Breast cancer presents the second largest cancer risk in the world to women. Early detection of cancer has been shown to be effective in reducing mortality. Population screening programs schedule regular mammography imaging for participants, promoting early detection. Currently, such screening programs require manual reading. False-positive errors in the reading process unnecessarily leads to costly follow-up and patient anxiety. Automated methods promise to provide more efficient, consistent and effective reading. To facilitate their development, a number of datasets have been created. With the aim of specifically targeting population screening programs, we introduce NL-Breast-Screening, a dataset from a Canadian provincial screening program. The dataset consists of 5997 mammography exams, each of which has four standard views and is biopsy-confirmed. Cases where radiologist reading was a false-positive are identified. NL-Breast is made publicly available as a new resource to promote advances in automation for population screening programs.

A major new study in Radiology shows that artificial intelligence (AI) is a promising tool for breast cancer detection in screening mammography programs. Mammograms acquired through population-based breast cancer screening programs produce a significant workload for radiologists. AI has been proposed as an automated second reader for mammograms that could help reduce this workload. The technology has shown encouraging results for cancer detection, but evidence related to its use in real screening settings is limited. In the new study--the largest of its kind to date, Norwegian researchers led by Solveig Hofvind, Ph.D., from the Section for Breast Cancer Screening, Cancer Registry of Norway in Oslo, compared the performance of a commercially available AI system with routine independent double reading as performed in a population-based screening program.

A new rapid screening test for glaucoma could help advance early detection of the disease, a leading cause of irreversible blindness. Developed by a research team of engineers and ophthalmologists led by RMIT University in Melbourne, Australia, the test uses infrared sensors to monitor eye movement and can produce accurate results within seconds. About 80 million people worldwide have glaucoma, with more than 111 million expected to be living with the disease by 2040. The loss of sight is usually gradual and 50% of people with glaucoma do not know they have it. Currently, glaucoma is diagnosed through a 30-minute eye pressure test delivered by an ophthalmologist.

Well, I think AI is quite a broad term. The type of AI that has generated a lot of excitement in recent years is called'deep learning'. This is a process by which software programs learn to perform certain tasks by processing large quantities of data. Deep learning is what has made ophthalmology a pioneer in the field of implementing AI in medicine, because we are increasingly reliant on imaging tests to monitor our patients. Particularly in my subspecialty of interest, medical retina, imaging tests such as optical coherence tomography (OCT) are performed very frequently and have provided the material to train and test and then apply AI decision support systems.

Tests for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were developed within days of the release of the virus genome ([ 1 ][1]). Multiple countries have been successful at controlling SARS-CoV-2 transmission by investing in large-scale testing capacity ([ 2 ][2]). Most testing has focused on quantitative polymerase chain reaction (qPCR) assays, which are capable of detecting minute amounts of viral RNA. Although powerful, these molecular tools cannot be scaled to meet demands for more extensive public health testing. To combat COVID-19, the “one-size-fits-all” approach that has dominated and confused decision-making with regard to testing and the evaluation of tests is unsuitable: Diagnostics, screening, and surveillance serve different purposes, demand distinct strategies, and require separate approval mechanisms. By supporting the innovation, approval, manufacturing, and distribution of simpler and cheaper screening and surveillance tools, it will be possible to more effectively limit the spread of COVID-19 and respond to future pandemics. Many types of tests are available for COVID-19 for clinical and public health use (see the figure). Testing can be performed in a central laboratory, at the point of care (POC), or in the community at the workplace, school, or home. COVID-19 testing begins with specimen collection. For medical use, a nasopharyngeal swab collected by a health care professional has been used for detection of virus infections. Demands on testing throughput for COVID-19, however, have driven new collection approaches, including saliva and less invasive nasal swabs. COVID-19 tests include molecular tests such as qPCR, isothermal amplification, and CRISPR, as well as antigen tests that detect SARS-CoV-2 proteins directly. Although rapid antigen tests have lower analytical sensitivity (i.e., require greater amounts of virus material to turn positive) than qPCR-based tests, their ability to detect infectious individuals with culturable virus is as high as for qPCR ([ 3 ][3]). Specificity (i.e., correctly identifying those not infected with SARS-CoV-2) of antigen tests achieves comparable results to molecular tests ([ 4 ][4]). Diagnostic testing for COVID-19 focuses on accurately identifying patients who are infected with SARS-CoV-2 to establish the presence or absence of disease and is performed on symptomatic patients or asymptomatic individuals who are at high risk of infection. This type of testing requires assays that are highly sensitive, so as to not miss COVID-19 patients (false negatives), and specific, so as to not wrongly diagnose SARS-CoV-2–negative individuals as having COVID-19 (false positives). These tests are typically performed by centralized high-complexity laboratories with specialized equipment using qPCR assays, with results that can be reported within 12 to 48 hours. Major bottlenecks in testing, however, have led to turnaround times exceeding 5 to 10 days in some regions, making such tests useless to prevent transmission. POC diagnostic testing at medical facilities can be qPCR assays, isothermal amplification, or antigen-based ([ 4 ][4]). These POC tests often require instruments that run a limited number of tests and can return results in under an hour. The need for an instrument limits the number of tests that can be performed and where they can be used. However, newer antigen tests are becoming available that do not require instruments or skilled operators, potentially allowing for much more distributed POC testing. Surveillance testing of populations can be used both as a tool for understanding historical exposures and as a measure of ongoing community transmission. For the former, serological testing of individuals for the presence of SARS-CoV-2–specific antibodies is used to identify those previously infected. For the latter, surveillance testing can be an effective way to monitor real-time SARS-CoV-2 spread in communities. One promising method is wastewater surveillance, which has been used to assess community transmission of poliovirus ([ 5 ][5]) and has shown potential for COVID-19 ([ 6 ][6]). qPCR testing of wastewater is used to detect SARS-CoV-2, and frequency dynamics of viral genetic material indicate COVID-19 infections in a community. Surveillance can also be performed from swab or saliva samples taken directly from individuals, and, in populations with low COVID-19 prevalence, pooling can be used to increase capacity and lower cost. For surveillance testing, the goal is not identification of every case but rather the collection of data from representative samples that accurately measure prevalence and serve to inform public health policy and resource allocation. Because the focus is on extrapolations to the population and not the individual, tests with known deviations from 100% sensitivity and specificity are still appropriate when the variance can be statistically corrected ([ 7 ][7]). To be most effective, results should include reported qPCR cycle thresholds, which is an estimate of viral load ([ 7 ][7]), to model epidemic trajectory and allow for real-time evaluation of mitigation programs ([ 8 ][8]), including once vaccination programs have begun. Screening testing of asymptomatic individuals to detect people who are likely infectious has been critically underused yet is one of the most promising tools to combat the COVID-19 pandemic ([ 9 ][9]). Infection with SARS-CoV-2 does not lead to symptoms in ∼20 to 40% of cases, and symptomatic disease is preceded by a presymptomatic incubation period ([ 10 ][10]). However, asymptomatic and presymptomatic cases are key contributors to virus spread, complicating our ability to break transmission chains ([ 10 ][10]). Entry screening to detect infectious individuals before accessing facilities (e.g., nursing homes, restaurants, and airports), along with symptom screening and temperature checks, can be beneficial, particularly in high-risk facilities such as skilled nursing facilities. When used strategically, entry-screening measures can be effective at suppressing transmission. Entry screening requires testing that provides rapid results—ideally within 15 min—to be most effective. The required sensitivity and specificity of entry-screening tests are, like all tests, context dependent. Entry-screening tests for a nursing home, for example, must be highly sensitive because the consequences of bringing SARS-CoV-2 into a nursing home can be devastating. Such tests must also be highly specific because the consequences of grouping a false-positive person with COVID-19–positive individuals could be deadly. Conversely, because children have substantially reduced mortality from COVID-19, entry screening into schools might require greater compromise that balances resources and sensitivity to test as many individuals as possible with a need to minimize disruptive false positives. Key to use of tests for entrance screening is that a negative test alone should not be considered sufficient to enter—that should be based on satisfying other requirements, including masks and physical distancing. Conversely, a positive test should be sufficient to bar entry in most settings. Public health screening is potentially the most powerful form of COVID-19 testing, aimed at outbreak suppression through maximizing detection of infectious individuals. This type of screening entails frequent serial testing of large fractions of the population, through self-administered at-home rapid tests, or in the community at high-contact settings, such as schools and workplaces ([ 9 ][9]). Public health screening can achieve herd effects by stopping onward spread through detection of asymptomatic or presymptomatic cases (fig. S1). Notably, not every transmission chain needs to be severed to achieve herd effects. Mathematical models that incorporate relevant variation in viral loads and test accuracy suggest that with frequent testing of a large fraction of a population, a sufficient number of cases could be detected to create herd effects ([ 11 ][11]). For example, Slovakia undertook public health screening to address COVID-19 ([ 12 ][12]): During a 2-week period, ∼80% of the population was screened using rapid antigen tests. With 50,000 cases identified, combined with other public health measures, it reduced incidence by 82% within 2 weeks ([ 12 ][12]). An important feature of large-scale public health screening is that centrally controlled reporting and contact tracing programs are not essential to induce herd effects as they are for surveillance testing. In a robust public health screening program, sufficient numbers of people are routinely testing themselves, such that contact tracing is subsumed by the screening program ([ 11 ][11]). Similar to home pregnancy tests, screening tests should be easy to obtain and administer, fast, and cheap. Like diagnostic tests, these tests must produce very low false-positive rates. If a screening test does not achieve high-enough specificity (e.g., >99.9%), screening programs can be paired with secondary confirmatory testing. Unlike diagnostic tests, however, the sensitivity of screening tests should not be determined based on their ability to diagnose patients but rather by their ability to accurately identify people who are most at risk of transmitting SARS-CoV-2. Such individuals tend to have higher viral loads ([ 13 ][13]), which makes the virus easier to detect ([ 14 ][14]). A focus on identifying infectious people means that frequency and abundance of tests should be prioritized above achieving high analytical sensitivity ([ 11 ][11]). Indeed, loss in sensitivity of individual tests, within reason, can be compensated for by frequency of testing and wider dissemination of tests ([ 9 ][9]). In addition, public health messaging should ensure appropriate expectations of screening, particularly around sensitivity and specificity so that false negatives and false positives do not erode public trust. ![Figure][15] COVID-19 testing strategies Testing for SARS-CoV-2 can be for personal or population health. Collection can be from symptomatic or asymptomatic individuals, as well as from wastewater and swabs of surfaces. The tests may be performed in central laboratories, at the POC, or using rapid tests. Attributes of tests differ according to application. GRAPHIC: KELLIE HOLOSKI/ SCIENCE Tests for public health screening require rapid, decentralized solutions that can be scaled for frequent screening of large numbers of asymptomatic individuals. Lateral-flow antigen tests and upcoming paper-based synthetic biology and CRISPR-based assays fit these needs and could be scaled to tens of millions of daily tests ([ 9 ][9]). These tests are simple and cheap, can be self-administered, and do not require machines to run and return results. The Abbott BinaxNOW rapid antigen test, which recently received an Emergency Use Authorization (EUA) in the United States as a diagnostic device, also comes with a smartphone app, allowing self-reporting of COVID-19 status that could be used instead of centralized reporting by public health agencies. Critically, despite being shown to be highly effective at detecting infectious individuals ([ 14 ][14]), very few of these tests are currently approved for screening of asymptomatic individuals, substantially limiting their utility. If such tests were made available direct to consumer (priced to allow equitable access) or produced and provided free of charge by governments, individuals could obtain their COVID-19 status at their own choosing and without complex medical decisions. Testing is a central pillar of clinical and public health response to global health emergencies, including the COVID-19 pandemic. Nearly all testing modalities have a role, and the one-size-fits-all approach to testing by many Western countries has failed. Many lower- and middle-income countries—including Senegal, Vietnam, and Ghana—have fared far better in their COVID-19 response, often using strong testing programs. The focus on diagnostic tests and the use of preexisting authorization pathways focused on qPCR-based clinical diagnostics not only slows the development and deployment of new surveillance and screening tests but also confuses the picture of what metrics effective public health tools should achieve. Testing to diagnose a patient with COVID-19 is fundamentally different from testing a person to prevent onward transmission. Regulatory pathways should be modified to incorporate these differences so that public health and screening tests are appropriately evaluated. 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Mina et al ., N. Engl. J. Med. 383, e120 (2020). [OpenUrl][40][PubMed][41] 10. [↵][42]1. X. He et al ., Nat. Med. 26, 672 (2020). [OpenUrl][43][CrossRef][44][PubMed][41] 11. [↵][45]1. D. B. Larremore et al ., Sci. Adv. 10.1126/sciadv.abd5393 (2020). 12. [↵][46]1. M. Pavelka et al ., “The effectiveness of population-wide, rapid antigen test based screening in reducing SARS-CoV-2 infection prevalence in Slovakia,” CMMID Repository, 11 November 2020; . 13. [↵][47]1. E. A. Meyerowitz et al ., Ann. Intern. Med. 10.7326/M20-5008 (2020). 14. [↵][48]1. V. M. Corman et al ., medRxiv 10.1101/2020.11.12.20230292 (2020). 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Dr. Ananya Malhotra speaks to News-Medical about her latest research into pancreatic cancer, and how its prognosis could be improved by using artificial intelligence. The prognosis of several cancers, including pancreatic tumors, has hardly improved in the last decades, contrasting with a general dramatic increase in survival for most cancers. We felt that a new approach was required. Pancreatic cancer is a very rare disease (8-12 new cases diagnosed every year in a population of 100,000). Due to such a low incidence of this disease, screening the whole population is neither practical nor appropriate.

Mass General's Constance ("Connie") Lehman, MD, PhD, is chief of Breast Imaging, Professor of Radiology at Harvard Medical School, and co-director of the Avon Comprehensive Breast Evaluation Center. Below, she describes her collaboration with colleagues from MIT's Computer Science and Artificial Intelligence Laboratory and their pioneering work developing an image-based model that predicts breast cancer up to five years in advance. Why is it important to have better breast cancer risk assessment tools? Most women diagnosed with breast cancer have no "known" risk factors other than being female. We knew if we could develop better methods to assess a woman's personal risk of breast cancer, we could redesign our screening programs, tailored to each individual woman's risk.

Most existing breast cancer screening programs are based on mammography at similar time intervals -- typically, annually or every two years -- for all women. This "one size fits all" approach is not optimized for cancer detection on an individual level and may hamper the effectiveness of screening programs. "Risk prediction is an important building block of an individually adapted screening policy," said study lead author Karin Dembrower, M.D., breast radiologist and Ph.D. candidate from the Karolinska Institute in Stockholm, Sweden. "Effective risk prediction can improve attendance and confidence in screening programs." High breast density, or a greater amount of glandular and connective tissue compared to fat, is considered a risk factor for cancer.

Research papers and patents contain huge numbers of molecular structures and experimental data that could be used in virtual screening programs, but getting it out of the documents is laborious. 'First you have to identify what compounds in the publication you want to actually extract,' comments Staker. 'So, you read through the paper and then … go into some drawing software and draw it manually.' Once the molecule is re-drawn in a computer-readable format (commonly known as SMILES), the information can be used in a screening program.

Medicine has come unimaginably far over the last century, driven by brilliant committed people and technology. In the last 20 years, we have seen the introduction of monoclonal antibody drugs, robotic surgery, and astounding intravascular treatments. All of medicine is entering a renaissance with a multitude of minimally invasive techniques and advancements. As we see the'old fashioned' physical exam go by the wayside as technology supplants and enhances our diagnostics by leaps and bounds. With cheap and plentiful EKG machines, how much less do we rely on a stethoscope?