s breasts are categorized into four classes, based on fibroglandular content. According to the Canadian Cancer Society, women with dense breast tissue have a higher risk of developing breast cancer than women with little or no dense breast tissue. It is also harder to detect cancer in dense breasts using mammography alone. To date, the researchers have tested the device on breast “phantoms” — a realistic breast model that mimics the properties of a human female’s breast — with encouraging results.

“So far, with all the phantoms and the testing that we’ve done, the device addresses our questions. Does it go through dense breasts? Absolutely, dense breasts are not an issue at all.”

From the lab to the clinic

The next step for the researchers is to develop a prototype that, with approval from Health Canada, can be tested on human subjects. Dr. Ramahi and his team are working in partnership with a start-up company, RBB Diagnostics, for the engineering and design of the prototype.

Stephen Bacso, the company’s CEO, said he saw the potential for the technology immediately.

“The first thing I thought is, ‘This could revolutionize things. If you could produce a device under $10,000 — compared to millions of dollars — machines like this could be doing breast cancer screening in clinics, doctors’ offices. It sort of democratizes that technology, even in other parts of the world where they can’t afford to have that kind of machinery, it makes that kind of scanning available for people.”

There will be two stages of testing. Starting in six to 12 months, the research group plans to test the device with volunteers at the U of Waterloo, under academic jurisdiction. The second stage of testing is planned at Grand River Hospital, where the medical team has already expressed interest in the technology.

“I would say in that 12 to 24-month span we could hopefully get the device out there and working in some sort of clinical setting,” said Mr. Bacso. He added that working with the hospital will enable the research team to directly compare their device with today’s breast screening technologies.

“We’ll scan a patient and we’ll have their results on the new machine and then they’ll have a mammography of that same person — or an ultrasound — and compare the results to make sure the efficacy is the same in both cases, or maybe better in the radio scan versus mammography.”

A new way forward

Dr. Ramahi’s vision is to help reduce the roadblocks that women face accessing breast cancer screening.

“The record shows that a high percentage of mortality can be eliminated if women catch their cancer early,” he said. “We want women to be able to test every month if they wish, at a low-cost clinic that’s operated by a nurse.”

Ms. Holland, now a strong advocate for women’s access to breast cancer screening, whole-heartedly agrees.

“Had this technology been available, it would have been a game changer for me, it would have changed the entire trajectory of my disease,” she said. “Had I been screened at 40, at 41, at 42 even, my cancer would have been caught before it grew and before it metastasized to my lymph nodes. It could have meant a lumpectomy and radiation, instead of really harsh chemo, double mastectomy, lymph node dissection and radiation.”