Women's Wellness Blog

 The Algorithm Saw It Coming

Ellen Costello is 68, retired, and had no reason to think anything was wrong. Her mammograms looked fine. Then an AI flagged her as high risk, testing found a precancerous growth, and now she's being watched closely instead of being surprised later.

Let me be clear about what this is and what it isn't. This is not a tool you can ask your doctor for on Monday. It's a preview. A trailer for a movie that's still being filmed.

The technology is called Mirai, built at MIT by Regina Barzilay. She's a computer scientist who was diagnosed with breast cancer at 43 with no family history and no genetic red flags. She built the tool she wished had existed for her. It analyzes mammogram images, finds patterns no human eye can detect, and calculates your odds of developing cancer in the next five years. It's been tested on over two million mammograms, and in one Mass General study it identified three times as many future cancers as our traditional risk models.

At UMass, researchers ran it on 65,000 women with normal-looking mammograms. It flagged 4,000 as high risk. Among the 145 who joined a follow-up study and got MRIs, six already had cancer. Six women whose cancers would have grown quietly until the next annual screening, or the one after that.

So why isn't this everywhere? Money and bureaucracy, the usual suspects. Insurance won't cover a $1,400 MRI based on an algorithm's hunch. Hospitals need expensive infrastructure. Guidelines move at the speed of committees. One FDA-authorized version exists, but patients pay $200 out of pocket, which means early warning currently goes to those who can afford it.

Here's why I'm still excited. I've practiced medicine for 35 years, and most of that time we've been playing defense. Find the cancer, treat the cancer. This technology plays offense. It predicts.

Someday soon, a mammogram won't just tell you what's there. It'll tell you what's coming. And when that day arrives, a lot fewer women will hear the words "I'm sorry, we found something."

That's a future worth being patient for. But not too patient.